Adult daycare is a rapidly growing service thatprovides valuable respite to caregivers as well as important mental and socialstimulation to people with early and mid-stage Alzheimer's. Programs varywidely in terms of their offerings and fees.
What is adult daycare?
The primary purposeof the adult daycare centers are to: prevent premature or inappropriateinstitutional placement of persons with moderate to severe levels of impairmentdue to dementia; provide support and respite for caregivers; serve as models ofthe optimum type and level of day care services that are needed by persons withdementia; make training opportunities available to professionals and otherpersons providing care and treatment for this population; and increase publicawareness and knowledge about Alzheimer's disease and related disorders.
The centers provideservices that support the physical and psychosocial needs of persons withAlzheimer's disease or related dementia. Individual care plans are developedfor each program participant with activities scheduled in accordance with theseplans. The overall objective is to keep the participants as healthy and activeas possible by helping them maintain their highest level of functioning and toimprove the quality of their lives while providing respite to caregivers.
Thus, adult daycare centers provide structuredactivities and therapy in a safe, supportive environment to adults who needmental and social stimulation. Typical daycare clients have lost a degree ofindependence due to normal aging, a medical crisis, or a chronic condition suchas Alzheimer's disease or other dementias, but they live alone or with acaregiver. Half of all users have cognitive impairment. As the name suggests,it's a day service, not a housing option.
This increasingly available type of eldercare may beaffiliated with (or run by) medical centers, nursing homes, assistive-livingfacilities, or other organizations either on site or at another facility (suchas a community center or church). Some are established as"stand-alone" private businesses. There are more than 3,500 adult daycenters in the United States.
Why should I consider adult daycare formy parent?
Adult daycare is a form of respite care that'sprovided outside the home by professionals (as opposed to in-home respitecare). It's designed to benefit both the person using the services and,especially in the case of Alzheimer's disease, that person's caregiver.
For the elder with Alzheimer's, adult daycareoffers:
- A chance to get out of the house
- A break from being with the caregiver
- Interactions with other people
- Stimulating activities
- Other therapies as needed (such as physical therapy or speech therapy)
- Possibly a delay in cognitive decline, in the early stages
- Prolonged independent living
For the Alzheimer's caregiver, adult daycareprovides:
- Stress relief, lessened depression
- Predictable hours of relief in order to attend to personal needs, run errands, and release stress
- The ability to continue caring for a parent at home
- Cost savings over more expensive in-home care
- Reduced guilt because the parent's independence is supported
- An improved mood in the patient, making care giving easier
- Possible family counseling or training through the center, to help cope
Programs run from several hours to a full day.Participants may attend daily, a few times a week, weekly, or just for specialactivities. Weekend and evening care are less common, although this is changingas demand for adult daycare rises. (All options vary by center.)
How is it different from a seniorcenter?
Senior centers tend to cater to a healthier, moremobile, and more independent clientele. Adult daycare programs generally offerservices that are more intensive. Some specialize in Alzheimer's disease, andstaff members have special education and/or training in working with geriatricclients and in managing behaviors characteristic of a disease like Alzheimer's.
What happens at adult daycare?
Programs typically include organized and supervisedhands-on activities that may involve:
- Stimulating recreation (such as crafts, group conversation)
- Music therapy
- Art therapy
- Sensory stimulation
- Physical therapy
- Occupational therapy
- Speech therapy
- Access to a library
- Entertainment (such as music, movies)
- Outings to museums, parks, or other local attractions
- Support groups and counseling
- Socialization activities
- Personal and nursing care (including help in keeping up with medications)
- Meals (usually lunch) and snacks
Activities are usually customized to individualneeds and abilities, but at the same time, there's an emphasis on groupparticipation. The setting is often homelike and comforting.
Additionally, some programs offer medically orientedcare for patients who need it (administering medication; caring for basicmedical or personal needs, such as podiatry services). Some offer counselingand educational services to caregivers and families.
Some adult day programs are connected withchildren's daycare centers. An advantage to this arrangement is thatintergenerational connections that are made. A potential disadvantage that someresearchers have found is that the adults can feel that they're being treatedlike children themselves, if the activities are largely child-centered.
Does a parent with Alzheimer's need aspecial kind of program?
Any daycare provides caregiver respite. But theideal type features services tailored to people with Alzheimer's. Some adultdaycare programs specialize in people with dementias of all kinds and stages,while others specialize more narrowly in early-stage Alzheimer's. In thesedementia-specific programs, you're most likely to find tailored activities andstaff who are specially trained in the disease. A 1991 study found thatAlzheimer's-specific daycare tended to provide more support for families and agreater emphasis on therapeutic recreation (rather than on clinical or rehabservices) than general adult daycare. Be aware, however, that there's nospecial licensing required for a facility to call itself an"Alzheimer's/dementia daycare."
Adult daycare is especially useful in the earlystage of Alzheimer's, when the afflicted person retains some good cognitive andsocial skills and might find it easier to become acclimated to the center andpeople there. There's also evidence that early stimulation of the type providedby adult day centers can slow cognitive decline.
Daycare is also useful in the middle stages ofAlzheimer's disease, when the burden of care becomes greater and caregiverburnout is a strong risk. People in the final stage of the disease tend to beunable to manage daily care tasks without help and are often nonverbal; whenthe burden of 24/7 care completely overwhelms, it may be a nursing home ratherthan respite care that the caregiver really needs.
Can both of my parents attend?
Many day programs accommodate both the adult withdementia and a partner without, or a couple whose members each have some kindof disability. If it's a dementia-specific program, though, your healthy parentmay feel out of place. In such cases, look into whether she might be able tovolunteer there. What's possible depends on the individual program.
Bear in mind that a key purpose of adult dayprograms is to provide relief for the caregiver. (And many nonprofit programsdescribed as "respite" obtain funding because of this.) If your wellparent is the main caregiver, she's supposed to be taking a break while herpartner attends. Even if your parents prefer being together, limited separationthrough a day program can benefit both of them.
What does adult daycare for a parentwith Alzheimer's cost? Who pays?
Daily fees range from $60 to $150 dollars per daybut can vary widely depending on the services provided, where you live and theneeds of the individual, according to the National Adult Day ServicesAssociation (NADSA). Most programs are nonprofits, which may cost less thanfor-profit programs. Ask if a center offers a sliding scale of fees based onincome.
Some places charge a fee per session; others chargemonthly "tuition." Many centers charge an added fee fortransportation, while some offer it free.
Social model day care services are usually paid forprivately. Some private insurance plans may cover some of the cost; check withyour plan's administrator or the facility to find out.
Medical day care services, which are usuallyaffiliated with a nursing home or health care provider, may be covered byprivate insurance or by Medicaid, provided your state's Medicaid plan includesit, the person needing care is eligible, and the facility participates. Contactyour local Medicaid office to find out. A few programs also accept Medicare ifthe person requires rehabilitative surgery, such as from hospitalization, butMedicare does not generally cover adult day care services. Otherwise, medicalday care must be paid for privately.
Are there any reasons not to like adultdaycare?
Some people hear the phrase "daycare" and,associating it with children's daycare, imagine being talked down to andbabied. Getting past suspicions and resentment can be a challenge. Run throughthe many benefits. Suggest a no-strings trial run: "Let's just go once andsee what it's like, Mom." You could also avoid describing it as"adult daycare" and find terms more palatable to your parent, such as"a senior club" or "therapy for people with early Alzheimer'sdisease."
Most participants quickly come to enjoy the newfaces and varied activity. Some, however, refuse to participate and may evenbecome belligerent or disruptive; in such cases, they're usually not allowed toreturn.
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