Many social adult day services programs (SADS) in New York operate without regulations or licenses, leaving disabled adults or seniors at potential risk, according to an audit released today by State Comptroller Thomas P. DiNapoli. The audit is the first in a series looking at issues affecting the elderly in New York.

“Absent a universal licensing or registration requirement, no agency has a complete accounting of all the adult day service programs that are operating in the state,” DiNapoli said. “While the providers that have state contracts are being closely watched – this demonstrates that there is a clear need for a more comprehensive system of regulation to ensure the wellbeing of many more vulnerable New Yorkers. Too many providers of these services operate with little or no regulatory oversight.”

SADS are structured, comprehensive programs providing functionally impaired adults with services such as socialization, supervision and monitoring, personal care, and nutrition in a protective setting at designated times of a day. The services can help to delay or prevent the need for nursing home care and other more costly advanced-care services while providing vital assistance to older people with cognitive or physical impairments in a safe and stimulating environment.

Currently, the state Office for the Aging (OFA) is the only agency with responsibilities to oversee individual programs. It currently monitors 17 programs that it directly funds through state contracts. Other programs are funded at least partially through counties and are overseen at the local level by 59 county Area Agencies on Aging (AAAs). However, DiNapoli’s auditors, based on their research estimate there are at least 500 SADS programs operating in New York without regulations or licenses. As a result, their precise number, cost, quality of service and who is operating them is unknown.

DiNapoli’s auditors examined the efforts of OFA for the period of April 2011 to March 2015 and conducted on-site visits of 14 locations. Auditors found OFA generally fulfills its responsibility to oversee compliance with regulations by the SADS providers that it funds, either directly or through the county AAAs. Still, auditors identified opportunities for OFA to improve its efforts, including more frequent on-site visits. Auditors also noted that program regulations, which were originally designed over 20 years ago, lack specific measures that would be helpful in evaluating program quality and performance in today’s environment.

SADS is also a benefit available under the state’s Medicaid Managed Long-Term Care (MLTC) model. The state Department of Health (DOH), as the Medicaid administrator, is responsible for supervising and overseeing Medicaid as a whole. It is not specifically required to oversee individual component services offered through MLTC plans. Instead, DOH relies on MLTC plans themselves to oversee these programs, which provided more than 15,000 New Yorkers with Medicaid-funded services each year and received over $175 million for services in 2013 and 2014.

This is in substantial contrast to most other Medicaid services, which are most often delivered by providers such as doctors, hospitals and pharmacies that are each still otherwise directly overseen by an agency outside the confines of the Medicaid program

DiNapoli’s auditors found DOH has provided guidance and direction to the MLTC plans, and has independently assessed the extent to which New York City-based programs comply with OFA’s regulations. Based on auditor field visits, it appears such compliance may have improved in recent years, although certain problems continue to exist, including participant service plans that are missing or outdated, staff health records that are not up-to-date, and fire drills that are not conducted as required.

DiNapoli recommended the stakeholder agencies:

• Carefully consider whether a more comprehensive system of regulation, such as licensing, registration, or mandated inspection, is warranted as the SADS program moves forward;
• Consider updating program regulations and providing supplemental guidance that more specifically defines expectations for factors that directly impact program quality and performance;
• Take steps to improve existing oversight and monitoring programs, including: conducting on-site monitoring of each of its direct SADS contractors at least annually and making provisions for unannounced site visits;
• Ensure consistent evaluation of program compliance at the county level by requiring all AAAs to utilize the standardized SADS monitoring tool as part of their annual on-site evaluations; and
• Work together to implement a comprehensive program to oversee Medicaid-funded SADS programs, which includes the oversight actions recently developed by OFA as well as procedures to verify the accuracy of the annual self-assessment certifications.

OFA and DOH both reported several actions they are taking to address the Comptroller's recommendations. The agencies’ comments in response to the audit can be read in the report Social Adult Day Services, or by going to: http://osc.state.ny.us/audits/allaudits/093016/14s31.pdf

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