Adult Day Care

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Adult day care, also known as adult day services (ADS), gives older adults individualized therapeutic, social, and health services for part of the day. For senior clients, these centers provide a coordinated program of professional and compassionate services in a community-based group setting. For their families, they offer respite from the demanding responsibilities of caregiving.

nurse serving older man

Facts on Adult Day Care

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Nearly 78% of adult day centers are operated on a nonprofit or public basis, while the other 22% are for-profit.

Seventy percent of adult day centers are affiliated with larger organizations such as home care, skilled nursing facilities, medical centers, or multi-purpose senior organizations.

The average age of the adult day center care recipient is 72, with two-thirds of them being women.

Nearly 80% of adult day services centers have a nursing professional on staff.

About 35% of seniors in adult day care live with an adult child, while 20% live with a spouse, 18% in an institutional setting, 13% with parents or other relatives, and 11% live alone.

Nationwide, 52% of adult day center clients have some form of cognitive impairment.

Daily fees for adult day services vary by services provided. The national average rate for adult day centers is $61 per day (for an average of 8-10 hours of care) compared to an average rate for home health aides of $19 an hour. Per day median cost in the U.S. for adult day services is $69 as opposed to $126 for home care, $120 for assisted living, and $235 for nursing home care.

Funding for adult day services comes from service fees and third-party sources, along with public sources and charitable contributions.

The average capacity of adult day centers is 40, with a staff ratio of 6:1.

There were 5,685 adult day care programs operating in the United States, up from 4,601 in 2010. Of older adults attending adult day services, 74% live at home.

The U.S. has seen a 35% increase in adult day services centers since 2002. These centers serve over 260,000 participants and family caregivers— an increase of more than 100,000, or 63%, since 2002.

Nearly 80% of adult day services centers have a nursing professional on staff. Almost 50% of these centers have a social work professional on staff, and about 60% offer case management services. Roughly 50% provide physical, occupational, or speech therapy.

Adult day services participants have increasingly higher levels of chronic conditions and disease, such as hypertension (46%), physical disability (42%), cardiovascular disease (34%), diabetes (31%), mental illness (25%), and developmental disability (20%).

On average, adult day care services have one direct caregiver for every six participants.

More than 80% of adult day care participants attend full days and 46% attend five days per week, enabling family caregivers to remain in the workforce.

The average annual cost for adult day services is $17,904 as opposed to “homemaker” home care at $44,616 and a home health aide at $45,760. Assisted living is $43,200, with semiprivate nursing home care at $80,300 and private nursing home care at $91,250.

Types of Adult Day Care

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Adult day programs aim to delay or prevent institutionalization by providing alternative care, enhancing self-esteem, and encouraging socialization. There are three general types of adult day centers:

Adult Social Day Services

Provide meals, recreation, arts and crafts, and some health-related offerings. These often include discussion groups and day trips – ideal for the active adult who does not have significant medical issues.

Adult Day Healthcare

More intensive health, social, and therapeutic services. The target consumers are seniors with significant medical issues and those at risk of requiring care at a nursing facility. Often, a registered nurse or other professional is on staff, as well as physical, occupational, and speech therapists. Signing up usually requires a medical assessment beforehand.

Specialized Day Cares

These are specific to certain patient populations, including those with developmental disabilities and dementia.

Unlike long-term care facilities, adult day centers generally operate during normal business hours five days a week, though some programs offer evening and weekend hours. Although each center may differ in terms of features, these general services are offered by most adult day centers:

  • Social programming—interaction with other seniors in planned activities appropriate for their conditions
  • Transportation—door-to-door service
  • Meals and snacks – generally accommodating clients with special dietary needs
  • Personal care—help with grooming, eating, restroom self-care, and other daily living activities
  • Therapeutic activities—exercise and mental engagement for all participants

In recent years, adult day services centers have played an increasing role in providing long-term care services, as evidenced by the rapid growth in programs from 2,000 in 1989 to more than 4,600 in 2009. In fact, adult day care is fast becoming a preferred platform for managing chronic disease. Centers are offering more and more disease-specific programs to address chronic conditions, with a heightened focus on prevention and health maintenance. They are also an emerging provider of transitional care and short-term rehabilitation following hospital discharge.

Today, adult day care centers are leading the pack in community-based care for individuals with Alzheimer’s Disease and dementia. Approximately 90% of these centers have cognitive stimulation programs, with 80% providing programming for memory training, and more than 75% offering educational programs. They are an interactive, safe, and secure environment for seniors with any form of dementia, and the care may help their clients delay the need to go to nursing homes. With $8 billion in annual revenue nationwide, and more than 200,000 employees at about 15,000 care facilities, the adult day care industry is a formidable competitor against other forms of senior assistance.

From an economic standpoint, adult day care is a win/win for society. Funding for adult day services decreases Medicaid costs. It lowers the rate of full-time institutional care while still offering consistent health monitoring. Among other benefits, this care reduces the rate of readmission and emergency room visits.

More important than industry metrics, however, is the savings in human cost. Adult day care allows a senior to age in place at a fraction of the expense of more advanced care, with stimulating social programming and services that ensure a better quality of life than if they spent weekdays at home. Families continue to have the primary care and control over their loved ones. These senior-oriented services allow the clients to engage in social and therapeutic activities during the day and compare notes with their loved ones at the end of the day. This enhances the quality of life for both the senior participants and their families.

