By Susanne Matthiesen and Carol Schumaker
Many older adults prefer to remain in their own homes as their years advance—referred to as aging in place. However, many persons are faced with losing a degree of their independence because of age-related physical or cognitive impairments or chronic health conditions. For these individuals, adult day services (ADS) might be an ideal alternative to congregate residential care such as assisted living and nursing homes.
“We know of adult children who rearranged their lives, given up their jobs, and moved long distances rather than putting their parent in a skilled nursing home. They felt that there was nothing else they could do,” says Jan Nestler, founder/retired CEO of Elder and Adult Day Services, www.eads-cares.org, in Bellevue, Washington. “Adult day services is an ideal option for those in the situation where their loved one is unsafe or unsure of being left alone. ADS focuses on the physical, social, and cognitive needs of clients and is designed to maximize function and to slow decline. We particularly address the isolation and socialization challenges that many seniors experience.”
Adult day services creates a partnership between caregivers, families, and professionals in managing the health and well-being of an individual to promote and support aging in place. An ADS program may provide health care, meals, activities, and care in a group setting for households where the caregiver might not be available to provide care at home during the day. Many ADS providers offer six-, eight-, or twelve-hour service options, which allows caregivers to continue working or have respite periods.
ADS centers build personal independence
Adult day services can benefit adults of all ages, although they are not suited for everyone. ADS typically serves individuals who live with a spouse or companion, family member, or their adult children. The persons who may benefit from these services are:
- Medically fragile adults with chronic conditions, such as diabetes, arthritis, hypertension, seizures, and depression.
- Persons with cognitive impairments, such as dementia.
- Persons with limited mobility or physical disabilities.
- Persons with developmental disabilities
- Persons who have had a stroke or traumatic brain injury.
Cindy Sharek, acting CEO of Elder and Adult Day Services adds, “We found a need for ADS among young adults with developmental disabilities. Lower functioning adults have few opportunities to participate in the workforce once their schooling has ended. They may live at home with a parent or in a group home. ADS can serve them well.”
The activities in many adult day services have therapeutic components that provide stimulation for adults. Each participant interacts with health practitioners, participates in social activities, exercise or wellness programs, and engage with the community. From addressing cognition, motor skills and range of function, each activity is designed to maximize personal independence.
Adult day services serves people who might otherwise live in a nursing home. Using consistent health monitoring and appropriate early interventions, ADS provides ongoing communication with participants’ physicians between office visits. The reports help to ensure that a participant’s health status is maintained.
Jan Nestler states, “We like to have people earlier in their diagnosis. At a low-acuity level, we can help monitor, maintain, and improve their health. It is a misconception by the public that adult day services exists to replace nursing homes or senior centers. ADS is a bona fide step along the continuum of care between the two.”
Evaluating adult day services
When evaluating an adult day services program, consider the facility, atmosphere, services, and staffing. Questions such as “Is it clean and home like?” and “Do they have services and additional supports that fit my loved one’s needs?” will assist you in evaluating the program’s suitability. Other questions address how person-centered the service provider is, “What choice in day-to-day activities does the participant have?” and the level of professionalism, “What are the staff members’ qualifications?” Comparing programs is easier if you create a checklist to track your impressions.
Nestler advises, “When evaluating a potential program, ask ‘Is the program accredited?’ That is the most reliable way to know that the program meets recognized standards for person-centered care. They know how to enroll persons appropriately for their respective center’s capacity to provide that care.” She continues, “Drop by at noon and see how you are greeted. A friendly face and professional welcome will give you a good idea how that center works. Other good signs are hearing noise and seeing participants interacting with each other and staff members—not just people gathered around a TV.”
Lisa Peters-Beumer, Assistant Vice President for Adult and Senior Services, Easter Seals, Inc., www.easterseals.com, headquartered in Chicago, Illinois, relates, “The biggest hurdle people have in choosing an ADS center is perception. When people walk in the door and see the staff in action, they change their perceptions as to how their loved one might respond to the program and how beneficial it would be to their families. We encourage drop-in visits. Some centers encourage guest programs, which is an opportunity to spend time in an ADS program to get a feel for it before enrolling.”
Sharek offers advice to persons considering ADS, “It’s okay to ask for and receive help. There’s no shame in that. It allows you to take care of yourself so you can continue to take care of the person you love. If you receive an intervention at an early enough point, your health will not suffer and the person you care for will have quality of life enrichment in the process.”
Cost-effective care helps preserve financial independence and enrich lives
The national average cost of adult day services is about $50 for a 6-hour day of care. This is approximately 33 percent less than home healthcare and 75 percent less than a skilled nursing facility. The cost-effectiveness of adult day services can preserve a participant’s financial ability to remain independent and reduces the overall healthcare costs to the government or other payer.
Sharek adds, “More than half our population is on Medicaid, with the other half being a combination of payers including long-term care insurance, Veterans Affairs, and private pay. For individuals who do not have insurance and who do not qualify for Medicaid, we have a sliding fee scale.”
“Adult day services is often the ideal solution for families caring for aging adults,” Peters-Beumer believes. “It is important to plan ahead and become acquainted with the services and adult day centers in your area because you and your family may turn to them during a crisis or for support in the future.”
Adult day services provides a safe, caring environment for people who want to remain independent in their homes and active in their communities.
About the Authors
Susanne Matthiesen, M.B.A., is managing director of the Aging Services customer service unit of CARF International, www.carf.org, an accreditor of services and residential options for seniors, including home and community services, assisted living residences, nursing homes, and continuing care retirement communities. Carol Schumaker, M.B.A., is a marketing resource specialist for CARF International.
