Tuesday, November 29, 2011

Adult Daycare for Alzheimer's Patients

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.

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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.

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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.)

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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.

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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.

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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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