Adult Day Care
Adult day care describes programs, services, and facilities intended to assist physically or mentally impaired adults who might otherwise require institutionalization, allowing them to remain in the community. It is generally considered an alternative to institutional long-term care and rehabilitation.
There are two general types of adult day care programs—a medical model and a social model. The medical model provides comprehensive medical, therapeutic, and rehabilitation day treatment. The social model offers supervised activities, peer support, companionship, and recreation. Both models assist older adults and those with chronic conditions to remain as independent as possible, for as long as possible.
Programs organized along the medical model lines are often called adult day health care to distinguish them from social programs. Adult day health care programs offer health services such as physician visits, nursing care, and podiatry, as well as rehabilitation services such as physical, occupational, and speech therapy in a secure environment. This model of adult day care is offered to clients with a variety of chronic medical conditions including:
- adults with Alzheimer's disease, other dementias, or depression
- patients recovering from stroke or head or spinal cord injuries
- patients with chronic diseases such as diabetes or cardiovascular disease
- adults with developmental disabilities such as Down syndrome
- adults suffering from mental illnesses
- frail older adults requiring nursing care and assistance daily living activities
The social model of adult day care emphasizes supervised group activities such as crafts, gardening, music, and exercise. Participants in this model may require some assistance with the activities of daily living(e.g., eating, bathing, dressing) but they generally do not require skilled nursing care. Like adult day health care facilities, these social programs generally provide transportation and a midday meal for clients, as well as care-giver support groups, information and referral services, and community outreach programs.
In 2005, there will be an estimated 36 million Americans aged 65 or older. According to U.S. Department of Labor statistics, the fastest growing segment of older adults is the population age 85 and older. About 80% of the frail elderly remain in the community and are cared for by relatives, most commonly by adult daughters. Today, however, an increasing number of women aged 35 to 54 are in the workforce and unable to care for aging parents or disabled adult children at home.
Though the clients of adult day care are the adults who attend the programs daily or several times each week, adult day care also meets the needs of families and other caregivers. Before women entered the workforce, they were available to care for relatives at home. Today, adult day care provides a secure, alternative source of care for women who work outside the home. It also offers respite, or much needed breaks, for caregivers. Older adults caring for spouses, or children caring for aging parents find adult day care helps ease the burden of caring for an ill, confused, or disabled family member.
The first adult day care centers opened in England during the 1940s and 1950s. Established by psychiatric hospitals, these centers were designed to reduce the frequency
of hospital admissions. The first adult day care centers in the United States appeared during the early 1970s, and today there are more than 4,000 services and centers. Most centers and programs operate during business hours, Monday through Friday, but some offer weekend and evening care.
According to a 1997 survey conducted by the National Adult Day Service Association (NADSA), 34 states offer licensure of adult day care, but only 25 require licensure. Adult day care services or programs may be affiliated with hospitals, nursing homes, home health agencies, or senior centers, but many are unaffiliated, independent programs. They may be located in storefronts, senior centers, community health and medical centers, and nursing homes.
Among centers responding to the NADSA survey, the average enrollment (number of clients) was about 40; the average client age was 76; and about three quarters of clients lived with family. Nearly 80% of adult day centers offered nursing services, and approximately 90% are not for-profit. Fees ranged from $1 to $200 per day, with an average of $28 to $43 dollars per day. As of 2001, Medicare does not pay for any type of adult day care; however, in 35 states, Medicaid can be used to pay for adult day care.
Though fees for adult day care vary widely, the service is generally considered cost effective when compared with the cost of institutional care, such as skilled nursing facilities or even home health care. More importantly, adult day care enables older adults, persons with physical disabilities, and those with cognitive impairments to maintain their independence. Research has demonstrated that adult day care also reduces the risks and frequency of hospitalization for older adults. Adult day care satisfies two requirements of care; it provides a secure, protected environment and is often the least restrictive setting in which care may be delivered.
Quality and standards of care vary from state to state and from one center or program to another. NADSA and the National Council on the Aging have developed standards and benchmarks for care, but adherence to these standards is voluntary. NADSA is currently developing a certification program for adult day center administrators and directors; there is already a certification process for program assistants. Since no uniform national standards exist, it is difficult for consumers to know whether a program or center is staffed by qualified personnel or provides appropriate services.
Generally, quality adult day care centers or programs conduct thorough assessments of each client and develop individualized plans of care and activities to meet the needs of the impaired, disabled, or frail older adults. The plans for each client describe objectives in terms of improvement or maintenance of health status, functional capabilities, and emotional well being. Centers must have high caregiver to client ratios to ensure safety, supervision, and close attention. Further, all personnel and volunteers should be qualified, trained, and sensitive to the special needs of the client population. For example, centers and services for persons with Alzheimer's disease or other dementias must take special precautions to ensure that clients can not wander away from the facility.
The aging population in the United States, the increasing incidence of Alzheimer's disease, and rising popularity of adult day care have created new and additional opportunities for health professionals and other care-giving and service personnel.
Along with nurses, physical, occupational, and speech therapists, adult day care centers employ:
- administrators, program, and activity directors
- recreational therapists and assistants
- health aides and program aides
- bus and van drivers
- social workers and counselors
- teachers and trainers
Geriatrician—Physician specializing in the care and treatment of older adults.
Ebersole, Priscilla, and Patricia Hess. Toward Healthy Aging Human Needs and Nursing Response, Fifth Edition. St. Louis: Mosby, 1998, pp. 822-823.
Hogstel, Mildred O. Nursing Care of the older Adult. New York: Delmar Publishers, 1994, pp. 439-440.
National Association of Adult Day Services. <http://www.ncoa.org/nadsa/ADS>.
Family Caregiver Alliance. <http://www.caregiver.org/work&eldercare/bdc.html>.
National Association of Adult Day Services. Adult Day Services Fact Sheet. <http://www.ncoa.org/nadsa/ADS_factsheet.htm>.
National Association of Adult Day Services. Your Guide to Selecting an Adult Day Services Center. <http://www.ncoa.org/nadsa/guide_2_ADS.htm>.