What to look for in adult day care centers

Make sure center is good fit for patient, family


When Frank Eisele of Cincinnati, Ohio, was diagnosed with Alzheimer's, his children wanted to care for him at home instead of placing him in a nursing home. As his illness progressed, however, it became more and more difficult. Frank's adult children all work during the day, but he could no longer be left alone. Not only that, but Frank, who had been very active his whole life, was getting depressed just sitting around the house all day.

Adult day care proved to be the answer. Frank now attends day care twice a week. The day care center even provides transportation. Despite his growing confusion and disorientation, Frank knows what days he goes to the day center. He gets up early on those mornings to get dressed and shave before the bus comes. He enjoys having someplace to go and likes participating in the activities. Meanwhile, his children are relieved to know he is getting the care he needs while they go to work, and they are happy to know he is enjoying his time there.


For elderly people who need some supervision and support during the day, adult day care can be the perfect solution. Adult day care centers (some prefer to call them adult day centers or adult day health centers) serve elderly people with dementia, Alzheimer's disease, and other cognitive and physical disabilities. There are currently about 3,500 such centers in the United States. Many more centers are needed, according to Nancy Cox, MSW, national director of Partners in Caregiving and instructor at Wake Forest University Baptist Medical Center in Winston-Salem, N.C. Adult day care centers are valuable, she says, because "they help keep individuals who are in need of chronic care at home, in the community, with family and friends as long as possible."

Adult day care centers provide a wide variety of services. Some are open only a few hours a day during the week, while others are open for a full day, seven days a week. Most provide a variety of social and recreational activities, such as games, music, and arts and crafts. These activities provide mental stimulation and encourage social interaction. Most centers offer some type of exercise program or physical activities. Meals and snacks are usually provided. Door to door transportation is often offered, as well.

Some centers also offer assistance with personal care, such as showering and shaving. Some offer physical, occupational, and speech therapies. Some offer medical monitoring and other healthcare services. At many centers, social workers, counselors, and health educators offer services to family members, as well.

Available services may vary widely from center to center. In addition to the usual services and activities described above, the monthly calendar for the Jewish Home and Hospital Adult Day Health Care Program in the Bronx, N.Y., offers outings to local shopping centers, movies, tai chi classes, Bible study groups, and classes on a variety of health-related topics. The McLean Adult Day Care Center in Simsbury, Conn., offers gardening activities, dancing, pet therapy, and visits from local children's groups.

David Kuhn, MSW, and author of Alzheimer's Early Stages: First Steps in Caring and Treatment, recommends family members consider adult day care when their loved one is isolated for much of the day and misses companionship, when they can no longer be left alone safely during the day, or when they become unable to provide themselves with structure for daily activities.

Donna Albright, an aide at the Riverside Adult Day Care in Newport News, Va., recommends that family members and their loved one in need of care go together for a tour of any adult day care centers they are considering.

Here are some questions to ask when selecting an adult day care facility: What kinds of services are provided? What kinds of activities are offered? Is transportation provided? What about meals? What are the qualifications of the caregivers? Do they have experience with your loved one's condition? What is the ratio of caregivers to clients? (One caregiver to three or four clients is a good number.) What are the hours of operation? What is the cost? Are they licensed or accredited by the state or any other organizations? Can they provide references? Can you talk to some clients and their families?

Paying for adult day center services can be expensive. The cost is generally about $50 to $60 per day, but can be higher depending on your location and the exact services needed by your loved one.

Veteran's Administration benefits, private health insurance plans, and long-term care insurance may help with the costs; check with your loved one's plan to find out. Medicaid may help with the costs for low-income residents. Most families end up covering a significant portion of the costs themselves.

For many elderly and their families, though, the cost is well worth it. "Day care has been like an oasis in the desert for Hughes and for me," says Lela Knox Shanks, whose husband has Alzheimer's. "The costs are now a necessary and integral part of our household budget." Shanks is the author of a book about her experience with her husband's illness, entitled ?Your Name is Hughes Hannibal Shanks: A Caregiver's Guide to Alzheimer's."

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