Adult Day Care
Abstract and Keywords
Adult day care centers provide important health, social, and support services for functionally and cognitively impaired adults and their caregivers. The adult day care services are underutilized, however, because of the shortage of centers, caregivers' lack of awareness of and resistance to using services, and the mismatch between the needs of potential consumers and their informal caregivers and the services provided by the centers. To foster and support the expansion of adult day care centers, lessons learned from national demonstration programs need to be disseminated, and social workers need to be trained to provide essential services at the centers.
Service Types and Funding
Adult day care centers, or adult day services, provide structured health-promoting programs, social activities, and support services for adults with functional impairments, cognitive impairments, or other mental health or developmental disabilities. The average age of the day care participants is 72, and more than half of them have some cognitive impairment (National Adult Day Services Association [NADSA], 2006).
A national study of adult day services between 2001 and 2002 found that 21% of the centers are based on the medical model of care, 37% are based on the social model of care (without a medical component), and 42% are a combination of the two (Robert Wood Johnson Foundation [RWJF], 2006). The medical model offers more intensive health and therapeutic services for individuals with severe medical problems and for those at risk of nursing home care and usually requires a health assessment by a physician before someone is admitted to the program. The social model provides social activities, meals, recreation, and some health-related services. Also, 78% of the centers are operated on a nonprofit or public basis and the remaining 22% are for profit, with 74% affiliated with larger organizations such as homecare, skilled nursing facilities, medical centers, or multipurpose senior service organizations. In addition to providing a protective and therapeutic environment for those needing care, the day care centers offer family caregivers respite from the burden of caregiving and allow employed caregivers to continue to work and care for their loved ones at home.
Currently, there are ∼4,000 adult day care centers in the United States, which is far short of the estimated 8,520 needed centers (NADSA, 2006; RWJF, 2006). Funding for adult day care centers comes from federal, state, and local sources such as the Federal Older Americans Act (OAA), Social Services Block Grant (SSBG), the Department of Agriculture's food reimbursement program, state general fund dollars, philanthrophic grants and contributions, and consumer fees and charges. If the day care centers provide medical services, they may also receive funds from Medicaid, local Veterans Affairs (VA) medical centers, and Medicare for only rehabilitative services such as physical or speech therapy. Payment by private long-term care insurance is rare, but its share may grow to some extent in the future as more adults buy private long-term care insurance. Fragmented funding structure and low utilization rates contribute to the financial problems of many centers.
Best Practice Models
Propelled by the need for control of the cost of institutional care and consumer preferences for home- and community-based care over nursing home care, every state now provides the Medicaid Home and Community-Based Services [HCBS, 1915(c)] waiver program. Adult day care centers, along with assisted living facilities, home health care, and hospice care, are cost-effective community-based alternatives to nursing home care that can benefit both functionally and cognitively impaired adults and their caregivers (Cubanski & Kline, 2002; Schacke & Zank, 2006; Valadez, Lumadue, Gutierrez, & de Vries-Kell, 2006). Nevertheless, adult day care services are underutilized because of the shortage of centers, caregivers' lack of awareness of and resistance to using services, and the mismatch between the needs and wants of potential consumers and their informal caregivers.
Between 1987 and 2002, national initiatives and demonstrations to foster and support the creation and expansion of adult day care centers were implemented with funding from the RWJF. The focus of the initiatives was dementia care; however, the findings from the demonstration programs showed the following elements of the best practice models for adult day care centers: (a) accommodation of the needs of caregivers, with extended hours of services for employed caregivers, weekend services, provision or arrangement of transportation, and overnight respites; (b) provision of a continuum of care, including assistance with information and referral, case management, in-home personal care, coordination of medical mental health services, and caregiver support programs; (c) recruitment and retention of quality staff; (d) working with participants' doctors to alleviate participants' dementia-related behavioral problems; and (e) development and adoption of creative strategies to engage frail and impaired program participants (Henry, Cox, Reifler, & Asbury, 2000). The demonstration programs also found that day care centers were able to achieve financial sustainability by using improved marketing to caregivers and formal referral sources as well as increasing the charges to consumers (with improved services). To better serve low-income adults needing care, however, funding levels of the OAA, SSBG, and Medicaid need to be increased.
Adult day care centers, in conjunction with home health care, hold promise to become essential components of the community-based long-term care service network. To meet the growing needs for quality long-term care in an increasingly aging society, however, adult day care centers need to continue to develop and adopt a comprehensive array of structured nursing, rehabilitative and personal care, social recreational activities, educational programs, and respite programs for family caregivers. Especially with the increasing number of older adults who have Alzheimer's disease and other forms of dementia, the proportion of participants with cognitive impairments is projected to grow in the future. Adult day care centers specializing in dementia care or having staff trained in dementia care will be in high demand. Trained staff members are key to provision of quality care (Salari & Rich, 2001). Increased federal and state support is essential to alleviate the day care center shortage in rural and underserved low-income areas, to develop workforce for the centers, and to improve the quality of services.
This requires an in-depth knowledge of other countries' programs with their strengths and deficits.
Roles of Social Workers
Social workers, with appropriate training at the micro and macro levels, are uniquely qualified to provide the following services for adult day care centers: (a) outreach services to isolated frail adults, their family caregivers, and formal service providers; (b) assessment of participants' needs for services and care planning; (c) design, implementation, and evaluation of programs; (d) individual and family counseling, group activities, and case management; (e) referrals to and coordination of other community services as well as other in-house supportive services such as transportation and volunteer programs; and (f) advocacy for increased funding for the services. With the serious current and projected future shortage of gerontological social workers (National Association of Social Workers [NASW], 2006), however, adult day care centers are and will be understaffed with social workers unless concerted efforts are made to recruit and train them to work in aging services settings. Social work education curricula need to continue to strive for incorporating more content on community-based long-term care services as well as practice and policy advocacy skills for the elderly and disabled.
Cubanski, J., & Kline, J. (2002, April). In pursuit of long-term care: Ensuring access, coverage, quality. The Commonwealth Fund Issues Brief. Retrieved from http://www.commonwealthfund.org/.
Henry, R. S., Cox, N. J., Reifler, B. V., & Asbury, C. (2000). Adult day centers. In S. L. Isaacs & J. R. Knickman (Eds.), To improve health and health care 2000: The Robert Wood Johnson Foundation Anthology. Retrieved from http://www.rwjf.org/content/dam/web-assets/2000/01/adult-day-centers.
National Adult Day Services Association. (2006). Adult day services: The facts. Retrieved from http://www.nadsa.org/adsfacts/defualts.asp.
National Association of Social Workers. (2006). Assuring the sufficiency of a frontline work force: A national study of licensed social workers; Executive Summary. Retrieved December 20, 2006, from http://workforce.socialworkers.org/studies/nasw_06_execsummary.pdf.
Robert Wood Johnson Foundation. (2006). Report: Shortage of adult day services in most U.S. counties. Retrieved December 20, 2006, from http://www.rwjf.org/newsroom.
Salari, S. M., & Rich, M. (2001). Social and environmental infantilization of aged persons: Observations in two adult day care centers. International Journal of Aging and Human Development, 52, 115–134.Find this resource:
Schacke, C., & Zank, S. R. (2006). Measuring the effectiveness of adult day care as a facility to support family caregivers of dementia patients. Journal of Applied Gerontology, 25, 65–71.Find this resource:
Valadez, A. A., Lumadue, C., Gutierrez, B., & de Vries-Kell, S. (2006). Comadres and adult day care centers: The perceived impact of socialization on mental wellness. Journal of Aging Studies, 20, 39–53.Find this resource: