The Yolo Adult Day Health Center (ADHC) provides an out-patient day program in Woodland for older persons and adults with chronic medical, cognitive or mental health conditions and/or disabilities that are at risk of needing institutional care. Due to issues regarding facility limitations and a structural deficit, on November 17, 2015 the Yolo County Board of Supervisors established an Ad Hoc Board Subcommittee to assist the Yolo ADHC in identifying strategies for continued sustainability. What follows is an update on the efforts of that subcommittee.
Background
The Yolo ADHC currently operates in accordance with a 2009 agreement, No. 09-151, (Attachment A) between the County and the non-profit organization, Dignity Health. Under the agreement the County leases the facility to Dignity Health for use as the Yolo ADHC and also provides the operating license. Dignity Health manages the Yolo ADHC and provides the services (equipment, personnel, labor, materials, etc.) necessary for its operation.
For several years the Yolo ADHC has struggled with both facility limitations and a structural deficit. A July 2015 strategic space utilization study conducted by Jacobs, found the current facility of the Yolo ADHC, which is owned by the County, to be inadequate to meet the needs of the program. The size of the facility results in a license limit of 59 clients that may be served daily in the facility despite a waiting list of 43 individuals. Additionally, the Yolo ADHC has been operating with a structural deficit ranging from $101,350 to $350,000 annually.
Ad Hoc Board Subcommittee
In accordance with the November 2015 Board of Supervisors directive, a Yolo ADHC Ad Hoc Board Subcommittee was formed with representatives from the County (Board of Supervisors, County Administrator’s Office, Health and Human Services, and County Counsel), Yolo Adult Day Health Center, Dignity Health, and the Yolo Healthy Aging Alliance.
Shortly after the development of the Ad Hoc Board subcommittee, an amendment, No. 16-75, (Attachment B) to the 2009 agreement was formed between the County and Dignity Health. This amendment extended the term of the original agreement by one year to June 30, 2017 with the option to extend for one additional year. It also altered the original contract so that operating losses for the Yolo ADHC are shared equally between Dignity Health and the County with an amount payable for the County not to exceed $150,000 per fiscal year.
2016: Best Practice Outreach
During 2016 County staff conducted site visits at various ADHCs in the region and met with potential stakeholders (totaling 16 organizations). The purpose of the meetings was to determine best practices and explore potential partnerships for future operations of the Yolo ADHC. Through this outreach it became apparent that structural deficits among ADHCs is common and that the key to a balanced budget was the number of participants; essentially, an ADHC must have enough participants, generally between 80-100, to generate sufficient revenue to cover expenses.
Two of the ADHCs explored were also reaching capacity and altering operational practices to accommodate. The Health for All ADHC in Sacramento increased operations to include Saturday hours and staggered staff accordingly. Additionally, one of the Stepping Stones ADHCs in San Francisco implemented a double shift model (mornings and afternoons).
Based on the outreach information gathered, Dignity Health determined that in order to operate with a balanced budget the Yolo ADHC would need a facility that accommodated an average daily attendance of around 100. Since the current facility is limited by license requirements to serve 59 per day, the subcommittee began exploring options to expand the facility. Additionally, Dignity increased their average daily attendance from 54 to 55 per day to assist with reducing the deficit and the waitlist.
2017: Facility Identification
In 2017 County staff began touring alternative facilities in Woodland for the Yolo ADHC and developing cost estimates which were presented to Dignity Health. Overall staff identified 5 potential site locations in Woodland, provided designs for 1 facility, and designs for a potential renovation of the current ADHC facility. In addition to the facility research, the County set aside $500,000 in Inter-Governmental Transfer (IGT) funds for Dignity to put towards tenant improvements or purchase of a facility for the Yolo ADHC. Ultimately, concerns regarding cost and potential licensing challenges stalled clear identification of a new facility.
2018: Deficit Reduction and New Contract Amendment
In 2018 several increases in funding sources are anticipated to occur for the Yolo ADHC as a result of efforts by various parties to reduce the program deficit. Ultimately, Dignity Health anticipates a deficit reduction of up to $251,000 in FY18-19. The breakdown for that deficit reduction is as follows:
| Action |
Estimated Annual Reduction |
Partnership Health Plan increased the Medi-Cal reimbursement
(From $90 to $100/ per person daily) |
$115,000 |
Increased Veteran's reimbursement
(From $76 to $100/ per person daily) |
$18,000 |
Increased average daily attendance (ADA) at the Yolo ADHC
(From 54 ADA in 2017 to 55 ADA in 2018) |
$25,000 |
| Awarded transportation operational grant funds (2 year grant) |
$93,000 |
| TOTAL ESTIMATED ANNUAL REDUCTION |
$251,000 |
Despite the estimated deficit reduction, Dignity still anticipates there will be a deficit in the Yolo ADHC program for FY18-19. As a result, a second contract amendment, No. 18-101, (Attachment C) occurred in June 2018 for FY18-19, with an option to extend for an additional year. Under this new contract amendment, the County shares operating losses up to $75,000 and, once an agreement regarding site location or renovation is reached between the parties, Dignity Health will apply to change ownership of the operating license into their name. Currently, the County has paid $300,000 over the past two fiscal years towards the Yolo ADHC deficit and by the end of FY18-19 the County may pay up to an additional $75,000.
Next Steps
Over the next six months, the subcommittee is exploring partnership potential to develop an ADHC alongside a housing project and will also re-examine the cost of expanding the current ADHC facility. The County has already set aside $500,000 in IGT funds to put towards an improved facility. Dignity Health and the Yolo Healthy Aging Alliance have also been working together to establish a Davis Adult Day Program to serve as an alternative location for those seeking a social model of care, as opposed to the medical model of care provided by the Yolo ADHC. It is envisioned that the Davis program would help relieve some of the current waitlist and may be open as early as summer 2019. |