Adult Day Care: Good for Caregivers and the People They Care For
Many of the 25 million or more Americans who care for an older adult feel overwhelmed and trapped by the situation. Adult day care programs can help caregivers and the people they care for.
"Adult day centers are the best thing you never heard of," says Burton V. Reifler, MD, director of Partners in Caregiving and professor and chair of psychiatry at Wake Forest University School of Medicine. "It gives people their lives back."
Relief for Caregivers
Caregivers Sue Coleman and Pam Buenaventura agree. Coleman began caring for her father, Harry, about eight years ago and ended up losing two jobs because her father, who was home alone and frightened, called her every 30 minutes.
"I'd have to leave and come home to try to figure out what was real," Coleman explains. "As he was aging and had more health problems, it was more difficult to hold down a job."
With her father's care her top priority, Coleman realized she had to come up with a solution but did not want to move him out of her home. A nurse told Coleman about Day Break at Winter Park, Florida, an adult day center where her father could socialize while Coleman worked. Once enrolled, the phone calls stopped. Her father is happy and Coleman doesn't know what she would do without day services.
"Caregiving was much more difficult than I had anticipated," says Buenaventura, whose grandmother, Myrtle, attends Eastside Adult Day Services in Bellevue, Washington. "Adult day care gives me time to go and do something I want to do. When she first came to live with us, I could not leave her. I couldn't go anywhere unless somebody was here."
Taking a Break
Caregiving often leads to feelings of entrapment, depression, and hopelessness. Researchers from Pennsylvania State University conducted a study to evaluate whether adult day services affected caregiver stress and psychological well-being. They found that three months after sending a loved one to adult day care twice a week, caregivers experienced fewer feelings of overload and strain and significantly less depression and anger.
"You're no longer a 24/7 caregiver," explains Steven H. Zarit, PhD, lead author of the study and professor of human development and assistant director of the university's Gerontology Center. "We had reports by family members that their relatives looked forward to going, that their behavior was better when they came home. They were more alert, less agitated."
Day Services Benefit Participants
Like many caregivers, Buenaventura and Coleman have seen an improvement in their older relative's conditions. Elders who participate in adult day care make friends, and day programs provide structure and remind some attendees of going to work. Meaningful activities fill the hours and give participants something to talk about over dinner.
"The biggest benefit for clients is having a reason to put their shoes on, a place to show up for life," says Jan Nestler, past chairperson of the National Adult Day Services Association and executive director of Eastside Adult Day Services in Washington. "It's a place where someone feels not only that they belong, but it's safe and they have dignity and are allowed a level of independence and choice."
Leaving her father, with tears in his eyes on the first day, tugged at Coleman's heart. But he agreed to give it a try and ended up loving it. He plays the piano again, something he had given up after his wife died, entertaining Day Break members and staff with upbeat renditions of big band tunes.
"His dementia has lessened, and he's more active," Coleman says. "He loved going out to get pumpkins and to the university to see how new classrooms were set up and what the students were working on. Those are things a caregiver doesn't have time to do."
Adult day programs have grown from just a handful of centers 30 years ago to about 4,000 today. Early centers started as grass roots, community initiatives and provided social interaction. Participants enjoy music, dancing, exercising and other activities. Many allow clients time to themselves to read, work on a craft item, or visit with someone. Some programs may provide transportation to and from the center.
Many centers also offer medical services. In adult day health programs, nurses check members' blood pressure and blood sugar, administer medications, and monitor chronic health conditions. Some centers provide bathing and personal care services. Social workers or nurses provide caregivers with suggestions for other community resources and sometimes facilitate support groups.
Day Centers May Not Be for Everyone
While most older adults enjoy the day out, the programs may not suit every potential client. Programs are tailored and paced to benefit adults with physical or cognitive limitations. An active senior, who still drives and handles the checkbook, potentially functions too well for an adult day center and might find a senior center more suitable.
Someone who has always been a loner may resist an adult day center's socialization. Patients with dementia may be fearful of going to a new location. Some centers will not accept clients who hit, kick, or punch other people. Some caregivers worry that staff will not correctly interpret a loved one's needs.
"We asked families about their satisfaction with day care, and they were overwhelmingly positive about all aspects except the cost. For many people, cost is a problem," Dr. Zarit says. Fees vary depending on the program. Long-term insurance might cover some of the expenses. Many nonprofit facilities offer a sliding scale, and some states provide financial assistance to eligible clients.
What to Look For
The National Adult Day Services Association recommends that caregivers considering a day program assess their and their loved one's needs before visiting a center. Keep the following questions in mind when looking for a program:
- Can participants with certain medical conditions be admitted? Under what circumstances would someone not be allowed to attend?
- Is help available for using the bathroom, cutting up food, taking medications, or walking or pushing a wheelchair?
- Can the center provide a special diet, a bath, or transportation?
- What type of exercise program is offered?
- What happens if a participant has an embarrassing incontinence episode? (Some centers keep clean, spare clothing available and will wash the soiled garments.)
- How long has the center been open? Is it licensed by the state?
- What is the cost?
- What is the ratio of clients to staff?
- Who owns the center? (Nonprofit organizations operate many centers.)
- Has the center received accreditation by CARF (the Rehabilitation Accreditation Commission (see resources section))?
- Do clients and staff seem happy about being there?
- Is the furniture comfortable?
- Is the center clean? Are there odors?
- Is the building secure? Could someone wander away?
- How are outings supervised?
- Are activities tailored to the individual or is everything done as a group?
Nestler suggests that families select facilities where they feel comfortable and accepted—a facility that feels like home.
"I would urge [anybody caring for someone with dementia ] as strongly as I can to go visit an adult day center," says Dr. Reifler. "People don't realize how good they are until they see one. They are places where there is a lot of vigor and vitality."
CARF--Commission on Accreditation of Rehabilitation Facilities
National Adult Day Services Association
National Family Caregivers Association
BC Health Guide, British Columbia Ministry of Health
Alzheimers Association of Canada
Zarit SH, et al. Stress reduction for family caregivers: effects of adult day care use. J Gerontol. 1998 Sep;53:S267-S277.
Last reviewed January 2008 by Ryan Estévez, MD, PhD, MPH
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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