Caring at Home: How to Find Help Part II: Adult Day Care
When seeking support for dementia care, an alternative to home care is an adult day care program. An adult day program runs 5 days a week, 7 to 8 hours a day, and provides social engagement, mental stimulation and nutritious meals. The daily activities typically include discussions of current events, gentle exercises for core strength and balance, arts and crafts and music. Not every adult day care program is geared to those with dementia. Some people think that all adult day programs work with dementia patients, but programs that are geared to dementia or memory loss are more likely to work well.
Caregivers often feel guilty when arranging for adult day care, thinking that it is solely to give them a break from the strains of constant caregiving. However, people with dementia are often very isolated, interacting only their spouse or immediate family members. By attending an adult day program, the participants get the stimulation of a larger community. They are able to participate in activities that are not available at home. At its best, adult day care is a “win-win” situation for both caregiver and patient.
Formal or informal programs?
Adult day care programs are offered by for profit and non-profit groups, as well as individuals who offer care in their own homes. The more formal programs can offer many resources, such as transportation to and from the center, professional health care consultations, and day trips to the wider community.
The more informal programs are run out of people’s homes, just like child care. These programs tend to accept smaller groups of people, and they typically have fewer professional resources. However, for those looking day care in a family setting, these small programs can be a great fit.
How to Find an Adult Day Care Program
Just like finding a home care provider, you should seek information from your personal physician, your friends, or discharge planners in a hospital or nursing home. The Alzheimer’s Association posts a listing of adult day programs on its website, although it does not include an evaluation of any of them.
What to Look For in a Program
The best way to choose a program is to visit, hopefully more than once, and at different times of day. Here are key elements to observe:
- Staffing. The staff to participant ratio depends on the needs of the participant population. For programs serving those with Alzheimer’s, the ratio should not be more than 1 to 5 or 6. Ask about the requirements for initial staff training and continuing education. Observe how the staff members interact with the participants. Are they encouraging and supportive? Are the participants accepted and affirmed? Do staff members transition easily to another activity if the first one is not successful? Do they seem to enjoy their work?
- Activities. There should be different activities available to accommodate participants with different interests and energy levels. Activities should include one on one options and group activities. All activities should be structured to enable everyone to succeed. Naps should not be a built in feature of the program; participants should remain engaged and alert, so that they will sleep through the night.
- Policies. Make sure that the philosophy of the program is a good fit for your family. If your loved one has behavioral quirks, or special dietary needs, discuss them with the staff and find out how they would handle them. Know how the staff handles aggression, incontinence, wandering tendencies and agitation. In addition to the written policies, observe the other participants. Do their interests and abilities match those of your loved one? Do they seem to be enjoying themselves? Can you see yourself and/or your family member being happy in this program?
- Licensure. Some states license adult day care programs; many do not. Massachusetts only regulates programs that care for indigent individuals who qualify for Mass Health. Find out if your state licenses these programs, and if so, confirm the program is licensed.
Costs for these programs vary by region. A general range is $50 to $75 per day. Medical insurance and Medicare do not cover adult day care. Some long term care policies do. Be sure to check to see if there are any specific requirements in the policy regarding coverage for adult day programs.
Getting Off to a Good Start
Starting an adult day program is a bit like going to the first day of school in a new town. Expect anxiety. If possible, shorten the hours for your loved one during the first few weeks. Many programs require that participants attend at least two days a week, which tends to lead to a better experience for the participant. Attending less frequently makes it more difficult to adjust.