Adult Day Care Services: USA perspective

With life expectancy rising, more and more of us find we need assistance as we age. Adult day care centers are designed for older adults who can no longer manage independently, or who are isolated and lonely. They
enable seniors to socialize with others while still receiving needed care services. At the same time, they offer caregivers a break from caregiving duties while knowing that their loved one is in good hands.

What is an adult day care center?

Adult day care is a planned program of activities designed to promote well-being though social and health-related services. Adult day care centers operate during daytime hours, Monday through Friday, in a safe, supportive, cheerful environment. Nutritious meals that accommodate special diets are typically included, along with an afternoon snack.
Adult day care centers can be public or private, non-profit or for-profit. The intent of an adult day center is primarily two-fold:

• 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

Regulation of adult day care centers

According to the National Adult Day Services Association (NADSA), there are currently more than 4,600 adult day care centers in the United States. Each state provides different regulations for the operation of adult day care centers, although NADSA offers some overall guidelines in its Standards and Guidelines for Adult Day Care.
NADSA recommends a minimum staff-to-participant ratio of one to six. This ratio can be even smaller, depending upon the level of participant impairment. If a program serves a large proportion of participants with dementia, for example, the ratio of staff to participants should be closer to one to four.

Staffing of adult day care centers

Though each adult day care center is staffed according to the needs of its participants, most programs operate with:

• Activity staff, usually an activity director and assistants
• Program assistants who aid with personal care
• A social worker
• A registered nurse or licensed practical nurse
• A center director
• Centers that serve a large number of participants may also employ a driver, secretary, and accountant

Source: National Adult Day Services Association (NADSA)

Adult day care center vs. adult day health care

A social adult day care center 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.

Services provided by adult day care centers

A well-run adult day care center's goals will focus on enriching the participants' lives, building upon their skills, knowledge, and unique abilities and strengths. Below are some of the activities that may be available:

• Arts and crafts
• Musical entertainment and sing-a-longs
• Mental stimulation games such as bingo
• Stretching or other gentle exercise
• Discussion groups (books, films, current events)
• Holiday and birthday celebrations
• Local outings

Some centers offer programs that include children. The Friendship Center in California, for example, developed The GOLD Project where older adults are encouraged to visit local classrooms and share their life experiences with the children, educating and enlivening both groups in the process. The Center also has an "Adventuresome Aging" program for people with early stage Alzheimer's disease, to help them remain engaged and active in the community.
Besides recreational activities, some adult day care centers provide transportation to and from the center, social services including counseling and support groups for caregivers, and health support services such as blood pressure monitoring and vision screening.

Benefits of adult day care

Almost Family, an adult day care center provider in both the U.S. and Canada, summarizes the benefits of adult day care well: "Adult day care offers a win/win situation for everyone in the family—not only the client or member who attends the program, but also for the family member who has primary responsibility as 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."
For the participant, an adult day care center'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

Is an adult day care center right for me?

Good candidates for adult day care centers 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
• Are mobile, with the possible assistance of a cane, walker, or wheelchair
• Are continent (in most cases)

When to opt for an adult day care center

As a senior, it can be challenging to admit that you need help, especially if you've been a highly independent person used to caring for others all your life. And if you're the caregiver, it may be equally difficult to consider allowing "strangers" to care for your beloved family member.
As with any service, the best time to start exploring what's available is before you actually need it. According to ElderCare Online, you should seriously consider using adult day care when a senior:

• Can no longer structure his or her own daily activities
• Is isolated and desires companionship
• Can't be safely left alone at home
• Lives with someone who works outside the home or who is frequently away from home for other reasons

Finding the right adult day center for your family's needs

The National Adult Day Services Association (NADSA) recommends you start by asking yourself what specific services both the senior adult and the caregiver need most. For the day care participant, are social activities primary? Assistance with walking, eating or medications? Mental stimulation? Exercise? As a caregiver, is support what you need most? Some free time? Help with transportation? Answering these questions will help you determine which of the three main types of adult day care centers (social, health-focused, and Alzheimer's/dementia oriented) will best serve you.

Where to locate adult day care centers 

In addition to the links in the Resources section below, you can also try:

• Your family doctor
• Local social services or health department
• Mental health centers
• Local senior center
• Area Agency on Aging in the U.S. (Call 1-800-677-1116 for the AAA in your area)
• Yellow Pages listings under Adult Day Care, Aging Services, Senior Citizens' Services, and similar categories

 

Questions to ask an adult day care center provider

When you contact the adult day care center(s) you've chosen to consider, NADSA suggests asking the following questions:

• Who owns or sponsors the adult day care center?
• How long has it been operating?
• Is it licensed or certified? (If required in your country or state)
• What are the days and hours of operation?
• Is transportation to and from the adult day care center provided?
• Which conditions are accepted (e.g., memory loss, limited mobility, incontinence)?
• What are the staff's credentials, and what is the ratio of staff to participants?
• What activities are offered? Are there a variety of individual and group programs?
• Are meals and snacks included? Are special diets accommodated?

Visiting an adult day care center

Spend a day at the adult day care center that sounds best to you, so that you can get a "feel" for the people and the environment. Also, check out references. Talk to others who have used the adult day care center and ask for their opinions. 
You may wish to try out different adult day care centers a few times each to see whether your experience on different days confirms your initial impressions. Be sure to bring the following site visit checklist with you each time:

Adult day care center site visit checklist:

• Did you feel welcome?
• Were the center services and activities properly explained?
• Were you given information regarding staffing, programming, and costs?
• Is the facility clean, pleasant, and free of odor?
• Is the building and site wheelchair accessible?
• Is the furniture sturdy and comfortable?
• Are there loungers and chairs with arms for relaxation?
• Is there a quiet place in the center?
• Did the staff and participants seem cheerful and comfortable?
• Are participants involved in planning activities?

Source: National Adult Day Services Association (NADSA)
 

 

 

Costs and financial assistance for adult day care

In the U.S., the average cost for an adult day care center is about $64 per day, depending on where you live and the services provided (e.g., meals, transportation, nursing supervision). Professional health care services will mean higher fees. Many facilities offer services on a sliding fee scale, meaning that what you pay is based on your income and ability to pay.

While Medicare does not cover adult day care centers, 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. Be sure to ask about financial assistance and possible scholarships.
Private medical insurance policies sometimes cover a portion of adult day care center costs when licensed medical professionals are involved in the care. Long-term care insurance may also pay for adult day services, depending on the policy. Additionally, dependent-care tax credits may be available to you as caregiver.