AURORA | Aurora families are again looking for alternatives after the closure of LiveWell Adult Day Services, a private adult day care facility that shut down about a year and a half after the city’s own program was discontinued.
Enrolling a family member who is unable to live independently because of Alzheimer’s disease or other cognitive problems in an adult day care center tends to be more affordable than placement in a long-term care facility, making it an attractive option for middle-class families.
One projection by insurance carrier Genworth estimates a monthly cost of about $2,414 for enrolling in an adult day program in Denver, compared to $5,835 per month for assisted living and $10,665 for a private room in a nursing home.
The enrollee can also continue to live at home, while their primary caregiver is able to work during the day.
But officials and local service providers say adult day care programs, particularly those that can accommodate people with behavior problems associated with dementia, are scarce in Denver and Aurora, with the scarcity driven by a shortage of professionals working in elder care, among other factors.
“That has a larger impact on families and on women in particular, because they’re largely the caregivers,” said Jayla Sanchez-Warren, the director of the Area Agency on Aging for the Denver Regional Council of Governments.
“If there’s nowhere for the person in your care to go during the day, your choices are either a nursing home, or you’ve got to hire someone, and that’s really costly. Or you quit your job to take care of Mom or Dad.”
Demand for elder care services is already outstripping the supply of providers working in the field. While the number of home health and personal care aides is projected to increase 25% over the course of the decade — adding close to a million jobs, according to the U.S. Bureau of Labor Statistics — the population older than 65 is expected to swell by nearly 17 million.
And the Aurora area is aging along with the rest of the country. Colorado’s State Demography Office estimates the proportion of older adults in Arapahoe County will grow by 2030, with those 65 and older making up about 17.9% of the population compared to 14.4% in 2021, and adults 45 and older making up 41.1% compared to 38.9%.
“We have a huge amount of older adults and less workers than we’ve had in a long time. And that’s going to stay that way for the next 30 years,” Sanchez-Warren said.
The landscape of elder care was greatly impacted by the COVID-19 pandemic, which resulted in some facilities like Aurora’s Morning Star Adult Day Program closing. The city-sponsored program was established in 1989 and offered meals, activities and some health care services to adults over the age of 55 suffering from memory disorders and other health problems.
Morning Star first closed its doors at the start of the pandemic, along with many other facilities catering to older adults. The final decision to discontinue the program was announced in January 2022, with city staffers saying Morning Star was already grappling with late reimbursements from the U.S. Department of Veterans Affairs and problems finding part-time and seasonal nursing assistants.
At the time, some city officials questioned how the decision was made, saying Morning Star was irreplaceable for the families that relied on it for respite and was worth the cost of restarting. Others argued that the need filled by Morning Star could be better met by the private sector.
LiveWell opened shortly after the city’s announcement. Mayor Mike Coffman wrote in a social media post at the time that the private facility was capable of accommodating up to 120 seniors at a time. But on July 10 of this year, families who relied on LiveWell for adult day services were told they had just four days to find another program.
A statement shared by spokeswoman Maryssa Baron said that “assistance was provided to anyone interested in transitioning to another adult day program in the area.” Baron did not reply to an email asking what specific assistance was offered to families looking for alternatives.
LiveWell founder and CEO John Bersani said in the same statement that the program wasn’t able to attract enough people to make the facility financially viable.
“It was a difficult decision to close the center after so much hard work by our team, but we really had no choice,” he said. “We did have a wonderful core group of regular daily attendees, but it just wasn’t big enough to support a facility of our size.”
William Zagorski — the chairman of the board of directors of the National Adult Day Services Association, who also serves as executive director of Centennial Adultcare Center in Nashville — said it’s rare to see adult day programs shutter shortly after opening.
“Generally, once they kind of hit a critical mass in the first year or two, they become bastions of that community and really thrive,” he said. “So we don’t see a lot of programs that open and close in the first few years unless they’re poorly run.”
He mentioned Morning Star as a program that served as a community hub in Aurora.
