Adult Day Care: Niche Offers Option to Home Care

Shay Stevens worked in hospital marketing and now owns Millennium Adult Day Care, but she could have been a comedian.

Her lilting laugh routinely lightens the load of clients seeking care for loved ones with dementia. To wit:

Does Millennium accept incontinent clients? “Every last one of them.” (Laughter.)

Does Medicare pay for adult day care services? “It does not; write your congressman!” (Laughter.)

Is it fun to employ her son, Shayne Simmons? “Good Lord! Did I tell you he’s 18? Next question!” (More laughs.)

But Stevens, 46, turns serious describing what her enterprise does for clients, who all have some form of dementia, mostly Alzheimer’s. “We keep them safe, dry and fed,” she says. “We give them a chance for activities and socializing. And we keep families intact.”

Kind patience, rather than humor, was on display later as Stevens soothed a dementia patient and then claimed her reward, a hug.

Driven out of New Orleans and her marketing job by Hurricane Katrina, Stevens has found success in Little Rock in a growing niche, adult day care.

Her Millennium Adult Day Care Inc. serves about two dozen clients at two locations, and she owns a separate care-at-home service with 26 patients.

Home care has long been an alternative for families resisting putting relatives into nursing homes, but adult day care is a relatively new option.

“Adult day care has been around since the 1980s,” Stevens said. “I think they’re becoming more prominent in Arkansas because the state is realizing the expense of nursing homes. Again, they play a crucial role in the health care system, but they’re hella expensive.”

She has helped several friends get into the industry, including Lonzell Blackmon of Blackmon Care Services LLC.

“A typical day for an adult day care client would include activities, light exercise, arts and crafts, games and maybe one TV show, probably ‘Golden Girls,’” Blackmon said. “We do word recognition, colors, shapes, things of that nature, and we work with clients on their first and last names and birthdays. Any cognitive activities are useful.”

There’s also breakfast, lunch and morning and afternoon snacks. Millennium is open from 7:30 a.m. to about 5:30 p.m., giving clients’ loved ones a chance to work daytime hours knowing the patient will be looked after. “I’d like to go 24 hours, because sundowning is real,” Stevens said, describing the late-afternoon time when dementia patients often grow more confused and agitated.

Blackmon, Stevens and Christel West, another protege Stevens helped break into the business, gathered last week at Millennium’s headquarters near the Homer’s West restaurant on Rodney Parham Road.

They described their part in an adult day care landscape with $8 billion in annual revenue nationwide, and more than 200,000 employees at about 15,000 care facilities, according to estimates by IBISWorld, a market research company.

“Our real competition isn’t from other adult day cares,” Stevens says. “It’s from home care. And from nursing homes.”

Medicaid pays for nursing homes and for skilled home health care, Stevens said, distinguishing that service from home care, which uses less-skilled labor. Home care attendants are most likely certified nursing aides who bathe patients, address their sanitary needs and handle light housework and meals. The same services are seen in adult day care, with the exception of bathing.

Stevens, West and Blackmon say that even as more Arkansans view adult day care as a viable nursing home alternative, it isn’t a major player yet. The state has more than 225 nursing homes but only 22 adult day care facilities with a capacity for just 400 clients, according to state statistics. Home services, including both home care and skilled home health enterprises, number 145.

“The state now realizes that, considering what it pays for nursing homes, it’s far cheaper to keep patients at home.”

Advice From Mother
Stevens, who struggled to find a hospital marketing position in Little Rock, started her adult day care at the suggestion of her mother, Marlo Stevens, who had experience running home health operations.

“I incorporated the business on May 6, 2011, my mother’s birthday,” Shay Stevens said. “I loved it, and it was so extremely easy to do business with the state. You pay to file with the secretary of state’s office, and a Medicaid provider ID is $500.” Still, regulatory costs for the startup totaled less than $2,000, she said.

The state funds its adult day care initiatives through ARChoices, a Medicaid program open to patients with disabilities between 21 and 64, and for Medicaid-eligible residents 65 and older.

