Adult day care is a form of respite care that's provided outside the home by professionals (as opposed to in-home respite care). It's designed to benefit both the person using the services and, especially in the case of Alzheimer's disease, that person's caregiver.
An adult day care center, or adult day center, provides structured activities and therapy in a safe, supportive environment to adults who need mental and social stimulation. Typical day care clients have lost a degree of independence due to normal aging, a medical crisis, or a chronic condition such as Alzheimer's disease or other dementias, but they live alone or with a caregiver. Half of all users have cognitive impairment. As the name suggests, it's a day service, not a housing option.
Whereas senior centers tend to cater to a healthier, more mobile, and more independent clientele, adult day care programs generally offer services that are more intensive. Some specialize in Alzheimer's disease, and staff members have special education and/or training in working with geriatric clients and in managing behaviors characteristic of a disease like Alzheimer's.
For the elder with Alzheimer's, adult day care offers:
- A chance to get out of the house
- A break from being with the caregiver
- Interactions with other people
- Stimulating activities
- Other therapies as needed (such as physical therapy or speech therapy)
- Possibly a delay in cognitive decline, in the early stages
- Prolonged independent living
For the Alzheimer's caregiver, adult day care provides:
- Stress relief, lessened depression
- Predictable hours of relief in order to attend to personal needs, run errands, and release stress
- The ability to continue caring for a patient at home
- Cost savings over mo re expensive in-home care
- Reduced guilt because the patient's independence is supported
- An improved mood in the patient, making care giving easier
- Possible family counseling or training through the center, to help cope
Programs run from several hours to a full day. Participants may attend daily, a few times a week, weekly, or just for special activities. Weekend and evening care are less common, although this is changing as demand for adult day care rises. (All options vary by center.)
What happens at adult day care?
Programs typically include organized and supervised hands-on activities that may involve:
- Stimulating recreation (such as crafts, group conversation)
- Music therapy
- Art therapy
- Sensory stimulation
- Physical therapy
- Access to a library
- Entertainment (such as music, movies)
- Outings to museums, parks, or other local attractions
- Support groups and counsel ing
- Socialization activities
- Personal and nursing care (including help in keeping up with medications)
- Meals (usually lunch) and snacks
Activities are usually customized to individual needs and abilities, but at the same time, there's an emphasis on group participation. The setting is often homelike and comforting.
Additionally, some programs offer medically oriented care for patients who need it (administering medication or caring for basic medical or personal needs, such as podiatry services). Some offer counseling and educational services to caregivers and families.
Some adult day programs are connected with children's day care centers. An advantage to this arrangement is that intergenerational connections that are made. A potential disadvantage that some researchers have found is that the adults can feel that they're being treated like children themselves, if the activities are largely child-centered.
Does a patient with Alzheimer's need a special kind of program?
Any day care provides caregiver respite. But the ideal type features services tailored to people with Alzheimer's. Some adult day care programs specialize in people with dementias of all kinds and stages, while others specialize more narrowly in early-stage Alzheimer's. In these dementia-specific programs, you're most likely to find tailored activities and staff who are specially trained in the disease.
A 1991 study found that Alzheimer's-specific day care tended to provide more support for families and a greater emphasis on therapeutic recreation (rather than on clinical or rehab services) than general adult day care. Be aware, however, that there's no special licensing required for a facility to call itself an "Alzheimer's/dementia day care."
Who is eligible for Alzheimer’s day care?
Adult day care services are typically available to people with Alzheimer's who are living in their own homes (or with a caregiver) and who:
- Are in the early- to mid-stage of the disease
- Don't require constant one-on-one assistance
- Have some mobility (most programs allow a self-propelled wheelchair)
- Are continent (sometimes just bowel, sometimes bowel and bladder)
- Are not physically or verbally abusive
- Do not wander excessively
Depending on the program, you may need:
- Documentation of a doctor's diagnosis of dementia or Alzheimer's
- Proof the person lives within the community (for state-sponsored programs)
- An intake examination by the staff to determine eligibility according to its own requirements
Adult day care is especially useful in the early stage of Alzheimer's, when the afflicted person retains some good cognitive and social skills and might find it easier to become acclimated to the center and people there. There's also evidence that early stimulation of the type provided by adult day centers can slow cognitive decline.
Day care is also useful in the middle stages of Alzheimer's disease, when the burden of care becomes greater and caregiver burnout is a strong risk. People in the final stage of the disease tend to be unable to manage daily care tasks without help and are often nonverbal; when the burden of 24/7 care completely overwhelms, it may be a nursing home rather than respite care that the caregiver really needs.
Can both spouses go together?
Many day programs accommodate both the adult with dementia and a partner without, or a couple whose members each have some kind of disability. If it's a dementia-specific program, though, the healthy spouse may feel out of place. In such cases, look into whether she might be able to volunteer there. What's possible depends on the individual program.
Bear in mind that a key purpose of adult day programs is to provide relief for the caregiver. (And many nonprofit programs described as &quo t;respite" obtain funding because of this.) If the well spouse is the main caregiver, she's supposed to be taking a break while her partner attends. Even if the spouses prefer being together, limited separation through a day program can benefit both of them.
What does adult day care for a patient with Alzheimer's cost? Who pays?
Daily fees average $56, according to the National Adult Day Services Association (NADSA). Costs vary depending on where you live, the type of program you choose, and how many hours the patient uses it. Most programs are nonprofits, which may cost less than for-profit programs. Ask if a center offers a sliding scale of fees based on income.
Some places charge a fee per session; others charge monthly "tuition." Many centers charge an added fee for transportation, while some offer it free.
Adult day care may be covered by Medicaid , long-term-care insurance, Veterans Administration policies, and possibly health insurance (though the latter is least likely, with the exception of some long-term care insurance). Medicare will not cover adult day care services.
Adult day care trial run
Enroll the person in your care for a few sessions and see how it goes. Start small, with just a few hours per day or week, rather than diving into full-time day care. It's common for new participants to express some stress or hesitation about a center -- but it's also common for them to overcome this pretty quickly.
If the transition proves difficult and he protests or expresses his dislike of his first visits, talk about his concerns. You and/or the director may be able to overcome specific objections. If he has problems with the day care center that don't resolve after several weeks, you'll probably want to look into a different program for a better fit, or for an in-home care or companion service.