Adult Day Care
Adult Day Care Introduction (What is it?)
Adult day care centers, also known as adult day services, have been providing a form of respite for caregivers for more than twenty years. In 1978 there were only 300 centers nationwide. By the 1980s there were 2,100 centers, and today there are about 4,000 centers nationwide, according to the National Adult Day Services Association (NADSA). NADSA reports that the need for such centers has "jumped sharply to keep pace with the mushrooming demand for home and community based services."
This growth also is due in part to new funding sources such as Medicaid waiver programs, which support alternatives to institutional long-term care and rehabilitation. According to Mary Brugger Murphy, director of NADSA, "many of the people served by adult day centers would have been institutionalized just ten years ago."
Adult day care centers provide a break to the caregiver while providing health services, therapeutic services, and social activities for people with Alzheimers disease and related dementia, chronic illnesses, traumatic brain injuries, developmental disabilities, and other problems that increase their care needs. Some adult day care centers are dementia specific, providing services exclusively to that population. Other centers serve the broader population.
One difference between traditional adult respite, both group and in-home care, and adult day care is that adult day centers not only provide respite to family caregivers but also therapeutic care for cognitively and physically impaired older adults.
What are some of the Adult Day Care Benefits?
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.
The care receiver can also benefit from adult day care. He or she is able to remain at home with family but does not require 24-hour care from the primary caregiver. Adult day care participants also have an opportunity to interact socially with peers, share in stimulating activities, receive physical or speech therapy if needed, and receive assistance with the activities of daily living with dignity.
A day at an adult day care center could include: supervised care; small group and individual activities such as reminiscence, sensory stimulation, music, art, and intergenerational activities; nutritious meals; transportation; case management; recreation and exercise; nursing care; education; family counseling; assistance with activities of daily living; and occupational, speech and physical therapies. These services are customized to each participants needs.
What are some types of Adult Day Care Services?
There are three types of adult day care:
- Adult day social care 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.
- Alzheimers specific adult day care provides social and health services only to persons with Alzheimers or related dementia.
Who uses Adult Day Care?
Many caregivers who work outside the home are unable to stay home to care for loved ones. In addition, caregivers who do not work outside the home may wish a break from caregiving to run errands, socialize, or simply to rest.
How long participants stay in Adult Day Care?
Generally, although programs vary, participants attend the program for several hours a day to a full day (eight hours), up to five days a week. Most programs do not offer weekend services, although a few may offer half-day services on Saturdays.
How do I choose an Adult Day Care Center?
Family members must do some research to determine whether the adult day care center is right for their loved ones. The components of a quality adult day care program should include the following:
- Conducts an individual needs assessment before admission to determine the persons range of abilities and needs;
- Provides an active program that meets the daily social, recreational, and rehabilitative needs of the person in care;
- Develops an individualized treatment plan for participants and monitors it regularly, adjusting the plan as necessary;
- Provides referrals to other needed community services;
- Has clear criteria for service and guidelines for termination based on the functional status of the person in care;
- Provides a full range of in-house services, which may include personal care, transportation, meals, health screening and monitoring, educational programs, counseling, and rehabilitative services;
- Provides a safe, secure environment;
- Uses qualified and well-trained volunteers;
- Adheres to or exceeds existing State and national standards and guidelines.
A good place to begin searching for a program is the Yellow Pages, which will list possible options under "Day Care Centers-Adult." The Better Business Bureau may have information on for-profit adult day care centers. At the national level, contact the National Council on Aging (NCOA), National Adult Day Services Association (NADSA) for a set of guidelines for adult day service programs (see Resources). Local Area Agencies on Aging can also direct you to adult day care centers in your area. Ultimately, word of mouth is often one of the best ways of finding quality adult day care.
For a detailed checklist on what to consider in selecting an adult day care center, visit the National Aging Information Center at www.aoa.dhhs.gov/NAIC. Click on "Adult Day Care," then on "Consumer Guides."
Adult Day Care statistics
An ongoing national survey from NCOA/NADSA found the following additional information:
- Approximately 80 percent of adult day care providers are nonprofit, 10 percent are for-profit, and 10 percent use only public funds.
- Fees range from $25 per day to $70 per day, with the average around $50 per day. Many facilities provide services with a sliding fee scale, meaning that family members pay a fee based on their income.
- Most adult day care centers provide transportation. Half the centers provide this service free of charge; others charge by the trip or the number of miles.
- Full-time nursing services are in place at most sites.
- A majority of centers are licensed by the State in which they are located.
Funding for Adult Day Care
Medicare does not cover day care costs, but Medicaid can pay all the costs in a licensed day care center with a medical model or an Alzheimers environment if the senior qualifies financially. Some day care centers offer need-based scholarships. Others may use a sliding fee scale based on income. Private medical insurance policies sometimes cover a portion of day care costs when registered, licensed medical personnel are involved in the care. Long-term care insurance may also pay for adult day services, depending upon the policy. Dependent care tax credits may be available to the caregiver as well.
Adult day care services are a welcome respite opportunity for individuals who work or who need stretches of time away from their loved one to complete tasks, socialize, or just refresh. Additionally, adult day care can be beneficial to the participant when he or she is willing and able to be part of the adult day care experience.
Adult Day Care Therapeutic Activity Manual, <www.therapeuticresources.com>.
Family Caregiver Alliance, FAC Clearinghouse, Fact Sheet: "Community Care Options," Adult Day Care, p.2, <www.caregiver.org>.
National Council on Aging, Metropolitan Area Agency on Aging, "Checklist on Adult Daycare," 1998.
National Council on Aging, National Adult Day Services Association, "Census of Adult Day Services; Centers Offering Adult Day Services Have Nearly Doubled Since 1989 as Demand Mushrooms," 1999, <www.ncoa.org>.
Senior Resource for Adult Day Care, Adult Day Care, 2002, <www.seniorresource.com>.
Administration on Aging, National Aging Information Center at <www.aoa.dhhs.gov/NAIC>.
This factsheet was produced by the ARCH National Respite Network and Resource Center, which is funded in part by the U.S. Department of Health and Human Services, Administration for Children, Youth and Families, Office of Child Abuse and Neglect, under discretionary grant #9CXA0019/01.