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Care Arrangement: Adult Day Care Centers

Those who act as caregiver to dementia patients almost always have a life of their own prior to becoming a caregiver. They have jobs, families, homes, and responsibilities that they have to keep up with. However, once a loved one is diagnosed with dementia, either through circumstance or by choice, they become caregivers. They then have to make many changes to both their lives in order to accommodate the needs of the dementia patient. One of these changes include the kind of care arrangement the patient will receive.

Depending on the stage of the person’s dementia, there are many different types of care arrangements available. From in-home or out of home care to full-time or part-time services. Caregivers must learn as much as possible about each of the options available to them before making a decision for the best of the dementia patient. In this article, the ins and outs of adult day care centers are elaborated. This can be stepping stone to start your search for the best care arrangement for your loved one.


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WHAT ARE ADULT DAY CARE CENTERS?

Adult day care is a non-residential center that provides support for the daytime needs of dementia patients, including health, nutritional, and social needs. These facilities possess a professional team that provides meals, meaningful activities, general supervision, social activities, as well as medical support. Some centers even have a nurse on-site and may also provide transportation and personal care, including support groups for caregivers.

These centers usually operate during normal business hours, five days a week, and some centers also offer additional services during evenings and weekends. People with dementia most often attend these programs during the day and return home in the evening.

The further the progression of the dementia, the greater the burden of care on the caregiver. Therefore adult day care provides caregivers with much-needed respite, giving them time to do their own activities, spend time with their families, or get away from the stress of caregiving for a short duration. In addition, it can prevent patients from needing to be re-hospitalized and may delay their admission to long-term residential care.

Although services may vary, there are generally three types of adult day care:

  • Adult social day care – provides social activities, meals, recreation, and some health-related services.
  • Adult day health care – offers intensive health, therapeutic, and social services for individuals with serious medical conditions and those at risk of requiring nursing home care.
  • Specialized adult day care – these centers specialize in caring for people with dementia and Alzheimer's disease, with dementia-tailored activities and staff who are specially trained to meet the unique mental, social, and physical needs of individuals with cognitive impairment and memory loss.

Adult day care is also extremely beneficial to the dementia patients themselves as it promote social interaction as well as exercise and music, giving way to not only improve the patient’s well-being, but also to delay the dementia’s progression somewhat. These centers provide a friendly and safe environment with staff trained to pay attention and look for signs of trouble or dangerous behaviors. However, it should be noted that day care facilities may vary in quality.

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THE POPULARITY OF ADULT DAY CARE

In 2014, there were an estimated 282,200 current participants enrolled in adult day services centers in the United States, of which 187,200 attended on a typical day in approximately 4,800 adult day services centers. 29.9% of the adult day care users were people with a diagnosed Alzheimer’s disease or other dementias as shown in the following figure.

Source: Harris-Kojetin L, Sengupta M, Park-Lee E, et al. Long-term care providers and services users in the United States: Data from the National Study of Long-Term Care Providers, 2013–2014. National Center for Health Statistics. Vital Health Stat 3(38). 2016.

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WHEN IS ADULT DAY CARE A GOOD CHOICE?

As mentioned, once a person is diagnosed with dementia, there will be many changes in both the patient and their caregiver’s lives. In some cases, the primary caregiver may have a job and is unable to stay at home. At times like that, adult day care can be a life-saver for the caregiver as it gives them extra support where the patient still receives proper care in a safe and friendly environment. Other instances when adult day care can be a good fit is if the caregiver has busy schedules, lacks time due to family responsibilities, taking care of children, or others.

But it should be noted that the progression of their dementia should still be in the early or middle stages, when they are still able to move about independently and only need some assistance with daily activities. This also gives the patient an avenue to exercise their ‘mental muscle’ through socialization and various activities, which is essential for their health. Either of the given reason can be a good motive to send your loved one to an adult day care center. Other questions that a caregiver should consider in order to assess the necessity of an adult day care center for their loved one are as follows:

  • Does the dementia patient seem unable to provide any structure for their daily activities?
  • Is the patient isolated from others for more than an hour or two each day and misses companionship?
  • Can the patient be safely left at home alone?
  • Does the caregiver work outside the home or need regular breaks?