Adult day services mean so much more than just respite for caregivers. They can be a reliable source of support, restore balance in times of crisis, and enhance overall quality of life for the entire family. Most centers provide programs for family members, caregiver support groups, individual counseling, and educational programs.

The Cost of Adult Day Care

Seniors Bills Fraud

The average daily adult day care  cost has been quoted from $61 to $70 for six to eight hours each day. That’s about half the cost of a home health aide – the cheapest care alternative – for the same period of time. Adult day services are also far less expensive than $198-per diem nursing home care. New evidence from a case-controlled study suggests that adult day care can improve health-related quality of life for participants. In addition, they are cost-effective in improving caregiver well-being and reducing burden, role overload, worry, anger, and depression. Nevertheless, this daily figure is cost-prohibitive for many families.

Many adult programs will not accept Medicaid and only take clients who can pay out-of-pocket.

Be aware that Medicare does not cover adult day care. Medicaid funding, on the other hand, depends on state law. Medicaid will pay something in nearly every state, though the amount is often limited, and participants may face long waiting lists. Many adult programs will not accept Medicaid and only take clients who can pay out-of-pocket. Long-term care insurance may cover adult day programs, but be sure to read your policy carefully for the fine print. Some financial assistance may be available through a federal or state program like the Older Americans Act or Veterans Health Administration.

When to Begin Adult Day Care

nurse with older woman

It helps for seniors to begin frequent adult day care while they can fully enjoy the activities and social life. As their abilities and needs change, this ensures that they are familiar with the setting and all of its health, social and support service components. Most importantly, they feel comforted and cared for.

Many nearby senior centers offer social programs that older adults can attend when they wish. However, many of them benefit from regular adult day care. This is especially true when they cannot be safely left alone or experience anxiety when no one else is around. Day care also helps adults who can no longer structure their own daily activities or have problems focusing on an activity like reading or watching TV. The peer interaction and emotional support helps them as well as relieving their caregivers.

Choosing the Right Adult Day Care

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Adult day care or adult day services (ADS) are regulated by state law, and rules and standards vary widely. In 2014, The U.S. Department of Health and Human Services reported that while all American states have some form of some regulation on adult day programs, only about half required them to be licensed and another 10 required certification. Some states perform annual inspections, while others may visit only every three to five years. Some may allow “social model” ADS staff to administer medications, whereas others may only allow medical model staff to do so.

You may experience some resistance at first until some time – and enjoyable visits – have passed.

With this laxity in mind, you may find a great deal of difference between individual centers. That is why it pays to learn more about each ADS within a reasonable distance. If possible, visit the centers closest to you, and talk with the staff and other families that use the centers to determine whether the facilities meet your needs. Also find out if your state has an adult day care association. 

As you begin to shop around for the right ADS, think of the specific services that are important for you or your loved one. You’ll want a safe, secure environment with social activities and a center that will accommodate any special diet your loved one may have. An established day care provider will have far more user reviews than one that is brand-new. It will also provide previous clients and families to talk to and get a feel for their experiences. Long-running programs are more likely to have trained staff, ample funding, and established programs, though you should check each of these components separately.

Exercise benefits any patient. Dementia patients benefit from specialized care, but if you are considering a non-specialized model ADS, find out if staff are accustomed to working with that population. If your loved one needs help with daily living skills – like eating, bathing, or taking medicine – you can find that need filled in at least one local day care center. Many take patients’ blood pressure, blood sugar levels, and other health monitoring. A patient can also benefit from physical, speech, or occupational therapy depending on his or her health or mobility issues.

Once you’ve considered what your loved one needs as a patient/client, consider what you need as a caregiver. If you work, you need a center that is open during your work hours. If you work at home, shorter hours to give you respite time will still go a long way. Transportation services may be essential for you, and help with planning care could tilt the decision in a particular center’s favor.

To find the right center for all parties concerned, contact your local Area Agency on Aging and your state’s Adult Day Services Association. You can also ask around at a local senior center or organization serving patients with a condition your loved one may have, like Alzheimer’s.

Now that you have narrowed your choices down, visit the centers. Be sure to make appointments to do so and prepare a list of questions to ask. Besides licensure and length of time in business, find out their policy concerning late arrivals or late pickups in case you are stuck in traffic one day. What is the staff-to-client ratio? Learn about the fee structure and what charges are tacked on for meals, snacks, and incidentals. If applicable to you, ask if financial assistance is available.

While ancillary features tend to be spelled out, go a step further. How are clients involved in planning activities? How are special diets accommodated? How often are individual service plans written and updated, and how are families involved? At what point is a client no longer eligible to receive services at the center?

Once you have enrolled your loved one in day services, it may take several visits to feel comfortable in a new setting and routine. You may experience some resistance at first until some time – and enjoyable visits – have passed. Your ADS staff may have some valuable suggestions for you in making the transition easier both at home and at the center.

After carefully choosing an adult day care, you can relax and know that you have done everything you can to put your loved one in good hands. You’ll have confidence about his or her safety without having to quit your job and stay at home. The senior has a comfortable and stimulating routine, and the entire family has the best quality of life possible.

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