Adult Day Care
Adult day care is for seniors who need extra help or supervision during daytime hours so caregivers can work or rest. Adult day care centers typically operate during regular business hours —
For many families, adult day care is an affordable alternative to putting an aging family member or loved one in a residential care facility like an assisted living community or nursing home. In this way, adult day care often functions as a form of respite care so that families and other caregivers can go to work, relax, run errands, or take care of personal business. In this article, we will delve into what, exactly, an adult day care provides, the most common ways families pay for it, and how to find the best care for your loved one.
Who should consider adult day care
Adult day care is best suited to seniors who 1) don’t require 'round-the-clock care but are looking for additional opportunities for recreation and socialization, or 2) live with family or have a nighttime caregiver but need assistance or supervision during the day.
There are adult day care options appropriate for either of these scenarios, and you can often customize your loved one’s care plan to meet his or her specific needs. However, if your loved one requires a level of care during the hours he or she is not at the adult day care center beyond what you or other family caregivers are able to provide, it may be time to consider a residential long-term care facility like an assisted living community or nursing home.
Types of adult day care centers
Adult day centers vary greatly in the services and levels of care they provide. Because of this, it is important to consider the specific needs and preferences of your loved one before choosing an adult day center. According to the U.S. Department of Health and Human Services, there are three general categories of adult day care services:
- Social adult day care
- Adult day health care (ADHC)
- Alzheimer’s and dementia
The type of adult day care your loved one needs will depend on a variety of factors, including his or her physical and cognitive health, whether or not he or she needs nursing care during the day, and his or her ability to complete activities of daily living (ADLs) like eating, bathing, and toileting.
Social adult day care
Social adult day care focuses on providing participants with opportunities for recreation, socialization, and engagement through exercise classes, games, local outings, discussion groups, arts and crafts, and other activities. Social adult day care centers are geared toward seniors who are still relatively independent, and while they provide structure and supervision, they do not usually provide much in the way of medical care.
Social adult day centers do not typically have nurses or other trained health care professionals on staff. As a result, they are not able to administer medications (though they may offer medication reminders) and can only provide limited assistance with activities of daily living (ADLs). If your loved one is able to eat, move around, and use the restroom independently, but would benefit from participating in social and recreational activities during the day, social adult day services may be a good option.
Adult day health care (ADHC)
Adult day health care (ADHC) centers offer many of the same amenities as social day care centers, but ADHC centers can accommodate seniors who suffer from serious medical conditions and require skilled nursing. ADHC centers provide assistance with activities of daily living (ADLs) like eating and toileting and have a registered nurse (RN) or other trained healthcare professional(s) on staff at all times to manage and administer medications and provide other medical care. In most cases, ADHC centers will perform a medical assessment prior to admitting new participants, and most centers will work with you to develop a customized care plan that is right for your loved one.
Many ADHC centers also offer occupational, physical, and speech therapy programs for those who require it.
Alzheimer's disease and dementia
These specialized adult day care centers are specifically designed to meet the unique needs of those living with Alzheimer’s Disease and other forms of dementia. Alzheimer's and dementia
In the later stages of dementia, most people require intensive, round-the-clock care and supervision, and a secured residential memory care community is usually the best option. However, in the early stages of dementia, many people are able to live alone, with a spouse, or with family or friends.
Socialization is extremely important for people suffering from Alzheimer’s and other forms of degenerative dementia. In fact, lack of social interaction can actually speed up the progression of the disease. If your loved one is in the early stages of dementia and does not yet require residential memory care, an adult day care center geared specifically toward those with memory loss and cognitive impairment may be worth considering, especially if he or she spends most of the day alone.
As previously discussed, the type of adult day
Adult day care regulation
There are very few federal rules and regulations governing adult day care. Like most forms of senior care, adult day care is instead regulated at the state and local levels.
Most states have licensing or certification requirements as well as zoning regulations, staffing requirements, and health and safety codes. Regulations vary from state to state and most states have different requirements for social adult day care centers and adult day health care (ADHC) centers. In addition, some states further regulate Alzheimer's and dementia
It is important to thoroughly research and understand your state’s laws and regulations before selecting a facility.