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THE SERVICES PROVIDED

In general, there are three main types of adult day care centers: those that focus primarily on social interaction, those that provide medical care, and those dedicated to Alzheimer’s and other dementia care. The services provided in each center may vary accordingly to the center’s focus. However, not all the centers provide all services and with the same quality. Some of the services include:

  • Counseling – the center may guidance on outside resources and arrange for supportive care in the home
  • Medical Services – provide help with medication administration; blood pressure checks; physical, dental, foot, eye or ear examinations; pet therapy or music therapy
  • Nutrition Services – the center provides nutritious meals and snacks for the patient while they are at the adult day care
  • Personal Care Services – assist with hairstyling, toileting, eating, showering and other personal care tasks
  • Social activities – daily activities may include music, art, recreation, games, gardening, holiday parties, exercise, discussions, and support groups
  • Educational Programs or Mental Stimulation
  • Behavior Management – have trained staff who are prepared to deal with dementia related problems such as wandering, incontinence, hallucinations, sexually inappropriate behavior, and speech difficulties.
  • Transportation Services – some centers may provide transportation to and from the day care center for the patient

Many of these centers are affiliated with home care agencies, nursing facilities, medical centers, and other senior service providers.

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HOW TO FIND AN ADULT DAY CARE CENTER

In order to find an appropriate adult day care facility for your loved one, you will have to learn about your options to educate yourself before making a decision. This can be done by getting information from your local dementia or Alzheimer’s association. If you know other caregivers, you can also speak to them about their own experiences. Your loved one’s doctor is also a very good starting point for information and recommendation. Other than that, you can search online for adult day care centers that are in your area. For example, in the US, you can find out if your state has an adult day care association at http://www.alz.org/apps/findus.asp.

It is important to note that not all states license and regulate adult day care centers. There may be a great deal of difference between each adult day care center, which is why it is important to learn more about each center. Below is a list of resources to help you get started:

  • Eldercare Locator

Your local aging information and assistance provider or Area Agency on Aging (AAA). For help connecting to these agencies, contact the Eldercare Locator at 1-800-677-1116 or www.eldercare.gov 

  • The National Adult Day Services Association

A good source for general information about adult day care centers, programs, and associations. Call 1-877-745-1440 or visit www.nadsa.org

  • Adult Day Care Directory

Go to www.adultdaycare.org/directory/ for a comprehensive listing of Alzheimer's and dementia resources, community programs and services.
  • Google Search

Google Search "Adult Day Care Near Me", or "Adult Day Care (enter your location)"
  • Caring.com

Caring.com provides a directory of adult day care centers. We do not recommend sharing your personal contact information since this website uses aggressive sales tactics to get commission for placements. 

  • APlaceforMom

APlaceforMom provides a directory of adult day care centers. We do not recommend sharing your personal contact information since this website uses aggressive sales tactics to get commission for placements. 

  • Yelp.com

Yelp.com provides a listing of adult day cares near you with reviews. Type in "Adult Day Care" in the Find box at the top and your location in the Near box at the top. Includes reviews from the public. 

Below are some resources to find adult day care centers in locations outside of the US:

  • United Kingdom

Search for adult day care centers in your area or call the Carers Direct Helpline on 0808 802 0202 for free information and advice. You can also visit www.gov.uk/day-care-centres to search

  • Australia

Contact your local Commonwealth Respite and Carelink Centre at 1800 200 422 for information on senior support services including local adult day care centers or visit www.myagedcare.gov.au/

  • Canada

Find information on services available for seniors in your region, including adult day care options through www.servicecanada.gc.ca/eng/audiences/seniors/index.shtml

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WHAT TO LOOK FOR WHEN SELECTING AN ADULT DAY CARE

Life expectancy is getting higher, leading to the appearance of possible diseases that may be typical for elderly people. As their age advances and some of these conditions start to appear, sometimes the best option might be to opt for programs such as adult day care. However, there are some things one should search and be aware of before getting their loved ones into such facilities.

Firstly you should check if the facility provides a number of activities designed to promote well-being through social and health related services. And secondly, although each center is staffed according to the needs of the people at the center, here are some things that a typical adult day care center should provide:

  • A good staff to participant ratio (the recommendation is 1:6 or smaller)
  • Convenient facilities for the patient
  • Social activities such as:
    • Arts and crafts
    • Music and singalongs
    • Mental stimulation games
    • Group exercise
  • Physical or behavioral therapy
  • Counselling

In any case, before deciding, as a caregiver, you should ask yourself what it is that you and your loved one need the most. Is it rest? Is it mental and physical stimulation? Is it safe caregiving during working hours? Or is it something else? It is highly recommended that you visit each of the day care centers in consideration before making your final choice. It would be even better if you can opt for a trial period at the center. In addition, you should obtain information on such things as:

  • Rates and financing options
  • Owner or sponsor
  • How long it’s been operating
  • Any licenses or certifications
  • Operating hours
  • Are there any transportation service to and from the center for the patient?
  • Are meals and snacks included?
  • Does the center accommodate special dietary requirements?

