Adult daycare is a rapidly growing service that
provides valuable respite to caregivers as well as important mental and social
stimulation to people with early and mid-stage Alzheimer's. Programs vary
widely in terms of their offerings and fees.
What is adult daycare?
The primary purpose
of the adult daycare centers are to: prevent premature or inappropriate
institutional placement of persons with moderate to severe levels of impairment
due to dementia; provide support and respite for caregivers; serve as models of
the optimum type and level of day care services that are needed by persons with
dementia; make training opportunities available to professionals and other
persons providing care and treatment for this population; and increase public
awareness and knowledge about Alzheimer's disease and related disorders.
The centers provide
services that support the physical and psychosocial needs of persons with
Alzheimer's disease or related dementia. Individual care plans are developed
for each program participant with activities scheduled in accordance with these
plans. The overall objective is to keep the participants as healthy and active
as possible by helping them maintain their highest level of functioning and to
improve the quality of their lives while providing respite to caregivers.
Thus, adult daycare centers provide structured
activities and therapy in a safe, supportive environment to adults who need
mental and social stimulation. Typical daycare 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.
This increasingly available type of eldercare may be
affiliated with (or run by) medical centers, nursing homes, assistive-living
facilities, or other organizations either on site or at another facility (such
as a community center or church). Some are established as
"stand-alone" private businesses. There are more than 3,500 adult day
centers in the United States.
Why should I consider adult daycare for
my parent?
Adult daycare 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.
For the elder with Alzheimer's, adult daycare
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 daycare
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 parent at home
- Cost
savings over more expensive in-home care
- Reduced
guilt because the parent'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 daycare rises. (All options vary by center.)
How is it different from a senior
center?
Senior centers tend to cater to a healthier, more
mobile, and more independent clientele. Adult daycare 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.
What happens at adult daycare?
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
- Occupational
therapy
- Speech
therapy
- Access
to a library
- Entertainment
(such as music, movies)
- Outings
to museums, parks, or other local attractions
- Support
groups and counseling
- 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; 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 daycare 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 parent with Alzheimer's need a
special kind of program?
Any daycare provides caregiver respite. But the
ideal type features services tailored to people with Alzheimer's. Some adult
daycare 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 daycare tended to provide more support for families and a
greater emphasis on therapeutic recreation (rather than on clinical or rehab
services) than general adult daycare. Be aware, however, that there's no
special licensing required for a facility to call itself an
"Alzheimer's/dementia daycare."
Adult daycare 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.
Daycare 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 of my parents attend?
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, your healthy parent
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 "respite" obtain funding because of this.) If your well
parent is the main caregiver, she's supposed to be taking a break while her
partner attends. Even if your parents prefer being together, limited separation
through a day program can benefit both of them.
What does adult daycare for a parent
with Alzheimer's cost? Who pays?
Daily fees range from $60 to $150 dollars per day
but can vary widely depending on the services provided, where you live and the
needs of the individual, according to the National Adult Day Services
Association (NADSA). 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.
Social model day care services are usually paid for
privately. Some private insurance plans may cover some of the cost; check with
your plan's administrator or the facility to find out.
Medical day care services, which are usually
affiliated with a nursing home or health care provider, may be covered by
private insurance or by Medicaid, provided your state's Medicaid plan includes
it, the person needing care is eligible, and the facility participates. Contact
your local Medicaid office to find out. A few programs also accept Medicare if
the person requires rehabilitative surgery, such as from hospitalization, but
Medicare does not generally cover adult day care services. Otherwise, medical
day care must be paid for privately.
Are there any reasons not to like adult
daycare?
Some people hear the phrase "daycare" and,
associating it with children's daycare, imagine being talked down to and
babied. Getting past suspicions and resentment can be a challenge. Run through
the many benefits. Suggest a no-strings trial run: "Let's just go once and
see what it's like, Mom." You could also avoid describing it as
"adult daycare" and find terms more palatable to your parent, such as
"a senior club" or "therapy for people with early Alzheimer's
disease."
Most participants quickly come to enjoy the new
faces and varied activity. Some, however, refuse to participate and may even
become belligerent or disruptive; in such cases, they're usually not allowed to
return.
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