Just the Facts and More: Adult Day Care

Adult day care centers provide a structured setting in which people with Alzheimer's Disease and other disabilities may enjoy group activities such as exercise and craft-making, and benefit from personal counseling, therapy and other services.

Reasons for using Adult Day Care

Most likely, one of the reasons you may be considering using a day care center is to give yourself an opportunity for relief time from caregiving. Give yourself permission to use day care. Day care benefits both the caregiver and the person with Alzheimer's. By using day care, you'll have time to rest, relax, and finish other tasks.

As a result, you will return to the task of caregiving feeling refreshed and renewed. If you find yourself feeling guilty, ask yourself: "If I wear myself out to the point of total exhaustion, what good will I be to my family member? If I don't take a break from caregiving, will I be able to handle his/her needs as well?"

Reflect on the benefits of day care for the person with dementia. Remember that day care offers the person with Alzheimer's opportunities to be with other people and participate in activities in a safe environment. Moreover, professionals at a day care center can help evaluate the person and provide you with ideas for enhancing caregiving.

Selecting a center

Day care centers may vary widely, and it is important to examine the key components of the best setting for your family member. By asking the right questions, you can find a day care arrangement that's right for you and the person with Alzheimer's disease. You may want to begin with the following:

Consult a variety of sources to find an appropriate day care center. Many caregivers rely on the recommendations of local Chapters of the Alzheimer's Association and of other caregivers who are members of support groups. Some chapters provide day care services either through their organization or through cooperation with another agency. Others consult with senior centers and local are agencies on aging.
Give the center a chance. Consider using adult day care at least twice a week for a month before making a final decision. Occasional use won't give you an accurate picture of how the center operates. In addition, give your loved one time to adjust to the experience of going to the day care center. While some people may resist going to the center at first, they often look forward to the visit after several weeks of attending, meeting people, and joining in activities.
Reevaluate your need for day care. At some point the person with Alzheimer's may need more care than the center can provide. Center staff and support groups can help evaluate your needs for future care.

Action Steps

Consider the following issues in evaluating a day care center that's appropriate to your needs:

Center Clients

Does the day care center provide services for people with different types of impairments, as well as those in good physical health? Knowing about any service restrictions before using the center may help prevent problems.

Assessment

Will the center evaluate the person's needs? How will this evaluation be accomplished and how often will it be repeated? Will it cover medical needs, social and family history, cognitive functioning, and social skills? Some centers perform assessments in the person's home.

Services

Does the center offer the services that you and the person with dementia need? These are some of the specific services you may want to investigate: (Keep in mind that few adult day care programs offer all of the services described below, and not all of these services are necessary for a program to be of high quality.)

Behavior Management - Is the center prepared to deal with wandering, incontinence, hallucinations, sexually inappropriate behavior, or speech difficulties?
Counseling - Will the center provide support for clients and families? For example, can they offer guidance on outside resources and arrange for supportive care in the home?
Health Services - Will the center provide blood pressure checks and physical, dental, foot, eye, and ear examinations? Will the center dispense medication and/or offer medication reminders?
Nutrition - Does the center provide nutritious meals and snacks? To make sure, you may want to sample one of the meals. In addition, can the center accommodate special diets or provide culturally specific menu? Does the center provide some sort of nutritional education program?
Personal care - Will the center's staff provide help with hairstyling, toileting, eating, showering, and appearance-related tasks?
Recreation - Does the center offer a program of activities that the person with dementia can participate in and enjoy?
Special Needs - Is the center equipped to deal with someone who is wheelchair restricted, hearing or visually impaired, or handicapped in another way.
Therapy - Will the center help arrange for needed physical, occupational or speech therapy? Are there therapists on site or on call?

Accessibility

Most centers are open from early morning to early afternoon, usually from 8:00 a.m. to 4:00 p.m., Monday through Friday. Some have extended or weekend hours. People may attend the center as little as one day per week, or as many as five. Be sure to ask about the minimum attendance requirements and the notification policy for absences.

Cost

Many centers offer services on sliding scales, where caregivers pay according to their ability or income. In some states, Medicaid covers costs for people with very low income and few assets. Be sure to ask about basic fees, financial assistance, and additional charges for such services as crafts or field trips.

Location and Transportation

Getting to and from some centers may consume a large part of your day and be stressful on the impaired person. However, some centers offer pickup and drop-off transportation services, while others provide transportation for outings and medical appointments. Be sure to ask about the policy for late arrival or late pickup.

Facility

Evaluate the overall appearance and quality of the facility.

Is it warm, inviting, and free of clutter?
Is there adequate space for activities and for furniture?
Is space available for outdoor activities?
Are there secured areas for outside walking?

Staff

Assess the qualifications of the staff.

What is the number of staff for each client?
Are the staff provided with dementia-specific training?
Does the center have a physician, nurse, or health care professional on staff or on call?
If the center uses volunteers, are they adequately trained and supervised?
Are staff warm and friendly to family members and caregivers?
How well do staff handle people with behavioral problems?

You may also want to discuss the person's specific problems with the center's director or "intake coordinator" to determine their level of disease awareness.

Evaluating day care settings for your loved one with Alzheimer's is time-consuming, but important. Choosing the best facility and program for your family member will help ease the burden of daily caregiving.

Resources

One of the best places to turn for additional help is the Alzheimer's Association. The Alzheimer's Association has more than 83 Chapters and 1,600 support groups nationwide, where family members of people with Alzheimer's disease or a related disorder share their experiences, provide each other with emotional support, hear practical suggestions and learn to rebuild their lives.

The primary resource for this fact sheet was Rhonda J. V. Montgomery, Ph.D., Director, Gerontology Center; Associate Director, Schiefelbush Institute for Life Span Development; Professor, Department of Sociology, University of Kansas, Lawrence, Kansas.

Additional information was also provided by:

The Northern Virginia Chapter of the Alzheimer's Association.
The Duke Family Support Program, Duke University, Chapel Hill, North Carolina

For more information on this topic, consult the following sources:

Aging Network Services, Bethesda, Maryland 1-800-477-4267
Healthy Older People, National Health Information Center
1-800-336-4797
National Institute on Adult Day Care, Washington, DC 1-800-424-9046 (Ask about "Guidelines for Adult Day Care Centers Serving Individuals with Alzheimer's Disease and Other Dementias")
Robert Wood Johnson Foundation, PO Box 2316, Princeton, New Jersey 08543-2316. (Ask about "Dementia Care and Respite Services Program" and "Partners in Caregiving: the Dementia Services Program.")

Compiled by the Lincoln/Greater Nebraska Chapter of the Alzheimer's Association, 1999.