About 3 1/2 years ago, Mark Hall’s family noticed that the custom tile installer was having his subcontractors drive him to job sites and that he could no longer write a check properly.
Those troubling symptoms eventually led to terrible news: Hall was diagnosed with early onset Alzheimer’s disease when he was 62. His wife, Sunny, and the couple’s adult daughter shared the job of taking care of Hall for a while, but that arrangement limited their ability to work for money, and financial difficulties forced the Halls to sell the Broad River home Mark Hall had built himself.
Now, Mark Hall goes four days a week to an adult day care program for people with cognitive impairments that until recently had been offered by CarePartners, a unit of Mission Health. Sunny Hall has a new job to pay the bills.
A separate nonprofit called MountainCare took over operation of the program Hall attends in South Asheville plus others in Flat Rock and Brevard on Feb. 1, the day after HCA Healthcare purchased Mission Health. It is one of many changes happening now or in coming months and years as the result of the sale of the nonprofit Mission to a for-profit company.
The adult day care services need donations to balance their books and thus were not considered good candidates to become part of HCA.
Music therapy and grief counseling services offered by CarePartners, which provides rehabilitation, home health and hospice services, have also shifted to MountainCare, which employs about 70 people. The new nonprofit also assumed operation of Rathbun House, a 36-room inn in Kenilworth formerly run by a Mission-related foundation. The facility provides free lodging for people with relatives being treated at Mission Hospital and other local hospitals.
A successor to CarePartners Foundation will now back MountainCare instead. The foundation will announce its new name and mission in mid-March. Changes including the sale of CarePartners real estate to HCA mean it will have millions more to distribute to providers of health care and related services in 18 Western North Carolina counties, making it a major player in regional philanthropy.
Mission and what was then Community CarePartners, also a nonprofit, merged in 2013. The CarePartners brand, its 1,200 employees in Buncombe and several nearby counties and most of the services it offers will remain a part of Mission.
The Mission/HCA sale agreement requires HCA to maintain many of the services Mission has offered for years. But the company will look to make Mission more financially efficient and bring in more revenue, a process that is bound to result in differences in the way Mission operates.
‘Where they want to come’
MountainCare’s adult day care primarily serves people with reduced mental capacities brought on by conditions usually associated with aging, such as strokes, Parkinson’s disease and Alzheimer’s. If that brings to mind an image of senior citizens sitting quietly in chairs and dozing off, think again.
On a recent morning at its main site off Sweeten Creek Road about a mile southeast of Biltmore Village, about 25 participants were sitting in chairs. But they moved their arms or legs up and down as instructor Laron Blake urged them to “raise the roof” by holding both arms high in the air or to “chop wood” by moving their clasped hands up and down in time to David Bowie’s version of the song “Under Pressure.”
In another room, participants sat around a table making edible chocolate slime.
Those in a section of the program for people with only minor impairments practiced breathing exercises or listened to and discussed a poem.
About 100 or so people attend adult day care at MountainCare’s three sites on any given day, says Elizabeth Williams, MountainCare director of adult day services. The program aims to stimulate participants’ brains and bodies and give caregivers back home a break or the time to earn a living. “Our job is to make it a place where they want to come, where they’re engaged, where they enjoy what they’re doing,” Williams says.
Some participants just need a little direction and come for the socialization, she says. They take on volunteer projects, and their skills are not much different from the average senior citizen’s. Others have difficulty with the routine functions of daily living and might not remember how they spent the preceding eight hours when it’s time to go home.
The program is as important for caregivers as it is for participants, many of whom might end up in nursing homes if adult day care were not available, Williams says. Many caregivers are spouses in their 70s, 80s or even 90s, watching over a husband or wife of about the same age but with reduced mental capacity. “That’s a full-time, 365-day job,” Williams says, and it may last for 10 or 15 years as the impaired person slowly declines.
Sunny Hall says her family “would be lost” without adult day care. She says she can no longer leave her husband home alone, and when he finishes day care, “He does not have any clue what he’s done all day.” As her husband’s condition worsens, the service “is invaluable,” she says.
That care, however, comes at a cost: MountainCare charges $70 a day. Some participants’ families pay the full cost, while long-term care insurance or the Department of Veterans Affairs pay for other participants. Some other government programs provide limited funds for adult day care, but the guidelines for payments in North Carolina are less generous than in other states, Williams says. It will always be difficult for adult day programs in the state to break even at current reimbursement rates, she says.
Scott Buchanan, president and CEO of CarePartners Foundation, says leaders at CarePartners and Mission approached HCA several months ago to discuss making adult day services part of an independent nonprofit instead of HCA. “The concern might be that those programs wouldn’t have the opportunity to flourish and grow … if they were in a for-profit world,” he says.
HCA agreed, and CarePartners Foundation committed to be MountainCare’s financial backer, including making a $1 million annual payment to the nonprofit.
“It really was our choice. [HCA] didn’t bring it up,” Buchanan says. He anticipates no major changes in the adult day program.
Rathbun House will continue to operate much as it has, Buchanan and Williams say. There have been preliminary discussions of charging fees for those able to pay at some future date, Buchanan adds.
New role, new money
CarePartners Foundation for years supported services provided by CarePartners, a separate nonprofit before its 2013 merger with Mission. That funding included expenditures like covering the bills of people unable to pay for care or buying new equipment, Buchanan says.
Federal rules make it difficult for a nonprofit foundation to subsidize the operations of a for-profit company. Buchanan says the foundation is now deciding what role it should play and what it should be called now that it is no longer associated with CarePartners.
The switch means a loss of roughly $2.5 million to $3 million in annual revenue for CarePartners from the foundation. “CarePartners anticipates overcoming the loss of foundation funds through the operational efficiencies that HCA brings,” says Nancy Lindell, a Mission Health spokesperson.
Dogwood Health Trust, the new foundation that will get most of the $1.5 billion HCA is paying for Mission Health, plans to spend its investment earnings on grants to agencies addressing social determinants of health such as poverty, access to transportation and housing.
The new version of CarePartners Foundation will primarily give money to nonprofits providing health care in WNC, Buchanan said, with a focus on services for the elderly. Its resources, while considerable, will be much smaller than Dogwood’s. The foundation has an endowment today of about $50 million and owns CarePartners’ Sweeten Creek Road campus, which includes several buildings on about 46 acres.
That endowment will get a boost of $15 million over the next three years in proceeds from the Mission sale, and HCA is in the process of buying the campus, Buchanan says, which will add millions more to the foundation’s coffers in the next few weeks. After the sale, MountainCare will lease the space the adult day care program occupies from HCA, he says.
The foundation will also continue operation of thrift stores in Asheville and Marion.
There are no immediate plans to expand adult day care, but there certainly could be a demand: State government projects that the number of Buncombe County residents age 65 and older will increase 29 percent over the next decade.
Buchanan said he has already met with about 40 nonprofits ranging from local Meals on Wheels to counseling centers to boys and girls clubs to discuss ways the foundation can help. The foundation is adding members from outlying counties to a committee that will award grants. The impact of the foundation’s grants may be more immediate than those made by Dogwood, he says, partly because of the size and complexity of the problems Dogwood is taking on.
Buchanan says money from CarePartners Foundation could go a long way in some smaller mountain counties.
“There’s a lot of poverty in Western North Carolina. There’s a lot of need,” he says.