- 26 states require licensure
- 11 states require certification
- 13 states do not require certification or licensure but require publicly-funded adult day care providers to enter into contractual agreements with a state agency
Visit your state’s .gov website to learn more about your state’s specific requirements.
Adult day care centers vary greatly in the nature and scope of the services they provide. Most centers provide the following:
- Recreational and social activities
- Arts and crafts
- Discussion groups
- Exercise classes
- Medication reminders or management
- Basic health-related assistance and personal care
Depending on the type of center and the participant’s individual care plan, adult day care centers may also provide the following:
- Assistance with activities of daily living (ADLs) like eating, toileting, and moving around
- Skilled nursing
- Occupational therapy
- Physical therapy
- Speech therapy
- Oxygen therapy
- Music and other entertainment
- Transportation to and from the center
- Salon and barber services
- Local outings
Paying for adult day care
According to a recent MetLife study, the cost of adult day care can range from $30 to upwards of $150 per day, depending on where you live and the services provided. Most centers fall in the $40 to $60 range, with specialty facilities—like those offering Alzheimer’s and dementia care—costing more.
Families always have the option of paying out-of-pocket, but most families require assistance paying for adult day care.
In some instances, Medicare will cover part of the cost of adult day care services. This is usually only the case if the participant is receiving regular occupational therapy, physical therapy, or speech therapy through the adult day care, and the therapy has been deemed medically necessary by a physician.
For most families who need assistance paying for adult day care, Medicaid is the best option. Although Medicaid is a federal program, it is managed at the state level. Nearly all states offer Medicaid funding for adult day care services through waivers and other programs.
Non-Medicaid state programs
In addition to Medicaid, many states have separate programs to assist residents in paying for care. Sometimes called nursing home diversion programs, the purpose of these programs is to prevent or delay residents from requiring nursing home care, which is often more costly than other forms of senior care. Visit your state’s .gov website to learn more about your options.
Long-term care insurance
Most long-term care insurance plans cover some of the costs of adult day care. If your loved one has long-term care insurance, you will want to start there.
Wartime veterans and surviving spouses may be eligible to receive up to $2,846 in funding assistance through the VA’s Aid and Attendance (A&A) benefits program. In order to qualify for assistance through the A&A program, veterans must require assistance with their activities of daily living (ADLs) and must meet certain income requirements.
The VA also manages its own adult day health care (ADHC) program. This program is available to all veterans enrolled in the VHA Standard Medical Benefits package, provided that they meet the medical need for care. A copay may be charged, depending on the veteran’s service-related disability status and income.
There are a number of private foundations and other organizations that may assist in paying for adult day care services. For example, Area Agencies on Aging (AAA) often offer funding assistance to eligible older adults.
Selecting an adult day care center
Finding the right adult day care center for your loved one takes time. You will want to research your options and carefully consider the needs of your family and loved one. In order to narrow down your search, it is helpful to first determine what type of adult day care your loved one requires. As discussed earlier, there are three general categories: social day care, adult day health care (ADHC), and Alzheimer's disease and dementia
Once you have determined what type of adult day care center your loved one needs based on his or her physical, cognitive, and behavioral health, it’s important to consider the specifics of what your family is looking for. Making a list of the services your family and loved one needs is a good place to start.
Important factors to consider when choosing an adult day care center:
- Geographic location
- Hours of operation — half days or full days?
- Number of days per week your loved one will attend
- Nursing and medical care
- Safety and security
- Social and recreational opportunities
- Religious or organizational affiliation
General information about hours of operation and the range of services offered is usually available on providers’ websites, but you may need to call or email to get more detailed information.
Questions to ask on a tour
Once you have narrowed down your search and identified a few adult day care centers that seem promising, you will want to schedule appointments to tour the facilities, meet the staff, and ask questions.
