Adult Day Care is a group of services that “provide for daily living, care, nutritional, and social needs” for older or disabled adults. These programs can give caregivers a break during the day while providing a chance for seniors who may be experiencing loneliness or isolation to socialize with peers.
According to the National Adult Day Services Association (NADSA) “Adult day services are a growing source of long-term care.” Over 4,600 adult day services centers operate in the US, serving more than 260,000 participants and family caregivers, a 63% increase since 2002.
The goal of the programs is “delay or prevent institutionalization by providing alternative care, to enhance self-esteem, and to encourage socialization” according to Eldercare Locator. Essentially, older adults who need assistance or supervision during the day get the care and companionship they need, while caregivers get a respite from their duties so they can go to work, run errands, or take a much-needed break.
Older adults, particularly those with dementia and other cognitive impairments, and their caregivers who use adult daycare have been found to have “positive health-related, social, psychological, and behavioral outcomes“. NASDA notes that these programs have an impact on caregiver well-being, “reducing burden, role overload, worry, anger, and depression.”
While senior community centers offer classes and exercise for healthy folks, adult day care centers usually serve those with major physical or cognitive disabilities who need more supervision and services. The NADSA states over half of participants have some degree of cognitive impairment. Think of them as an alternative or supplement to home care. In addition to the services provided, the biggest benefit of adult day care is keeping your loved one out of an assisted living facility or nursing home. Plus, it’s way less expensive!
What is adult day care
Adult day care centers provide care in a safe, friendly environment. They usually operate during normal business hours during the week, but some centers offer additional services during the evening and on weekends.
There are three types of adult day care based on the care needed: social, medical/health, and specialized. Social day care/social centers focus on enriching seniors’ lives. According to Eldercare Locator, “Adult social day care provides social activities, meals, recreation, and some health-related services.” While Adult Day Health Care (ADHC) “provides social activities as well as more intensive health and therapeutic services” according to NADSA. Therapies offered by an ADHC can include physical, occupational, and speech therapy. Thirdly, adult day specialized care provides “services only to specific care recipients, such as those with diagnosed dementia or developmental disabilities.”
While both ADHCs and specialized care facilities provide medical care, ADHCs are for older adults with “physical, mental or social problems associated with stroke, isolation, confusion or other conditions” according to Agingcare.com. Specialized facilities like Alzheimer’s and Dementia Day Care are just for seniors who have a particular condition, specifically, cognitive challenges. These specialized centers provide a secure environment to prevent wandering.
Adult day care centers can be public or private, non-profit, or for-profit. According to NASDA, 70 percent are affiliated with other organizations, “including “home care, skilled nursing facilities, medical centers, or multi-purpose senior organizations.” Three-quarters or more are run by nonprofits, such as medical centers or senior organizations.
Participants come on a scheduled basis for an average of 8-10 hours a day. Most (over 80%) attend full days and 46% attend five days a week. This enables family caregivers to know their loved one is in good hands when they go to work.
According to NADSA, “nearly 80% of centers offer physical activity programs to address cardiovascular disease and diabetes.” The majority of centers also offer cognitive stimulation programs, memory training programs, and educational programs. Social centers provide engaging activities “that build upon each individual’s skills, knowledge and unique abilities” according to Agingcare.com.
The most common programs are “counseling, education, evening care, exercise, health screening, meals, medical care, medication management, physical therapy, recreation, respite care, socialization, supervision, and transportation” as AARP states. Daily activities usually include arts and crafts, musical entertainment, games, light exercise, discussion groups, celebrations, local outings, and nutritious meals and snacks.
In addition to recreational activities, some programs “provide transportation to and from the center, social services like counseling and support groups for caregivers, and health support services such as blood pressure monitoring and vision screening” as cited by Agingcare.com.
Caregiver support programs can include education, support groups, and counseling. Alzheimer’s and Dementia Day Care activities are tuned to the participants’ functional abilities.
There has to be at least one direct care worker for every six participants. Volunteers may run various activities, but the NADSA states that the centers are staffed with “a full range of interdisciplinary professionals” to “meet the physical, emotional, and social needs of participants and family caregivers.” The Caregivers Library says “staff usually consists of a social worker, an activity director, and an activity aide, who often is a certified nursing aide (CNA).”
Most (nearly 80%), have a nursing professional on staff. Almost half have their own social worker, and over half offer case management services. Alzheimer’s and Dementia Day Care staff have specialized training in dementia care.
When should you consider adult day care
Two-thirds of adult day center care recipients are women. The average age of participants is 72 years old. Adult day care provides transitional care for those who have been in the hospital, but they also provide long-term care. NASDA recommends looking into adult day care when your loved one:
- Can no longer structure his or her own daily activities
- Finds it difficult to initiate and focus on an activity, e.g. reading, conversation, watching television
- Is isolated and lonely or desires peer interaction
- Cannot be safely left alone
- Lives with someone who works and is away from the home most of the day
- Is anxious or depressed and needs social and emotional support
- Feels uncertain and anxious when left alone
- Requires attention that leads to your own anxiety, frustration, compromised health and/or depression
When you are considering a potential day care, bring along this handy dandy checklist to answer questions like:
Who owns or sponsors the center?
How long has it been open?
Are they licensed or certified by the county or state?
When are they open?
How much does it cost?
Do they provide transportation to and from the center?
Which conditions (i.e. memory loss, limited mobility, incontinence) are accepted?
What are the staff’s credentials?
What is the ratio of staff to participants?
What activities do they offer? Are there a variety of individual and group programs?
Does the center provide meals or snacks? Do they accommodate dietary restrictions?
Visit the center you are considering multiple times in order to get a good feel of the place. Pay attention to the overall atmosphere, as well as how staff interact with participants. NADSA recommends to talk to others who use the facility and check the center’s references.
Paying for adult day care
Daily fees for adult day services vary depending upon where the center is located and which services it provides (i.e. meals, transportation). Professional health care services come with higher fees. Costs can range from $25 to over $100 per day, with a national average estimated at $67. Compare this to $19/hour for a home health aide, or $198/day for a semi-private room in a nursing home and adult day care sounds like quite a deal!
Medicare does not pay for any form of adult day care, however Medicare Part C/Medicare Advantage might. According to the Caregivers Library, “if the center is a licensed medical or Alzheimer’s facility and your care recipient meets state qualifications some of the expenses may be covered by Medicaid”. According to agingcare.com, “Joint Medicare and Medicaid participants may be eligible to receive ADHC from a local Program of All-Inclusive Care for the Elderly (PACE)” if they meet certain qualifications.
If medical personnel are involved, some of the costs could be covered by long-term care insurance. NADSA notes that “long-term care insurance policies that cover adult day services can serve as a less costly solution that will help to efficiently use the maximum benefits available under their plan.”
Other financial assistance can come from federal or state programs like Medicaid, Older Americans Act, and the Veterans Health Administration. Ask the center about financial assistance and possible “scholarships”.
Adjustment to adult day care
It is important, especially for those diagnosed with dementia, to gradually make the transition to adult day care. Before enrolling, start by having lunch at the center, or just dropping in for an activity to see how it goes. While your loved one may not want to change their routine at first, hopefully they’ll make friends at the center and look forward to the activities. AARP suggests to take them out for now and try again at a later date if it just isn’t working the way you’d hoped.