About Adult Daycare
Adult daycare is a great option for seniors who are living at home with loved ones and who require supervision during the day, or even for those seniors who are simply in need of a way to socialize with other individuals their age. Typical adult daycare options provide services such as medication management as well as meal and entertainment options. Transportation options may also sometimes be provided with adult daycare services. Pricing for adult daycare may be available on a daily basis as well as on an ongoing basis, depending on the way that seniors and their loved ones use it.
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More About Adult Day Care
Adult day care is a great option for seniors who are living at home with loved ones and require supervision and positive social interaction during the day. According to the National Adult Day Services Association (NADSA), adult day services are a growing source of long-term care. More than 260,000 participants and family caregivers are serviced through more than 5,000 adult day services centers across the United States.
What is Adult Day Care?
Adult day care offers an interactive, safe, supervised environment for older adults and adults with a dementia-related disease, Parkinson's Disease, or other organic brain syndromes. This community-based alternative to institutionalization also acts as a reliable source of support for caregivers. Adult day care services are a rapidly growing source of long-term care for elders due to the availability, lower cost and high demand for caregivers to have a break from caregiving responsibilities. Although services vary, most provide:
- Personal care like bathing, dressing or eating
- Nursing services like injections, IVs, medication and pain management
- Social services like pet therapy, art and music programs, exercise
- Therapeutic services like physical, occupational or speech therapy
- Ancillary services like podiatry, dental check-ups
- Nutritional meals, snacks and therapeutic diets
- Emergency care
Just as a day care for children provides social enjoyment and activities as well as a break for the caregiver, an adult day care is the same concept but for a different generation - usually for those over age 65. Adult day care can improve the overall mood, offer an enjoyable environment and provide the caregiver with much-needed time off. Most adult day care facilities operate during the day, but some provide services during evenings and weekends. Many centers provide transportation to and from the center at no cost or on a per ride basis.
It's typical for an adult day care center to be affiliated with another elder care program such as nursing homes or skilled nursing facilities (SNF), home health care agencies and other health service providers. The centers are state regulated with staff that includes an activity director, a certified nursing aide and a social worker. Volunteers are also widely used in adult day care facilities.
Types of Adult Day Care
In general, there are three types of adult day centers, defined by the level of services provided.
- Social (meals, recreation and some health-related services)
- Medical/Health (social activities and intensive health and therapeutic services)
- Specialized (only serve specific care recipients, such as those with diagnosed dementias or developmental disabilities)
There are also adult day cares that are geared toward certain groups:
- Congregational adult day care - Some religious organizations fund and offer the physical space for adult day cares. Catholic Social Services is an example.
- Veterans adult day care - Veterans enrolled in the VHA Standard Medical Benefits Package are eligible to receive Adult Day Health Care services if they have a clinical need and space is available.
Adult day care is also categorized by the purpose of the care:
- Transitional Care - The adult day care offers short-term rehabilitation after a hospital stay. The senior would go to an adult day care center during the day for a limited amount of time to ensure they are in a safe environment with medical supervision while they recover.
- Palliative Care - The adult day care focuses on relieving the side effects and symptoms of an illness but does not replace the senior's primary care for the illness.
Adult Day Care vs. Respite Care
The main difference between adult day care and respite care is the setting. Adult day care services are provided in community-based centers and group settings. However, respite care can occur in any variety of care setting such as a nursing home, residential center or at home. Both respite and adult day care services can be provided for a few hours per day up to a period of several weeks or more. Unlike adult day care which is restricted to 4-12 hours per day, respite care can extend to overnight care. Many adult day care centers also offer daytime respite care.
Adult Day Care vs. Home Care
Home care services are ideal for seniors who need help with daily living activities, household tasks, or medical care. However, home care by itself doesn't provide the crucial social interaction that seniors need to maintain cognitive abilities and healthy mental outlook. Combining the two services can be an option to keep your senior safe at home but also provide the stimulation necessary for a good quality of life.
Adult Day Care vs. Assisted Living
Assisted living facilities are residences offering personal assistance and hospitality services to seniors who are still able to live independently. Depending on the needs of the resident, they provide services such as meal preparation, bathing, hygiene, incontinence care, and dressing. Adult day care offers these services, but much more affordably while keeping your loved one in their familiar environment.
When to Consider Adult Day Care
It's best to test out an adult day care when your loved one can still fully enjoy the activities and company of others. As their abilities and needs change, they feel familiar with the setting, staff and other participants. The National Adult Day Services Association recommends adult day care for individuals who fit some or all these criteria.
- They can no longer structure their own daily activities
- They find it difficult to initiate and focus on an activity, e.g. reading, conversation, watching television
- They feel isolated and lonely or desire peer interaction
- They cannot be safely left alone
- They live with someone who works and is away from the home most of the day
- They are anxious or depressed and need social and emotional support
- They feel uncertain and anxious when left alone
- They require attention that leads to the caregiver's anxiety, frustration, compromised health and/or depression
Adult Day Care Costs
Adult day cares are the most economical way to provide supervision and personal care for an elderly loved one. When compared with home care for an equal number of hours, adult day care usually costs at least 50% less. Nationwide in 2018, the projected average daily rate for adult day care is $70. Most centers bill in half-day or 4-hour increments.
Paying for Adult Day Care Services
As with any long-term care need, often expenses are paid for out-of-pocket or by a combination of other methods such as Social Security, pensions, Veterans benefits, insurance, home equity, and various savings.
Long-Term Care Insurance
Long-term care insurance is a policy that is purchased through a private insurance company. Like health insurance policies, the price varies greatly depending on age, general health and amount of coverage needed. Coverage could be denied for people with pre-existing conditions such as Alzheimer's disease or Parkinson's disease. Not all insurance will deny based on these conditions, so it is important to explore different insurance companies. Every policy is different, so make sure adult day care is included as a covered service.
Medicare and Medicaid
Adult day care is not covered under Medicare, but depending on the state, Medicaid can be an option if the senior has a condition such as Alzheimer's, dementia, or Parkinson's.
Programs of All-Inclusive Aid for the Elderly (PACE) is a joint program between Medicare and Medicaid. It is designed to help 55+ adults stay in their homes instead of entering nursing home care. PACE programs might pay for all services covered by Medicare and Medicaid that are medically necessary for care, including:
- Adult day care
- Nursing care
- Home care
- Activities, meals and exercise
- Social Services
- Other specialty medical care and therapies
To discover more about PACE and see if it is offered in your location, you can visit their website.
Some life insurance policies may provide options to help pay for adult day care. These options greatly depend on the type of life insurance policy so it's best to discuss with an insurance broker or financial advisor.
- Life Settlement - You can sell your life insurance policy to a third party for market value and use the proceeds to fund home adult day care.
- Surrender Policy - You give up ownership and the death benefit. If the policy has accumulated cash, the insurance company writes you a check for the full amount of cash value, which is often taxed.
- Policy Loan - You can take a loan from your life insurance policy, which means you won't pay taxes. However, you can't take it all or the policy will lapse.
- 1035 transaction - This allows you to exchange cash value tax-free from an existing life insurance policy into a new life insurance policy that provides adult day care benefits.
Reverse Mortgage Loans
The Home Equity Conversion Mortgage (HECM) is a reverse mortgage that seniors take against their home's equity. Insured by the federal government, it is only accessible via lenders approved by the Federal Housing Administration (FHA). Once finalized, the lender makes payments in a single lump sum, monthly installments, or as a line of credit. The loan does not have to be paid back until the last borrower passes away or moves from the home for one full year. The home is usually sold, and the lender is paid back the full loan amount plus interest.
Aid and Attendance Benefit for Veterans
According to the VA website, the Aid and Attendance (A&A) benefit is a special benefit for war era veterans and their surviving spouses. It is a tax-free benefit designed to provide financial assistance to help cover the cost of long-term care in the home, in an assisted living facility or in a nursing home. This benefit is for those who require the regular attendance of another person or caregiver in at least two of the daily activities of living. An adult day care center falls into that category in most cases. To learn more about the eligibility requirements and to apply for these veteran benefits visit VeteransAid.org online.
In situations when costs aren't covered through other means, paying via private funds is an option. Sources of private funds for adult day care include retirement accounts and 401Ks, savings accounts, annuities and insurance plans (including life settlements), trusts and stock market investments. Home equity and bridge loans can also be used when transitioning to the increased care that a day care facility provides. Social Security can also be used as a means of paying for adult day care and other long-term health care needs.
Evaluating Adult Day Care
Since every adult day care is different, your first step is assessing the needs of your loved one, so you can match them with the right facility. Check off your criteria from the list below.
- A safe environment during the day
- Recreational activities to keep their mind stimulated
- Help with activities of daily living - walking, eating, taking medications, bathing
- Physical therapy
- Speech therapy
- Occupational therapy
- Specialized nursing services
- Health monitoring such as blood pressure, blood sugar levels, food/liquid intake, weight
- Nutritious meals and/or snacks
- Exercise, stretching or balance programs
- Specialized care such as dementia care or palliative care
- Transportation to and from the facility
Questions During Your Tour
The National Adult Day Services Association offers a helpful checklist for evaluating an adult day care. We've summarized their questions below:
- How many years has the day care been in operation?
- Is the center licensed, certified or accredited?
- What are your days and hours of operation?
- What is your policy regarding late pick-up?
- What personal care services are provided? (eating, toileting, transfers, medication)?
- Do you provide specialized care for dementia/memory disorders?
- Do you offer physical or occupational therapy?
- What recreational activities are provided? Do they align with your loved one's interests and/or skill/awareness level?
- What ancillary services are provided - hair styling, dental check-ups, podiatry?
- Do you provide transportation? If so, what is the cost?
- Do you provide meals and/or snacks? Can you accommodate special diets? How does the food look? Can you have a meal?
- How do you involve the family and keep them updated?
- What criteria makes an individual not eligible to receive care?
- What is the staff/participant ratio?
- What kind of training does staff receive?
- Do you conduct background checks on staff?
- What is the fee - hourly, half-day, full day?
- Is there a deposit required?
- Do you offer financial assistance?
In addition, how did you feel about the facility? Was it clean, pleasant and welcoming? Did the staff seem engaged with the participants? Use your instincts to assess whether the facility is the right fit for your loved one.
How to Get References
In addition to asking family and friends, you can also contact your local Area Agency on Aging, your state's Adult Day Services Association, or a local senior center. There are also numerous websites that provide reviews by individuals in your community. Just search for "your town/city" and the phrase adult day care.
Easing the Transition
Your loved one might be resistant to the idea of adult day care. It's understandable that a change in their environment can be confusing or scary. It is best to introduce them gradually. Stop into the facility together for a brief visit. If your loved one typically accompanies you on daily errands, act as if it is just part of the routine. If it is out of the ordinary, make it something special and positive to look forward to. For the first few visits you may want to remain with them if possible, making the transition less abrupt.
Why Adult Day Care is Good for Caregivers Too
The biggest benefit of adult day care for the caregiver is a break from the stress of balancing caring for your loved one with work or other family obligations. In addition, adult day care centers offer an array of services an individual caregiver cannot provide like health services, physical therapy, and the social interaction with their peers. For caregivers who work full-time, most centers are open seven to 10 hours a day during the week, and some centers offer weekend and evening hours, with meals and transportation also provided. Adult day care often delays the need to move an elderly loved one into a nursing home, which gives families more time together.
Adult Day Care Regulations
Adult day cares are not regulated nationally like long-term care facilities. Each state has its own laws, regulations and licensing standards. The National Adult Day Service Association maintains a list of adult day care regulations state by state. Most states require licensure, certification, or both. According to the US Department of Health and Human Services:
- 26 states require licensure only
- 10 states require certification only
- 4 states require both licensure and certification
- 11 states do not require licensure or certification
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