Courtesy of Susan Hindman

If the plagues of long-term care are “loneliness, helplessness, and boredom” (according to Dr. Bill Thomas), then the antithesis is adult day care centers. Older adults who would otherwise be isolated at home, with little to do and few to interact with, instead spend their daytime hours engaged in activities tailored to their needs, tended to by a nurturing staff, and surrounded by former strangers who are now close friends. And caregivers, with never enough hours in any day, can relish the respite as well as the focus on their loved one.

If you were to ask day center participants what they like about the centers, you won’t hear them talk about their exercises or how a nurse is managing their hypertension, says Sara Myers, managing director for the National Adult Day Services Association (NADSA). They will talk about how much they love being there. “To a person, they say, ‘I love meeting my friends there. The staff listens to me,’” she said. “A lot of times, the world doesn’t have time for them (the elderly). They have problems with memory and cognition, so people will ignore them. Because they’re difficult to get out of the house, they don’t get out. The (day service) world is designed around them, and they love it.”

The type of care day center participants receive and the centers they attend depend on their needs. The center might be a social model, which provides meals, recreation, and some health-related services; a medical/health model program, which provides more-intensive health and therapeutic services in addition to the social activities; or a specialized program, which provides services only to specific care recipients, such as those with dementia or developmental disabilities.

Day centers differ from recreation or senior centers. The distinction, says Myers, is that “there’s an attention to the needs of the individual from a therapeutic perspective.” Exercises are specifically designed to perhaps build strength and stamina to decrease the risk of falls, or to increase range of motion, or to build upper body strength. “The stronger a person is, the easier they are to care for,” she says. “So it’s not exercise for the sake of exercise.”

The activities—both physical and cognitive—“help them move to greater levels of independence,” Myers said. “There have been people sitting in wheelchairs who through their program at the day center are now using walkers. People using walkers are now using canes. Day services work.”

And they help older adults stay in the community and in their own homes as they age.

A little history

Adult day care services’ history dates back to the post–World War II period. British veterans were coming home in large numbers, and hospitals were not able to care for them, said Myers. “So they created a model called a ‘day hospital.’” They would go to the hospital during the day and get their health care, and go home at night and be with their families.” It turned out to be a successful model. “People did really well living at home and receiving health care in the amounts they needed it, rather than being in the hospital (all the time).

“I think it lay dormant for a number of years until the mid-1970s, and there emerged probably a couple dozen day care centers all over the country,” she said. “It took off once they became eligible for federal Medicaid long-term care dollars. That provided a more stable funding source.” According to 2002 numbers at the NADSA site, nearly 78% of adult day centers operate on a nonprofit or public basis, and 22% are for-profit.  

The cost of adult day care varies around the country, according to the Market Survey of Long-Term Care Costs, released in 2009 by MetLife. The extreme end is places like Vermont, at $150 a day; in Alabama, it’s $27 a day. On average, the daily cost is $67. By comparison, the survey showed, the average rate for a home health aide—someone trained to provide hands-on care and assistance in the senior’s home—is $21 an hour. Because home health aides often require a minimum commitment of three to four hours a day, Myers said, day centers wind up being less expensive and offer a wider range of services, as well as the social stimulation, than someone who comes into the home.

“Many day centers have their own sliding scale, so an individual may be over income for Medicaid or public dollar services, but day centers do fund raising to raise money for uncompensated care,” said Myers. “Never let price or cost keep you from exploring the option. Because day centers are there to serve their communities, many centers will figure out a way to provide the service.”

In addition, a bill currently before Congress, called the Medicare Adult Day Care Services Act of 2009, would, if passed, authorize Medicare to pay for certain services at adult day centers.

Close to 4,800 day programs are operating in the United States, according to NADSA, which was formed in 1979 to establish national standardized criteria for care centers. Though they may differ in their specifics, most centers offer social activities, exercise and mental interaction, meals and snacks, transportation services, and help with activities of daily living. A study in 2001 showed that more than 150,000 older adults are in adult day programs each day, but that number will be updated in a survey to be released in fall 2010.

Day care centers sometimes have limitations on the level of care they can offer. Those who require transferring from a wheelchair to the bathroom, or other lifting, for example, may pose difficulties for a center. The same is true if a person wanders because of dementia, or if the person is difficult or combative. In those cases, a day health center might be better suited, Myers said. “People should visit a couple of them (day centers) to get a sense of what services are offered and what the staff can provide, particularly with regard to transfers and wandering.” Ask questions such as, what are the center’s limits? Even ask, what gets a person kicked out?

“A sense of validation”

Day centers, she said, “are a godsend for caregivers,” who in 2002 made up almost half of workers in the United States, according to congressional statistics. They allow the caregiver to work and to take a breather from the stress.

“It’s really hard to let someone else take care of your parent,” said Myers, who blogs on Silver Planet about her experiences with her own mother’s dementia. “It’s never perfect. To find a place that’s acceptable and allow that caregiver to relax is critically important.”

With a typically small ratio of staff to seniors—the national average is one to six—there’s a lot of hands-on and personal attention.

“They (the elderly) receive a sense of validation that’s hard to get,” she said. They get touch, a hand held, a shoulder rubbed. “It’s designed for people shut away in our culture. We’re not very good at figuring how to integrate very old or very disabled people. We don’t see them out very much. Wheelchair access is lousy, sidewalks are lousy. . . . The day center is a life-affirming experience. When people are around others who love them and respect them and treat them as individuals, they heal.”