Adult Day Care: What Family Caregivers Need to Know

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Adult day care programs can provide caregivers with a needed break while giving older people a chance to socialize with their peers and alleviate the isolation and loneliness that many experience.

Although traditional community senior centers can be a great place for relatively healthy older people to exercise or take classes, adult day care centers serve those with physical or cognitive disabilities who may need more supervision and services. More than half of older attendees at adult day care facilities have cognitive impairment, according to the National Adult Day Services Association (NADSA), an industry group.

Evidence shows that older people who attend these centers have a better quality of life. A 2017 review of research on adult day care programs, published in the journal The Gerontologist, found that they provided health-related, social, psychological and behavioral benefits for participants, particularly those with dementia and other cognitive impairments.

Arranging for a loved one to spend time in adult day care can also be beneficial to a caregiver’s well-being. A 2021 study, published in the journal Aging & Mental Health, found that both dementia patients and caregivers slept better, with fewer disturbances, on the nights before the patients attended adult day care.

Other research has shown that using adult day care has a positive impact on dementia caregivers’ mood, health and relationships and reduces their sense of “role overload,” according to a 2017 review by a researcher at the School of Social Work at St. Catherine University in Minnesota.

Who provides adult day care?

In 2018, the most recent year for which figures were available, about 4,200 adult day care centers in the U.S. served more than 251,000 participants, according to the National Center for Health Statistics.

Nearly 58 percent of adult day care centers are nonprofit, according to a 2018 federal survey. The remainder are for-profit businesses. The nonprofit operators include local governments, universities, hospitals, national groups (such as Easterseals and the Alzheimer’s Association), religious organizations and Native American tribes. Major for-profit providers include Active Day, Sevita and SarahCare.

Adult day care services are regulated by the states, which generally require operators to obtain a license or certification, to maintain a minimum staff-to-participant ratio and to provide a baseline set of services, including monitoring clients’ health and assisting them with activities of daily living. Requirements in areas such as specialized services and staff training vary from state to state, with some having specific provisions for serving people with dementia.

Adult day care services available

Adult day care centers vary in their programs and services, NADSA says, but most offer therapeutic exercise, brain stimulation for clients, social activities appropriate for their condition and help with personal care, such as grooming and using the toilet. Facilities often provide meals and snacks, including special diets for those who need them, and door-to-door transportation.

Some focus on specific areas of care.

• Social centers concentrate on meals and recreation while providing certain health-related services.

• Medical/health programs provide more intensive health and therapeutic services as well as social activities.

• Specialized centers accept those who have only a particular condition, such as dementia.

Adult day care centers normally operate on weekdays, during regular business hours, though some offer weekend or evening services.

Day care costs

Prices can vary, depending on factors such as geographic region and range of services. The median cost across the U.S. is $1,690 a month, or $78 per day, according to the 2021 “Cost of Care” survey from long-term care insurance company Genworth.

While Medicare generally doesn’t cover the fees, financial assistance may be available through other government programs, like Medicaid, the Veterans Health Administration and state agencies. Thus, adult day care may be a more affordable option for caregivers seeking help and respite than hiring a worker to provide in-home care.

COVID-19 impact 

The pandemic took a toll on adult day care centers, according to data gathered by the National Center for Health Statistics. Between January 2020 and March 2021, nearly three-quarters of centers had to temporarily close or limit their hours. There were 12,272 COVID-19 cases and 1,494 deaths among adult day care participants in that period, and 6,181 cases and 38 deaths among center employees and contract staff.  

As a result, centers became more vigilant about safety, with 72 percent conducting daily COVID-19 screenings, in an effort to reduce the disease’s spread. About 8 in 10 facilities restricted access for family members, visitors and volunteers all or some of the time. Nearly half (46 percent) provided notification of new cases within 24 hours to local health officials and to clients’ caregivers and families. 

Since 2021, adult day care providers in some parts of the U.S. have eased certain COVID precautions, while others have maintained measures such as mask-wearing, based on what their state and local public health agencies require, according to Lance Roberts, associate director of membership and education for NADSA.

When to consider adult day care

NADSA suggests that caregivers look into day care when they start seeing signs that an older loved one:

• Is unable to structure his or her daily activities.

• Feels isolated and lonely and wishes for interaction with other older people.

• Experiences anxiety or depression and needs social and emotional support.

• Has difficulty starting and focusing on an activity, whether it’s conversation, reading or watching TV.

• Seems not to be safe on his or her own or feels uncertain and anxious about being alone.

Family caregivers also should consider adult day care services when they need to work or be away from home for most of the day or if they are experiencing negative effects like anxiety, frustration, depression or other health problems.

Finding and evaluating programs

To find adult day care programs in your area, type your zip code into NADSA’s searchable directory or contact your local Area Agency on Aging, which you can find via the federal government’s Eldercare Locator or by calling 800-677-1116.

Once you identify a center that seems to meet your loved one’s needs, the next step is to visit the facility. NADSA recommends asking some basic questions, such as:

• How long has the center been in operation?
• What licenses, certifications and accreditation does it have?
• What’s the ratio of staff to attendees (the lower the better), and what kind of training do employees receive?
• What days and hours is it open?
• What’s the policy on late arrivals or pickups if you won’t be using transit services that the center provides?

You’ll also want to explore the facility’s full range of services. Does it offer physical, occupational and speech therapy? (Nearly half of centers do.) Does it have specialized care for conditions such as memory loss?

Ask whether the center creates individual service plans for attendees, how often those plans are updated and whether you can provide input.

Spend some time simply observing the center itself.

• Does it seem clean and generally pleasant?
• Is the furniture comfortable and sturdy, and is the facility wheelchair accessible?
• Is there a quiet area where your loved one can relax if he or she needs a break?
• Are the restrooms conveniently located and outfitted with grab bars and space for wheelchairs? 

Pay attention, too, to how the staff and clients interact and whether they seem comfortable with one another.

Helping your loved one adjust

The transition to adult day care can be stressful for an older person with dementia. The Alzheimer’s Association suggests a gradual approach.

Once you’ve vetted a center, take your loved one there for lunch or an activity. Then start using its services a couple of times a week, for a month or so, before making a final decision about enrolling.

Your family member may resist adult day care at first, but participants often warm to it after several weeks and begin looking forward to seeing other people at the center and engaging in activities, NADSA says. If the program doesn’t seem to be working for your family member, you might remove them from it and reintroduce them to it at another time.

Editor’s note: This article, originally created in 2012, has been updated with more recent information.

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