Everyone has different needs and concerns, but the following list of questions will help get you started:
- What are your hours of operation? Are you open during the evening and/or on weekends?
- Do you offer half days, full days, or both?
- How many days per week does the typical participant spend at the center?
- How are your staff members trained?
- Do you have a registered nurse or another healthcare professional on staff?
- What is your staff turnover? How long has the average staff member been here?
- What is the staff-to-participant ratio?
- What medical care can you provide? (Be sure to ask about any specific ongoing medical treatments or care your loved one requires)
- What social and recreational activities do you offer?
- What is your fire/emergency evacuation plan?
- How many nutritious meals do you offer? What is the food like? Do you provide snacks?
- Can you accommodate special dietary needs or preferences?
- Do you administer medications?
- What is your procedure in case of a medical emergency?
- Do you provide assistance with activities of daily living (ADLs)?
- How customizable are care plans?
- Do you accept Medicaid? Other assistance programs and benefits?
When you visit the facility, make sure to take in your surroundings. Pay attention to things like the security of the building, whether or not participants seem to be enjoying themselves, and the attentiveness of the staff.
Adult day care FAQs
1. How does adult day care differ from in-home care?
Adult day care and in-home care offer many of the same benefits. Both are seen as less disruptive, more affordable alternatives to putting a loved one in a residential long-term care facility. However, there are some key differences worth considering.
Adult day care offers more opportunities for socialization and recreational activities than in-home care. Adult day care offers your loved one the chance to spend time outside of his or her usual residence, engage with other participants, and participate in stimulating social and physical activities. In-home care, on the other hand, provides unparalleled convenience, as you don’t have to worry about transportation. In-home care also provides individualized, one-on-one care, which is not generally the case with adult day care.
The question of which is right for your loved one comes down to your family’s unique needs and preferences.
2. How do I know what services my loved one needs?
If you are currently responsible for caring for your loved one, you likely already have a pretty good idea of his or her care needs. If not, talking with his or her spouse or current caregiver is a good place to start. You may also consider scheduling an appointment with your loved one’s primary care physician. In many cases, he or she will be able to help you determine what level of care your loved one needs.
It is also important to talk with your loved one about what he or she wants in an adult day care center. Some people are more social and enjoy participating in games and other activities, while others prefer listening to music or taking a walk. Finding the right cultural fit for your loved one is an important part of finding a center that he or she will be happy attending.
3. How many days a week should my loved one attend adult day care? Full days or half days?
The number of days your loved one attends adult day care will depend on a number of factors. If your loved requires round-the-clock assistance and supervision, and his or her caregiver works a full-time job, you will likely want to find a facility that accepts participants five full days per week. On the other hand, if your loved one is still relatively independent, and will only be attending adult day care for socialization and recreation purposes, two or three half days per week may be sufficient to meet his or her needs.
Most adult day care centers offer both half and full days, and most participants attend two, three, or five days per week depending on their needs. A study conducted by MetLife found that about 81 percent of adult day care participants attend full days. 46 percent of participants attend five days per week, while 29 percent attend three days and 19 percent attend two days per week.
4. How do I go about applying for Medicaid assistance?
As previously discussed, Medicaid is managed at the state level. Every state has its own program, waivers, and rules, so the application process is different depending on where you live. Learning about using Medicaid for senior care costs.
Learn more about your state’s Medicaid program and begin the application process.
Proximity of care is very important when considering options
Research care options that are nearby when thinking about the next step for your loved ones.
Leona J. Werezak RN, BSN, MN is a registered nurse and adjunct nursing professor. She has 24 years experience working in a variety of healthcare settings including such remote locations as the Arctic Circle. Her research in early stage dementia was published in the Canadian Journal of Nursing Research and re-published in their 40th anniversary issue which showcased exceptional research published since the journal began. Her work in dementia care has also been published in the Journal of Gerontological Nursing. She currently teaches surgical nursing care on a thoracic/vascular unit to baccalaureate nursing students. Her clinical work with nursing students involves extensive work with older adults who have multiple chronic health conditions.