Should Seniors Choose Adult Day Care?

Senior citizens fear moving into a nursing home and the loss of their independence far more than death.

A recent study commissioned by Clarity and the EAR Foundation found that 89 percent of American seniors want to age-in-place, that is, continue to live in their homes as long as possible, and are willing to use adaptive technology that will allow them to maintain their independence.

The study found that their children—Baby Boomers born between 1946 and 1964, now faced with the responsibility of dealing with the housing care and other needs of their aging parents—share the same concerns and are willing to support their parents’ efforts. This means, of course that many of the more than 76 million Boomers have assumed the caregiving role for their aging parents. Most are unprepared for the cost, emotional toll, and health issues they face as caregivers.

Seniors rated loss of independence (26 percent) and moving from their home into a nursing home (13 percent) as their greatest fears. Death was listed as a fear by only three percent of the respondents questioned for the research study. “These findings tell us that, above all else, older Americans value their ability to live independently,” notes Peter Bell, president of the National Aging in Place Council.

Adult Day Care is a particularly attractive solution that can provide comfort to aging seniors, as well as their Baby Boomer caregivers. It’s true that these caregivers may be somewhat reluctant to use adult day care services because these services are unfamiliar to them, or because the elder is hesitant to try something new. The benefits of adult day careadult day care are these:

• Participants benefit from socializing with others and receiving the kinds of care services they need.

• Equally important, the caregiver benefits by getting a break from caregiving duties while knowing that their loved one is in good hands.

The fact is, of course, is that because life expectancy is continuing to rise, many, if not all of us may need assistance as we age. Help of all kinds is becoming increasingly available, and an especially valuable option is adult day care. It’s specifically designed for older adults who can no longer manage independently, or who are isolated and lonely.

What is an adult day care center? Adult day care is a planned program of activities designed to promote aging seniors’ well-being by means of social and health-related services. Adult day care centers typically operate during weekday daytime hours, offering a safe, supportive, cheerful environment. Nutritious meals that can accommodate special diets are typically included, along with an afternoon snack.

The centers can be public or private, non-profit or for-profit. The intent of an adult day center is primarily two-fold:

• To provide the elderly an opportunity to get out of the house during the day, and to receive mental and social stimulation; and

• To give the elder’s caregiver with a much-need break, which can be used to attend to other responsibilities or to rest and relax.

The National Adult Day Services Association (NASDA) estimates that there are approximately 4,000 adult day care centers operating nationwide. The proliferation of centers over the past two decades corresponds to what NASDA believes is the "mushrooming demand for home and community based services" to meet the needs of a rapidly-escalating elder population.
Good candidates for adult day care 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.

Adult day dare center participants need to be mobile, with the possible assistance of a cane, walker or wheelchair; in most cases, they must also be continent.

Adult day care is different than “adult day health care.” The latter usually requires a physician-performed health assessment as a precondition to admission 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. ADHCs are usually staffed with a registered nurse, as well as other health professionals. There is a third type of day care that provides social and health services specifically for seniors with Alzheimer's or a related type of dementia.

Services provided by adult day care centers. The mission of these centers is to maintain and build upon seniors’ skills, knowledge, and their particular abilities and strengths. Typical activities are these:

• Arts and crafts;
• Musical entertainment;
• Mental stimulation games;
• Stretching or other gentle exercise;
• Discussion groups;
• Holiday and birthday celebrations; and
• Local outings.

Some centers offer programs that include children and animals. Indeed, recent research has found that the availability of animals in these environments provide the following benefits:

• Improved sense of purpose and fulfillment.
• Reduced feelings of loneliness and isolation.
• Lowered blood pressure and cholesterol levels.
• Increased survival among heart-attack victims who own dogs.
• Improved blood circulation.
• Slowed loss of bone tissue.

One Australian study revealed that pet owners typically visit the doctor fewer times and use less medication; recover more quickly from surgery and illness; and deal better with stressful situations. Pets also have been found to relax us, entertain us and open up opportunities for socializing.

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. The benefits of adult day care can be substantial and significant. Here are some examples.

• A safe, secure environment to spend the day;
• Enjoyable and educational activities;
• Improvement in mental and physical health;
• Enhanced level of independence;
• Socialization and peer support; and
• Nutritious meals and snacks.

When to opt for an adult day care center. 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 wants companionship;
• Can't be safely left alone at home; or
• 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 elder adult and caregiver most need.

• Are social activities the primary need?
• Is there a need for assistance with walking, eating or medications?
• Is mental stimulation required? Exercise?
• As a caregiver, do you need support? Some free time? Help with transportation?

The answers to 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.

There are numerous references and resources that can help locate adult day care centers in your area, including http://www.greatplacesinc.com. In addition, you can also try:

• Your family doctor
• Local social services or health department
• Mental health centers
• Local senior center
• Area Agency on Aging (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.

When you phone the center(s) you've decided to consider, ask the following questions:

• Who owns or sponsors the agency?
• How long has it been operating?
• Is it licensed or certified? (If required in your state)
• What are the days and hours of operation?
• Is transportation to and from the 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?

Next, spend a day at the center that sounds best to you, so that you can get a "feel" for the people and environment. Be sure to bring a site checklist with you. You may wish to go back a few times to see whether your experience on different days confirms your initial impressions.

Costs and financial assistance for adult day care. The cost for an adult day care center ranges from $25 to $70 or more 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.

Although Medicare does not cover adult day care, Medicaid will pay most or all of the costs in licensed adult day health care settings and in 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 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.