Closing a lifeline: TLC Medical Day Care for Adults to close next month

  • Judi Bluto talks about her mother's illness and her time at TLC Adult Day Care on October 23, 2018. TLC, the only adult day care in the city, is closing on November 21 due to funding issues. Caitlin Andrews—Monitor staff

  • Judi Bluto talks about her mother's illness and her time at TLC Adult Day Care on October 23, 2018. TLC, the only adult day care in the city, is closing on November 21 due to funding issues. Caitlin Andrews—Monitor staff

  • Jean Fiske and Stephanie Gagne talk about TLC Adult Day Care on October 23, 2018. TLC, the only adult day care in the city, is closing on November 21 due to funding issues. Caitlin Andrews—Monitor staff

  • Jean Fiske and Stephanie Gagne talk about TLC Adult Day Care on October 23, 2018. TLC, the only adult day care in the city, is closing on November 21 due to funding issues. Caitlin Andrews—Monitor staff

  • Stephanie Gagne (left) talks with Hazel Paris, who dressed up for the day, at TLC Medical Day Care for Adults on Wednesday. GEOFF FORESTER / Monitor staff

  • Barbara Bluto plays with her doll at the TLC facility on Loudon Road on Wednesday, October 31, 2018. When Barbara Bluto began showing signs of dementia 10 years ago, Judi Bluto did her best to provide care and found it at TLC. GEOFF FORESTER—Monitor staff

  • Barbara Bluto plays with a doll at the TLC Medical Day Care for Adults on Loudon Road on Wednesday. The facility will be closing Nov. 21. GEOFF FORESTER / Monitor staff

Monitor staff
Published: 10/31/2018 6:29:40 PM

TLC Medical Day Care for Adults has been a lifeline for Judi Bluto and her mom, Barbara.

When Barbara Bluto began showing signs of dementia 10 years ago, Judi Bluto did her best to provide care. It was hard enough to slowly lose Barbara, who she described as being prim and proper, a woman who “wouldn’t swear if you chopped her leg off,” and was a champion bowler, to dementia.

She still recognizes her daughter, but Barbara no longer knows how to put her shoes on, or bowl. When she’s scared or nervous, she swears.

By 2015, Bluto was in an impossible position: her schedule as a manager at McDonald’s, which required 24/7 availability, made taking care of her mother difficult. But a nursing home was financially out of reach.

Then she found TLC, a small facility off Loudon Road with warm yellow walls, comfortable chairs and plenty of staff to watch over Barbara. They know Barbara’s favorite breakfast (pancakes), provide showers and, sometimes, field trips for their clients. Many of their clients are at TLC from 6:30 a.m., when they open, to 5:30 p.m., when they close.

Perhaps most importantly, they accept weekly payments and have hours long hours that allowed Bluto to get another job in a warehouse.

When TLC announced it would be closing its doors Nov. 21 due to lack of funding a few weeks ago, Bluto was devastated. There are no other adult day care providers in Concord who can help her with her mom, and she’s unsure of what the next step is.

“When you have someone that has Alzheimer’s or is challenged in any way, to have a safe place to put them is so important,” she said. “... I don’t worry that anything bad is going to happen to her. My mom might fall, but I don’t worry about that stuff because they’ll take care of her.”

The problem, TLC founder Jean Fiske said, is that several of their clients’ caretakers have not been paying consistently for their care.

The enrollment at the day care varies, and TLC needs roughly 25 consistent clients to break even. They charge $75 a day or $20 an hour and require no minimum. Clients who receive Medicaid through the state are required to spend at least four hours at the center whenever they visit it, said TLC administrative manager and Fiske’s daughter, Stephanie Gagne.

Fiske couldn’t bear to stop giving clients care, and TLC began falling behind on its bills – about $50,000 behind, to be exact. She had to sell the building, which she owns outright, to make up for the debt.

Some individual clients have outstanding bills in the thousands, Fiske said. The Veterans Association recently owed TLC $11,000 – they paid off about $4,000 of their bill a few weeks ago. She said state Medicaid comes in every Friday, like clockwork. They also accept N.H. Healthy Families, which comes in regularly, and private insurance.

Reasons why individuals don’t pay vary, Gagne said. One person claimed they sent her a bill, but TLC requires a signed contract that payment must occur at the end of the week, unless clients have a personal guardian.

Alzheimer’s is the most expensive disease in America, according to the Alzheimer’s Association website, with costs in 2017 exceeding a quarter of a trillion dollars.

Care for people with degenerative brain diseases can be prohibitively expensive. The national average cost for basic services in an assisted living facility is $45,000 per year. In a nursing home, the average cost of a nursing home is $85,000 to $97,00 per year.

Most families pay for residential care costs out of their own pockets. Medicare does not cover the cost of long-term care in a care facility. Medicare only covers short-term skilled care after a hospital stay.

Costs for in-home care and adult day centers vary, according to the Association’s website, and can be covered by Medicaid.

The decision to give up the center wasn’t easy, Fiske said. She’s run the care center for more than 20 years, and her family members make up some of the staff.

Originally, Fiske was hoping to move into a smaller facility next to TLC, but the amount of work the building required and the loss of space wasn’t worth it.

She said some of her clients will be landing at Maintaining Independence, an adult care facility in Hooksett, and some at Easter Seals in Manchester.

Bluto doesn’t know what the next step for her mother is.

“I changed everything (for her mother),” Bluto said in a recent interview. “I gave up my house, my car and my job to care for her because it was the right thing to do for my mom.”

(Caitlin Andrews can be reached at 369-3309, candrews@cmonitor.com or on Twitter @ActualCAndrews.)


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