Adult day care...the best kept secret in eldercare

Submitted By: Patricia Grace

Adult day care allows caregivers to continue working outside the home, receive help with the physical care of a loved one, avoid the guilt of placing a loved one in institutional care, and have respite from what can be a "24/7" responsibility. Sounds like an ideal option for those caring for a frail or cognitively impaired loved one…then why is it the most under-utilized service in the continuum of senior care services?

There are three models of adult day care: social, medical and Alzheimer’s.

• Social - provides social activities, meals, recreation, and some health-related services.
• Adult day health care - offers more intensive health, therapeutic, and social services for individuals with severe medical problems and for those at risk of nursing home care.
• Alzheimer’s specific - social and health services only to persons with Alzheimer’s or related dementia.

The purpose of an adult day center is primarily:

• To provide older adults an opportunity to get out of the house and receive both mental and social stimulation
• To give caregivers a much-needed break in which to attend to personal needs, or simply rest and relax
Good candidates for adult day care are seniors who:
• Can benefit from the friendship and functional assistance a day care center offers,
• May be physically or cognitively challenged but do not require 24-hour supervision,
• Are in the early stages of Alzheimer's disease.
Participants need to be mobile, with the possible assistance of a cane, walker or wheelchair, and in most cases, they must also be continent.

A social adult day care setting differs from adult day health care, which usually requires a health assessment by a physician before someone is admitted into the program. Adult day health centers, which typically use the term "Adult Day Health Care" (ADHC) in their names, often provide physical, occupational, and speech therapy, and are usually staffed with an RN and other health professionals. A third type of day care provides social and health services specifically for seniors with Alzheimer's or a related type of dementia.

Costs and financial assistance for adult day care:

The national average cost for an adult day care center is $55 per day, depending on the services provided (e.g., meals, transportation, nursing supervision) compared to the national average cost of assisted living which is $100 per day. Centers that provide professional health care services will mean higher fees. Dollar for dollar adult day care is the most cost effective long term care service available at this time.
Medicaid will pay most or all of the costs in licensed adult day health care settings and Alzheimer's focused centers, for participants with very low income and few assets. Due to Medicaid funding requirements many social adult day care programs have transitioned to the ADHC model. Many centers offer services on a sliding fee scale and possible financial assistance or scholarships. Long-term care insurance may also cover services for adult day programs. Additionally, dependent-care tax credits may be available to you as caregiver.

The goal of adult day programs is to improve the well being of the participants, with a wide variety of activities such as:

• Arts and crafts
• Musical entertainment and sing-a-longs
• Stretching or other gentle exercises
• Interactive games such as Wii
• Discussion groups (books, films, current events)
• Holiday and birthday celebrations
• Local outings
• Intergenerational programs that include children of all ages are regularly included especially for arts and crafts programs.

Adult day care offers a win/win situation for everyone in the family—not only the senior who attends the program, but also for the family member who more than likely is working a full time job as well as being the primary caregiver. Adult day care provides a much-needed respite for the caregiver, affording a break from the physical demands and stress of providing round-the-clock care while providing much needed socialization for the older adult.

For the participant, adult day care's benefits can be extensive:

• a safe, secure environment in which to spend the day
• enjoyable and educational activities
• improvement in mental and physical health
• enhanced or maintained level of independence
• socialization and peer support
• nutritious meals and snacks

National Adult Day Service Association suggests asking the following questions when choosing an ADC or ADHC:

• Is it licensed or certified? (If required in your state)
• What are the days and hours of operation?
• Is transportation to and from the center provided?
• Which conditions are accepted (e.g., memory loss, limited mobility, incontinence)?
• The ratio of staff to participants?
• What activities are offered? Are meals and snacks included? Are special diets accommodated?

It is always a smart idea to spend a day at the center before you enroll your family member, so that you can get a "feel" for the people and environment. It’s also advisable that you visit at different times and days to confirm your initial impressions.

Are you still asking yourself why adult day care is the most under-utilized eldercare service? The answer is the misperception that adult day care is baby-sitting for old people. However, with the cost of long term care skyrocketing and Aging in Place becoming the aging choice for many, adult day care will finally take its seat at the table of eldercare services.