Morning Star and LiveWell were one of a small number of adult day facilities serving the area and were also notable for accepting U.S. Department of Veterans Affairs benefits. Lori Sanchez of the City of Aurora said in an email shortly after LiveWell closed that she was aware of at least 18 people seeking alternative programs that accept VA benefits.
While the exact number of operational adult day cares is hard to come by — a list of licensed facilities maintained by the state describes LiveWell as active — local service providers and experts agree there aren’t enough spaces to meet the need.
“With the closure of LiveWell being pretty sudden, people are left with not a lot of choices in the area,” said Tia Sauceda, director of caregiver and respite services at Seniors’ Resource Center, an adult day facility in Wheat Ridge.
“I know it’s a challenge for the VA to find providers, but it’s also just been a challenge for everyone to find providers, whether you’re paying for it privately, or you have Medicaid, or you have a voucher. It’s a very limited resource at this point, which is unfortunate.”
Jeannie Davis, who chairs the city’s Commission for Older Adults, said her commission identified four Aurora-area programs that offered services similar to Morning Star around the time of the city’s announcement. One of those programs was LiveWell.
“Some of the programs are not open five days a week, and caregivers have to figure out what to do about that. Some programs won’t administer meds during the day. There are very few that accept the VA reimbursement,” Davis said. “Some of these facilities take individuals who are at higher risk of wandering, while others often just don’t.”
She described her own mother’s experience in a local skilled nursing facility. One Sunday morning, Davis’ mother wandered out of the building with a church choir that had come to sing, prompting a search by Denver police.
“They had six Denver police patrol cars out looking for my mother. And when they found her, she was almost three quarters of a mile away from that facility,” Davis said.
“Nobody even noticed. She walked right out the door with the choir, and nobody even noticed. I guess they thought that she was a part of that group. They weren’t paying attention. That’s why you really need to have a staff that’s knowledgeable about the behaviors of these dementia-related patients.”
Sanchez-Warren said staffing challenges driven by industry-wide pay problems have stopped more programs from opening. She said the COVID-19 pandemic also resulted in many hospital workers exiting the health care field, resulting in those higher-paying jobs opening up to people who may have previously worked in elder care.
“It’s just been so hard to find and pay for the staff that we need in all services,” she said. “It’s not easy work, either. It’s really intense. It’s very rewarding, but it’s still intense. And it’s not like a job where you can just go into a patient’s room, and serve them for 15 minutes, and then leave and go to someone else.”
Zagorski said staffing is less of a challenge for programs nationwide than changes in Medicaid reimbursement rates and regulatory obstacles. He said that, while entry-level turnover can be high, those rates decline significantly for people who remain on the job for several months.
When asked about potential policy solutions, he praised the state of Washington’s 1% payroll tax, which went into effect in July and will go toward long-term care programs, as well as grants and tax rebates for adult day facilities backed by federal funds that have been rolled out by other states.
Michael Macklin, associate vice chancellor for workforce partnerships and development for Colorado Community College System, said one of the ways the state has responded to the shortage of elder care workers is through Care Forward Colorado, a program which pays for students’ health care credentials, funded by $26 million in federal COVID-19 relief dollars.
Macklin said the program has so far covered the cost of more than 400 nursing credentials. He said the Colorado Community College System is also considering ways of attracting recent high school graduates to careers in health care.
“Earlier on in the pandemic, there were definitely folks leaving the industry but we also saw people who wanted to come in and support their communities or those around them and so definitely movement out of the industry,” Macklin said.
“And so I feel like in this space and with the support of Care Forward Colorado and some of these other programs, we’re seeing those program numbers increase now as well.”
In 2022, the state reported that about 93,430 people were employed in health care support roles, making a median salary of $37,270, compared to a pre-pandemic 2019 figure of 95,560 people making a median salary of $32,142.
While Macklin said there hasn’t been movement at the state level toward subsidies that could help adult day care facilities pay employees more, he suggested one way of increasing expectations for pay could be raising the bar for certification, though he said that wouldn’t necessarily increase the pool of candidates for jobs.
