SHALLOTTE — Brunswick Senior Resource Center, Inc. (BSRI), the county’s lead non-profit senior services agency, terminated its contract with the county’s lone adult day health and care center late last month.
Woodard’s Adult Day Health Center in Shallotte no longer has access to previously-awarded public grant funding, which BSRI oversees. The decision comes months following an unannounced site visit mid-November that classified the center as “high risk.”
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The Cape Fear Area Agency on Aging (AAA), a program within the Cape Fear Council of Governments, arrived at this conclusion after recent site visits, determining Woodard’s Adult Day Health Center was repeatedly noncompliant with federal policies tied to the grant funding. Despite the funding setback, Woodard’s Adult Day Health Care is still open and accepting new clients.
AAA Director Jane Jones said often new agencies may be classified as high risk. Of the eight provider and subcontractor agencies AAA is tasked with overseeing in the four-county region, only Woodard’s Adult Day Health Care meets this designation, according to Jones.
Though BSRI senior centers are located throughout the county, the for-profit business Woodard’s Adult Day Health Center provides more hands-on day and health care for seniors that cannot be left on their own for extended periods of time. BSRI’s existing services provide meals, activities, and social events for seniors that are more independent compared to the seniors Woodard’s Adult Day Health Center is geared toward assisting.
More than 31% of Brunswick County residents are age 65 or older, according to 2019 U.S. Census estimates. This represents nearly twice the state average, with a higher percentage of seniors than all four adjacent counties.
Funding withdrawn
Management at Woodard’s said the funding cut comes as a blow to their daily operations. Staff were not expecting their contract to be terminated and said issues identified in the joint BSRI and AAA on-site visit in November had already been rectified.
AAA, the entity tasked with reviewing BSRI grant expenses, required Woodard’s to respond in writing acknowledging the findings, sent to Woodard’s Dec. 5, 2019, and submit a formal corrective action plan by Jan. 6 — steps the facility did not take. Woodard’s staff members said they called AAA more than a dozen times following the site visit to follow-up on the issues they said were quickly fixed after the November site visit; Jones said AAA received approximately three calls and no written indication that Woodard’s would complete the action plan or make corrections by early January.
“They won’t call me back,” Stacey Woodard, the facility’s office manager, said. “Everything they wanted, we had fixed. The longest thing it took us to fix, it took us four days, three days. By the time the letter got here, everything had been fixed.”
Woodard said after the site visit, an AAA representative verbally informed them they would return in early January. Jones said no written or verbal indication that a representative would return in January was shared with Woodard’s staff. “Nobody showed up. We’re thinking it’s all good,” Woodard said. Jones said this assumption was incorrect.
“The steps needed to be taken by Woodard’s for corrective action were clearly stated in the monitoring letters,” Jones wrote in a statement.
One of AAA’s functions is to conduct monitoring visits of all providers receiving public funds to ensure accountability, eligibility, and appropriate use of funds, according to Jones.
The noncompliance report noted the facility continued to submit items for grant reimbursement for services that weren’t rendered, but not to the degree it was previously doing so. Grant funding reimbursed Woodard’s for the cost of assisting five clients for daily services, costing the facility about $70 each patient daily. During a previous site visit in June 2019, no client records included a reference to an opportunity to voluntarily contribute to the cost of services rendered. Woodard’s staff members said now this information is posted and clearly marked in the facility.
Some clients, whose income is below the federal poverty guideline, were asked to contribute to services. This is” prohibited,” according to the report.
“In review, it is clear that [Woodard’s] does not understand the consumer contribution policy and is not able to implement the policy as intended and required. Extraordinary guidance, technical assistance and education have been provided by the AAA and as well as BSRI to this end, with little improvement,” the report states.
BSRI
BSRI’s Jan. 28 contract termination letter freezes the center’s funding half-way through the fiscal year. About $5,000 in Home and Community Care Block Grant (HCCBG) funding had already been administered to Woodard’s, with $10,000 awarded the previous fiscal year.
About $1.3 million in HCCG funding — a blend of federal and state money — was administered to BSRI from AAA last year, as Brunswick County designates BSRI as the county’s aging services provider. Brunswick County contributed more than $2.4 million in local matching funds to BSRI and provided about $705,000 through donating its facilities to be used rent-free last fiscal year. In all, public funding comprises 92% of BSRI’s total revenue, with the rest coming from local donations, according to its 2019 audit.
BSRI uses these funds to run its five senior centers each weekday, with locations in Shallotte, Southport, Leland, Supply, and Calabash. The non-profit also provides a transportation service, manages six meal sites, and operates a thrift store.
Jim Fish, BSRI’s director, explained clients served by the non-profit are not required to pay for its donation-based services. Managing HCCBG funding requirements, in addition to keeping in line with policies from the Division of Aging and the Department of Health and Human Services can be complex.
“We know that it is complicated to do on the front end,” Fish said. “These types of funds are not intended to prop up a business or be the lion’s share of somebody’s private business model.”
Fish described the problems identified in the report as “correctable.” The findings were mostly clerical, he explained, not dangerous. However, he noted it’s BSRI’s job to enforce policy.
“Our only option was to withdraw funds,” he said. “We just didn’t have a choice. It bothers me that there are three families that are negatively affected.”
Woodard’s is still eligible to reapply the next funding cycle, Fisher confirmed. “At the end of the day, BSRI wants Woodard’s to succeed. The things that needed to be fixed, can be fixed.”
Woodard’s
Woodard’s Adult Day Health Center, a for-profit business, first opened in early 2017. The facility is licensed to serve 49 seniors, but currently only serves 23 each week. Its program director, Sharon Woodard Crawford, said the center financially operates on a month-to-month basis, with tight funds and a limited ability to compensate staff.
The level of service received at Woodard’s is intensive, Crawford said, with vulnerable seniors constantly under the watchful eye of staff. Seniors can receive transportation to-and-from the facility, two hot meals a day, with snacks in between. It is designed to allow caregivers — often the adult children of seniors — the ability to hold a job and still care for seniors at home.
“The whole point of our facility is to help alleviate putting folks in nursing home facilities prematurely,” Crawford said.
Because of funding issues, Crawford said they’ve had to turn away more than 50 clients in one year. “I hate turning folks away,” she said. “My building probably could be full if I had the funding,” Crawford said.
As the only adult day health center in Brunswick County, Crawford said she believes the facility deserves a higher funding allocation. “You send me a lousy $10,000 out of $2.5 million to shut me up,” she said, referencing BSRI. “They are over the whole shebang. The only thing that they don’t really have a hand on, is me.”
Crawford’s sister, Stacey Woodard, works as the office manager. Woodard estimated $75,000 in grant funding would be enough to help the facility run smoothly. “They gave us a little crumb,” Woodard said of the $10,000 allocation.
“We’re running as short as staff as we can to make sure the budget goes where it can go. We’re cutting everything we can,” Stacey Woodard said.
If done right, an adult day health center can be successful, she said. A lack of capital is what’s preventing Woodard’s from getting it right, according to Woodard. “That’s our big conundrum: capital,” she said.
Crawford said she is most disappointed that the county’s lead funding agency for senior care has withdrawn funds from the county’s only adult care and health facility.
“There’s a need, but yet you’re not willing to work with me,” Crawford said of the partnering agencies. “If they really wanted to work with me, I believe we could save this program.”
However, according to Fish, extensive staff resources and time have been extended to help the facility become compliant.
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