If your loved one needs more care than you can provide during the day, or you worry about them being alone while you’re at work, an adult day care may be the answer. In this blog, we’ll cover all the common questions about these programs, so you can decide if it’s the right setting for your loved one.
What is adult day care?
Adult day care is a program that provides social, health, and personal care services to older adults who need supervised care during the day. Due to the connotation with children’s day care, sometimes these programs are simply called Adult Day Programs or Adult Day Centers. Adult day care is an alternative or supplement to home care. The goal is to enable continued community-based living for individuals with physical and cognitive limitations. An equally important goal is to provide respite for their caregivers.
Who manages adult day care programs?
Medical centers, non-profit organizations, nursing home facilities, and home care agencies all offer adult day care programs, which are state regulated. 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
The National Adult Day Services Association (NADSA) offers a comprehensive Standards and Guidelines for Adult Day Care. This organization is leading the way in best practices for adult day care centers. They also maintain links to all state regulations.
What kinds of adult day care programs are there?
There are three levels of service in adult day care centers. Talk with your loved one’s healthcare team and the day care director to make sure the services are a good fit for their needs.
- 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)
Adult day care can also help in these specialized situations:
- 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.
What services do adult day care programs provide?
As noted above, services vary from program to program, but most provide the following services. Just be aware that some options may require an extra fee.
- 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 and dental check-ups
- Nutritional meals, snacks, and therapeutic diets
- Emergency care
Adult day care programs are designed to increase physical activity and mentally stimulation, which help to strengthen muscle functions, improve memory, and enhance cognitive skills.
Who staffs adult day care programs?
Staffing will depend on the services provided by that particular adult day care program. However, to give an idea of the staff make-up, here are some statistics from NADSA.
- Nearly 80% of adult day services centers have a nursing professional on staff
- Nearly 50% have a social work professional on staff
- Approximately 60% offer case management services
- Approximately 50% provide physical, occupational, or speech therapy
There is one direct care worker for every six participants, facilitating individualized, person-centered care and enabling staff to care for increasingly complex needs.
Can adult day care programs offer overnight respite?
No, adult day care programs are different than respite care. Unlike adult day care which is restricted to four to twelve hours per day, respite care can extend to overnight care. Adult day centers generally operate during normal business hours five days a week. However, some programs offer services in the evenings and on weekends.
Who should consider adult day care?
NADSA recommends adult day care for individuals who fit some or all these criteria. Does your loved one:
- Have trouble structuring their own daily activities
- Find it difficult to initiate and focus on an activity, e.g. reading, conversation, watching television
- Feel isolated and lonely or desire peer interaction
- Fall or hurt him/herself when left alone
- Live with someone who works and is away from the home most of the day
- Feel anxious or depressed and need social and emotional support
- Feel uncertain and anxious when left alone
- Require attention leading to the caregiver's anxiety, frustration, compromised health and/or depression
How can I help my loved one adjust to adult day care?
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. For the first few visits you may want to remain with them if possible, making the transition less abrupt.
How should I choose an adult day care program?
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
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.
How should I evaluate adult day care programs?
The NADSA offers a helpful checklist for evaluating an adult day care. We've summarized some of the most important questions below:
- Is the center licensed, certified or accredited?
- What are your days and hours of operation?
- What personal care services are provided? (eating, toileting, transfers, medication)?
- What recreational activities are provided? Do they align with your loved one's interests and/or skill/awareness level?
- 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 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.
What is the cost of adult day care programs?
Adult day care is often an economical solution for families, especially when you consider it’s keeping them from moving into an assisted living community or nursing home. According to Paying for Senior Care, the daily state median cost for adult day care is $65 a day, making adult centers affordable for many families. Most centers bill in half-day or four-hour increments, so you have flexibility in creating the schedule that works for your family.
For those who need more help, Medicaid is an option. Medicaid provides comprehensive support to the elderly and those of low incomes, connecting individuals to the services they need, including adult day care programs. To those who qualify, it will cover most (if not all) expenses associated with this program. Medicaid eligibility requirements include:
- Individuals who need long-term medical care (including those who are mentally or physically impaired, those who need intermittent skilled nursing, or those who are unable to care for themselves during daily living activities)
- Individuals who generate less than $2,199 in Social Security benefits and/or other streams of income
- Individuals who are 65 or older
- Individuals who are under the age 65 but are also disabled
Cost compensations vary from state to state, however, so it's essential that families research their options. Visit the official Medicaid site to discover the full list of eligibility rules, as well as crucial financial planning resources.
Adult day care provides a place for older adults to go every day and receive care, nutritious meals, mental and physical stimulation, and companionship. It’s a reliable and affordable source of support for families. For caregivers who work full-time, most centers are open seven to ten hours a day during the week, with meals and transportation provided. Most importantly, adult day care often delays the need to move an elderly loved one into a nursing home, which gives families more time together.