Adult day care includes programs, services, and facilities designed to assist physically or mentally impaired adults remain in their communities. These are persons who might otherwise require institutional or long-term care and rehabilitation.
There are two general purposes for adult day-care. The first is to provide an alternative to placement in a residential institution. The second is to create a respite for care-givers, often the children of the persons for whom the care is being provided.
There are two general types of adult day care programs. One is based on a medical model and the other on 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 persons with a variety of chronic medical conditions including the following:
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 participants, as well as caregiver support groups, information and referral services, and community outreach programs.
In 2005, an estimated 36 million Americans will be aged 65 or older. According to statistics from the U.S. Department of Labor, the fastest growing segment of older adults is the population aged 85 and older. Historically, approximately 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 35–54 are in the workforce and unable to care for aging parents or disabled adult children living at home.
Although the participants of adult day care are 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 that adult day care helps ease the burden of caring for ill, confused, or disabled family members.
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. Today, there are more than 4,000 services and centers. Most centers and programs operate during normal business hours, Monday through Friday, but some offer weekend and evening care.
As of 2003, 34 states offer licensure of adult day care, but only 25 require such 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 a 1997 National Adult Day Services Association (NADSA) survey, the average number of persons in an adult day care facility was approximately 40 and the average age of persons served was 76. About three out of four persons receiving adult day care services lived with family. Nearly 80% of adult day centers offered nursing services, and approximately 90% were not-for-profit. Fees ranged from $1 to $200 per day, with an average of $28 to $43 dollars per day. As of 2003, 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 services.
Though fees for adult day care vary widely, the service is generally considered to be 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. A certification process for program assistants also exists. 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 person and develop individualized plans of care and activities to meet the needs of impaired, disabled, or frail older adults. The plans for each individual describe objectives in terms of improvement or maintenance of health status, functional capabilities, and emotional well being. Centers must have sufficient staff to ensure safety, supervision, and close attention. Further, all personnel and volunteers should be qualified, trained, and sensitive to the special needs of older adults. For example, centers and services for persons with Alzheimer's disease or other dementias must take special precautions to ensure that people do 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.
See also Nursing homes .
Arnold, Dorothy T. Better Elder Care: A Nurse's Guide to Caring for Older Adults. Philadelphia: Lippincott Williams & Wilkins, 2001.
Beisgen, B. A., M. C. Kraitchman, and A. C. Ellis. Senior Centers: Opportunities for Successful Aging. New York: Springer Publishing Company, 2003.
Clark, Chris L. Adult Day Services and Social Inclusion: Better Days. London: Jessica Kingsley Publishers, 2001.
Harris, Phyllis J. The National Directory of Adult Day Care Centers, 3rd edition. Silver Spring, MD: Health Resources Publisher, 2002.
Nieves, E. J. "The Effectiveness of the Assertive Community Treatment Model." Administration and Policy in Mental Health 29, no. 6 (2002): 461–480.
Powell, J., and H. Roberts. "Identifying 'Value' in Day Care Provision for Older People." Journal of the Royal Society of Health 122, no. 3 (2002): 158–164.
Ritchie, L. "Adult Day Care: Northern Perspectives." Public Health Nursing 20, no. 2 (2003): 120–131.
Sanfilippo, J. G., and J. E. Forker. "Creating Family: A Holistic Milieu at a Geriatric Adult Day Center." Holistic Nursing Practice 17, no. 1 (2003): 19–21.
Adult Day Care Group. 3 Ramsgate Ct., Blue Bell, PA 19422. Telephone(610) 941-0340, FAX (610) 834-0459. http://www.libertynet.org/adcg .
Alzheimer's Association. 919 North Michigan Avenue, Suite 100, Chicago, IL 60611-1676. 800-272-3900 or 312-375-8700, FAX 312-335-1110. http://www.alz.org .
California Association for Adult Day Services. 921 11th Street Suite 701, Sacramento, CA 95814. (916) 552-7400, Fax: (916) 552-7404. firstname.lastname@example.org.
National Adult Day Services Association. 8201 Greensboro Drive, Suite 300, McLean, VA 22102. (866) 890-7357 or (703) 610-9035, Fax: (703) 610-9005. email@example.com.
U.S. Administration on Aging. 200 Independence Avenue, SW, Washington, DC 20201. 202-619-0724. AoA Info@aoa.gov.
Administration on Aging. 1998 State Performance Reports. 1998 [cited March 21, 2003]. http://www.aoa.gov/napis/98spr/tables/table4a.html .
"Adult Day Care Checklist." Care Guide. [cited March 21, 2003]. <http://www.careguide.com/Careguide/livingalternatives contentview.jsp?ContentKey=1060> .
"Nursing Homes: Alternatives for Care." Medicare. [cited March 21, 2003]. http://www.medicare.gov/Nursing/Alternatives/Pace.asp .
L. Fleming Fallon, Jr., M.D., Dr.PH