Those involved in the adult day programs said the fact that adult day is a lesser-known option compared to long-term care and skilled nursing has limited its utilization with Sauceda calling it the elder care industry’s “best kept secret.”
Still, whether demand is keeping up with the need or not, Zagorski said he sees more adult day programs opening and getting ready to open across the country now than in the past 15 years combined.
“The drive for deinstitutionalization was absolutely if not exponentially increased through COVID. People did not want to go to a nursing home and be isolated. And people also don’t want to be isolated at home,” he said. “The best way to cure geriatric depression and loneliness is to have people being cared for and enjoying themselves in a group-based environment.”
AURORA | Aurora families are again looking for alternatives after the closure of LiveWell Adult Day Services, a private adult day care facility that shut down about a year and a half after the city’s own program was discontinued.
Enrolling a loved one who is unable to live independently because of Alzheimer’s disease or other cognitive problems in an adult day care center tends to be more affordable than placement in a long-term care facility, making it an attractive option for middle-class families.
One projection by insurance carrier Genworth estimates a monthly cost of about $2,414 for enrolling in an adult day program in Denver, compared to $5,835 per month for assisted living and $10,665 for a private room in a nursing home.
The enrollee can also continue to live at home, while their primary caregiver is able to work during the day.
But officials and local service providers say adult day care programs, particularly those that can accommodate people with behavior problems associated with dementia, are scarce in Denver and Aurora, with the scarcity driven by a shortage of professionals working in elder care, among other factors.
“That has a larger impact on families and on women in particular, because they’re largely the caregivers,” said Jayla Sanchez-Warren, the director of the Area Agency on Aging for the Denver Regional Council of Governments.
“If there’s nowhere for the person in your care to go during the day, your choices are either a nursing home, or you’ve got to hire someone, and that’s really costly. Or you quit your job to take care of Mom or Dad.”
Demand for elder care services is already outstripping the supply of providers working in the field. While the number of home health and personal care aides is projected to increase 25% over the course of the decade — adding close to a million jobs, according to the U.S. Bureau of Labor Statistics — the population older than 65 is expected to swell by nearly 17 million.
And the Aurora area is aging along with the rest of the country. Colorado’s State Demography Office estimates the proportion of older adults in Arapahoe County will grow by 2030, with those 65 and older making up about 17.9% of the population compared to 14.4% in 2021, and adults 45 and older making up 41.1% compared to 38.9%.
“We have a huge amount of older adults and less workers than we’ve had in a long time. And that’s going to stay that way for the next 30 years,” Sanchez-Warren said.
The landscape of elder care was greatly impacted by the COVID-19 pandemic, which resulted in some facilities like Aurora’s Morning Star Adult Day Program closing. The city-sponsored program was established in 1989 and offered meals, activities and some health care services to adults over the age of 55 suffering from memory disorders and other health problems.
Morning Star first closed its doors at the start of the pandemic, along with many other facilities catering to older adults. The final decision to discontinue the program was announced in January 2022, with city staffers saying Morning Star was already grappling with late reimbursements from the U.S. Department of Veterans Affairs and problems finding part-time and seasonal nursing assistants.
At the time, some city officials questioned how the decision was made, saying Morning Star was irreplaceable for the families that relied on it for respite and was worth the cost of restarting. Others argued that the need filled by Morning Star could be better met by the private sector.
LiveWell opened shortly after the city’s announcement. Mayor Mike Coffman wrote in a social media post at the time that the private facility was capable of accommodating up to 120 seniors at a time. But on July 10 of this year, families who relied on LiveWell for adult day services were told they had just four days to find another program.
A statement shared by spokeswoman Maryssa Baron said that “assistance was provided to anyone interested in transitioning to another adult day program in the area.” Baron did not reply to an email asking what specific assistance was offered to families looking for alternatives.
LiveWell founder and CEO John Bersani said in the same statement that the program wasn’t able to attract enough people to make the facility financially viable.
“It was a difficult decision to close the center after so much hard work by our team, but we really had no choice,” he said. “We did have a wonderful core group of regular daily attendees, but it just wasn’t big enough to support a facility of our size.”