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COST OF ADULT DAY CARE CENTERS

In the US, the price for an Adult Day Care Centre is on average, 68$ a day, depending on the services offered (transportation, meals, special cares). If you opt for the service in the long term, some centers may offer weekly, monthly, or even yearly rates. As for financial assistance, state or federal subsidies through programs such as Medicaid, Medicare, veterans’ benefits, or private health insurances may cover a part of the costs of long-term needs. However, it is unlikely to obtain 100% coverage.

Depending on finances and functional eligibility, Medicaid may be a good option. If the patient has a medical condition such as Alzheimer’s or Parkinson’s, for example, then Medicare for health insurance is more likely to cover such care. There are long-term care insurance policies that may cover some or all the costs associated with adult day care services as well. Other than these options, there may be grants and charity funds that may pay for the partial or full cost of the adult day care, subject to eligibility. For more information concerning financial aid in your state, visit: www.payingforseniorcare.com/medicaid-waivers/adult-day-care.html#title7. And lastly, for those who are financing the care through the patient’s savings or a family member’s, it should be noted that your out-of-pocket expenditures may qualify as a tax-deductible medical expense.

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POTENTIAL ISSUES WITH ADULT DAY CARE CENTERS

You should keep in mind that no adult day care center will be perfect. While many will strive to provide the best level of service they can, sometimes, there may be some dissatisfaction. This is why it is important to do extensive research in order to minimize the number of issues you face later on. Some of the problems you could easily avoid through this are:

  • Insufficiently trained staff
  • Centers with inconsistent licensing or regulation
  • Inadequate programs concerning the services your loved one needs
  • Inability to accommodate dementia patients
  • Inability to accommodate special medication administration or dietary needs
  • Centers that cost above your budget
  • How to get loved one to go if they are resistant.

At other times, unforeseen issues may arise, some as soon as the patient starts attending adult day care and some much later. If the matter is small, you can always speak to the staff in-charge or management to rectify the matter. But if the issue at hand is more serious, you can file complaints either directly to the management of the adult day care center or through regulating organizations, whose purpose is to deal with these types of matters.

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OVERCOMING PATIENT RESISTANCE

Sometimes, as a caregiver, you may decide that adult day care is the best option for your loved one, but as a dementia patient, they may not always be willing to accept the change. They may resist for various reasons. They may refuse to attend due to a change in routine, unfamiliar environment, or shame for having to be ‘babysat’. They may also have wrong ideas concerning the center, be distrustful of it, or feel put aside by their family or caregiver. In these situations, first and foremost, the caregiver must be patient and calm. It will take an adjustment period before your loved one fully gets settled into the care arrangement. Here are some ways to pass the hurdles of the patient’s resistance:

  • Do not call it daycare. This may lead them to think you are picturing them as children. Call it a group, class, club, other less infantilized term
  • Give the patient importance. If they are still quite aware and their dementia hasn’t progressed too far, they may be able to help out at the center with other patients. You can tell them that they are going to volunteer or help out at the adult day care. This can help make them feel validated.
  • Try to make it fun. Try enticing them by explaining the activities provided there. Your loved one may be motivated if the center provides activities and facilities that they enjoy. Try to find a hook and a reason for them to feel comfortable with the idea
  • Ask a professional for help. Having the patient’s doctor or therapist explain might make the person more willing to accept it.
  • Start with a short schedule. There is no need for your loved one to stay the entire day initially, especially if they are not at ease with the idea. Convince them to attend the center for a few hours at first. Once they get used to it and are more accepting, you can consider increasing the duration of their stay there. The patient may even start to look forward to adult day care as it can be their chance to socialize and make friends.
  • Be patient. There may be some complaints and hesitance at first, but as time goes on your loved one will surely get used to it and enjoy it. Be sure that you are there to give them all the support they need.

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WHEN IS IT TIME TO FIND A NEW CARE ARRANGEMENT?

Adult day care services can be an excellent idea for dementia patients. However, once the disease progresses to a certain point, it can even become a hindrance to their well-being. For example, at some point the patient’s dementia will cause them to require full-time care or be completely dependent on a caregiver for their daily activities and personal care. That is when it is to find a new care arrangement for your loved one. Sometimes, a more personal and health directed care arrangement may be needed, with professionals on site and ready to assist with hygienic, nutritional, and health matters. At other times they may need constant supervision throughout the day and night.

You should prepare yourself for this change in care arrangement by talking to your loved one’s doctor, seek information through local dementia or Alzheimer’s associations, online, or even at the adult day care center itself. Thereafter you can weigh your options and accordingly decide on the best course of action both yourself as a caregiver and your loved one.

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