It pays $10 an hour per patient in adult day care, which Stevens said is just enough to make a well-run operation profitable. The state pays her home care company, Millennium Companion Inc., $18 per hour for each of its 26 clients.

“We have the lowest reimbursement, or one of the lowest, for adult day care in the country,” Stevens said.

“But cost of living here is low, so the $10 an hour does work for me.

“For home care the state reimburses $18 an hour, up from $16 in 2016, which was when I got into home care.” She splits the home care fees evenly with attendants, paying them $9 an hour for essentially 1-to-1 work with patients, “which I’m told makes our pay better than average.”

The state touts ARChoices online, offering potential clients help with “everyday activities that you may not be able to do for yourself, like bathing, dressing, getting around your home, preparing meals,” etc.

Millennium Adult Day Care at 9700 Rodney Parham Road is a bright, clean facility — three large rooms with a kitchen, dining tables, an aquarium and rows of comfortable chairs. The doors have magnetic locks controlled by attendants. “People with dementia wander, you see,” Stevens said. She arrived at lunchtime as clients were enjoying corn, cornbread and chicken-fried steak with gravy.

As if on cue, an elderly client gestured impatiently toward the kitchen, and Stevens calmly asked a series of questions to determine what was the matter. Eventually she wheeled the client in the direction of her gestures, then returned her, contented, to her place at the table.

Stevens, who employs four people at the two adult day cares, says she didn’t always aspire to a health profession.

“I wanted to be a wife with about a thousand kids, but it didn’t work out,” she says, flashing her bare ring finger. But she is close with her son and daughter, Jeana Simmons, an aesthetician and a board member at Millennium, which was named for the theological concept of Christ’s future reign over a thousand years of peace on earth.

Christel West

Stevens sees her businesses as extensions of her Roman Catholic faith, and finds caring for her clients personally fulfilling, an observation that resonated with West and Blackmon.

West operates Promised Land Adult Day Care at 6911 Geyer Springs Road in addition to a Medicaid transportation service and an auto detailing shop in Conway. A Greenbrier resident, she has considered herself an entrepreneur since she sold popcorn and homemade lemonade off her front porch as an 8-year-old. With the profits, she treated herself to roller-skating.

“We at the day care become part of the family for the client,” West said. “Because you’re there, providing support to the family, sometimes they just want to talk, knowing that they can turn to you for support. People realize they can offer a life in adult day care that’s fulfilling, that allows socialization, and that they can still bring their loved one home to get that nurturing love and family care.”

Improving Awareness
Stevens emphasizes compassionate care, saying her team is well versed in clients’ symptoms. “We understand the many intricacies of dementia, and we know how to care for clients, how to treat them well. We’re client- and family-focused first, as opposed to thinking of ourselves as businesspeople.”

Blackmon, 34, is looking to expand his adult day care in Sweet Home south of Little Rock. “I have to. I’m full,” he said, with a roster of five patients.

West said her 70-year-old mother works at her adult day facility and can hardly be kept away. “It’s done a world of good for her,” she said. “She’s able to interact and serve clients, and it’s a joy to her as well as for me. She also gets paid!”

Stevens said the state has only two qualifications, beyond age and disability, for adult day care. “Clients have to be able to take their own medication and to sit up for the hours that they’re here. The sitting up part is easy, but the medication can be difficult because clients often have tremors.” (See Pulaski, Crittenden Counties Lead State in Adult Day Care.)

She said that as a business, adult day care is remarkably stable, though numbers shift as clients age, go into nursing care and, of course, eventually die. But she would favor Medicaid even if she weren’t a provider.

“I would always recommend it because of the socialization,” she said. “Instead of having to place Grandma in a nursing home, people can drop relatives off at the day care, go on to work or whatever task they have to accomplish, and then pick them up at the end of the day. It gives more enrichment than parking a client in front of the TV while the attendant takes care of chores in home care. For many clients and families, adult day care’s ideal.”