William Zagorski — the chairman of the board of directors of the National Adult Day Services Association, who also serves as executive director of Centennial Adultcare Center in Nashville — said it’s rare to see adult day programs shutter shortly after opening.
“Generally, once they kind of hit a critical mass in the first year or two, they become bastions of that community and really thrive,” he said. “So we don’t see a lot of programs that open and close in the first few years unless they’re poorly run.”
He mentioned Morning Star as a program that served as a community hub in Aurora.
Morning Star and LiveWell were one of a small number of adult day facilities serving the area and were also notable for accepting U.S. Department of Veterans Affairs benefits. Lori Sanchez of the City of Aurora said in an email shortly after LiveWell closed that she was aware of at least 18 people seeking alternative programs that accept VA benefits.
While the exact number of operational adult day cares is hard to come by — a list of licensed facilities maintained by the state describes LiveWell as active — local service providers and experts agree there aren’t enough spaces to meet the need.
“With the closure of LiveWell being pretty sudden, people are left with not a lot of choices in the area,” said Tia Sauceda, director of caregiver and respite services at Seniors’ Resource Center, an adult day facility in Wheat Ridge.
“I know it’s a challenge for the VA to find providers, but it’s also just been a challenge for everyone to find providers, whether you’re paying for it privately, or you have Medicaid, or you have a voucher. It’s a very limited resource at this point, which is unfortunate.”
Jeannie Davis, who chairs the city’s Commission for Older Adults, said her commission identified four Aurora-area programs that offered services similar to Morning Star around the time of the city’s announcement. One of those programs was LiveWell.
“Some of the programs are not open five days a week, and caregivers have to figure out what to do about that. Some programs won’t administer meds during the day. There are very few that accept the VA reimbursement,” Davis said. “Some of these facilities take individuals who are at higher risk of wandering, while others often just don’t.”
She described her own mother’s experience in a local skilled nursing facility. One Sunday morning, Davis’ mother wandered out of the building with a church choir that had come to sing, prompting a search by Denver police.
“They had six Denver police patrol cars out looking for my mother. And when they found her, she was almost three quarters of a mile away from that facility,” Davis said.
“Nobody even noticed. She walked right out the door with the choir, and nobody even noticed. I guess they thought that she was a part of that group. They weren’t paying attention. That’s why you really need to have a staff that’s knowledgeable about the behaviors of these dementia-related patients.”
Sanchez-Warren said staffing challenges driven by industry-wide pay problems have stopped more programs from opening. She said the COVID-19 pandemic also resulted in many hospital workers exiting the health care field, resulting in those higher-paying jobs opening up to people who may have previously worked in elder care.
“It’s just been so hard to find and pay for the staff that we need in all services,” she said. “It’s not easy work, either. It’s really intense. It’s very rewarding, but it’s still intense. And it’s not like a job where you can just go into a patient’s room, and serve them for 15 minutes, and then leave and go to someone else.”
Zagorski said staffing is less of a challenge for programs nationwide than changes in Medicaid reimbursement rates and regulatory obstacles. He said that, while entry-level turnover can be high, those rates decline significantly for people who remain on the job for several months.
When asked about potential policy solutions, he praised the state of Washington’s 1% payroll tax, which went into effect in July and will go toward long-term care programs, as well as grants and tax rebates for adult day facilities backed by federal funds that have been rolled out by other states.
Michael Macklin, associate vice chancellor for workforce partnerships and development for Colorado Community College System, said one of the ways the state has responded to the shortage of elder care workers is through Care Forward Colorado, a program which pays for students’ health care credentials, funded by $26 million in federal COVID-19 relief dollars.
Macklin said the program has so far covered the cost of more than 400 nursing credentials. He said the Colorado Community College System is also considering ways of attracting recent high school graduates to careers in health care.
“Earlier on in the pandemic, there were definitely folks leaving the industry but we also saw people who wanted to come in and support their communities or those around them and so definitely movement out of the industry,” Macklin said.
“And so I feel like in this space and with the support of Care Forward Colorado and some of these other programs, we’re seeing those program numbers increase now as well.”
In 2022, the state reported that about 93,430 people were employed in health care support roles, making a median salary of $37,270, compared to a pre-pandemic 2019 figure of 95,560 people making a median salary of $32,142.
While Macklin said there hasn’t been movement at the state level toward subsidies that could help adult day care facilities pay employees more, he suggested one way of increasing expectations for pay could be raising the bar for certification, though he said that wouldn’t necessarily increase the pool of candidates for jobs.
Those involved in the adult day programs said the fact that adult day is a lesser-known option compared to long-term care and skilled nursing has limited its utilization with Sauceda calling it the elder care industry’s “best kept secret.”
Still, whether demand is keeping up with the need or not, Zagorski said he sees more adult day programs opening and getting ready to open across the country now than in the past 15 years combined.
“The drive for deinstitutionalization was absolutely if not exponentially increased through COVID. People did not want to go to a nursing home and be isolated. And people also don’t want to be isolated at home,” he said. “The best way to cure geriatric depression and loneliness is to have people being cared for and enjoying themselves in a group-based environment.”
What is not mentioned in this article is that Morning Star, a City of Aurora self sufficient program, meaning the City paid nothing and it flourished with reimbursements from medicaid and VA payments for years, was the only certified adult day program in Aurora open enough hours in the day to allow care givers to work a full time job. City Council was provided with the research showing the need for Morning Star, but nonetheless, at a study session, by one vote, the mayor’s, they closed this vital program that cost the city nothing. It appeared the closing of Morning Star was simply a political move. The day after voting to close Morning Star, Coffman was the guest of honor at the opening of Live Well. The problem with Live Well was two fold 1) it wasn’t open enough hours in the day to allow a care giver to work a full time job and 2) it aimed to have 120 dementia, intellectually challenged, deaf, blind and physically challenged individuals in a huge facility. This borders on the old concept of “warehousing” in the 50’s and 60’s in the state hospitals. Who would want to put their loved one in there?
Morning Star was an established, proven, amazing and innovative program that could have been a model for other cities. It was a cold blooded move to close it right after the pandemic with no warning to participants or those on the waiting list. Older adults in Aurora and their caregivers deserve more from the City.
Well said Sandy! The closure of Morning Star certainly has that unmistakable aroma of a politically motivated move! I wonder why Mayor Coffman was a “guest of honor” for Live Well’s opening? I’d also be very interested to know if Mayor Coffman “offered” Live Well anything once/if Morning Star was closed? What did Live Well “offer” Coffma…anything, nothing? I may not be a politician, I may not know the Mayor personally, but we all know his game. Coffman is a political heavyweight fighting in small arena. His political record with the City of Aurora as well as when a member of the House of Representatives reveals his true nature…he has always been far more concerned with his conservative views, his personal political interests and above all else his own personal gains than his constituents, which in this case are the aging, older adults of the City of Aurora. Shuttering a much needed, 30+ year old City-run program is the story! This article only scratches the surface of a much deeper question, an agenda pushed by Mayor Coffman, in favor of Live Well that ended with a City Council vote that closed a much needed program. How did this happen, why, who benefited from Morning Star closing…it certainly wasn’t the citizens of Aurora, more specifically the older adults of Aurora! Also I would very much like to know why certain Council Members voted as they did…I seem to recall a censorship issue floating around City Hall during that time…humm? I hope this is thoroughly researched, questioned and brought into the light.
You bring up some very important issues, Riley. It is my understanding that on Saturday before the Monday evening study session, the Council had the votes to keep Morning Star open (by one vote.) By Monday evening, a council member changed their vote to close the program…hummm. I too hope this is looked into. To play politics with the lives of older adults and their caregivers who desperately need adult day programs is a sin, and certain council members and the mayor have a lot of explaining to do. Don’t forget that certain staff members may also need to do some explaining as to why they even recommended its closure to bring it to city council in the first place. They played loose with the financial numbers and presented outdated and false information as to the availability of certified programs (a program must be certified to accept medicaid and VA payments.) It is not a good time to be an older adult or a caregiver in Aurora.