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Adult Day Services: More Than a Stopgap Measure
By Barbara Worthington

Adult day care provides for specific acute needs of older adults and their caregivers. But to successfully address the approaching wave of baby boomers, such services will have to be modified in both programming and flexibility to meet boomer needs and expectations.

Ideal for providing an intermediate step between aging in place and institutionalization for older adults, adult day services continue to expand and evolve. It may be surprising that such services have been in place for more than three decades. In 1978, only 300 adult day care centers existed nationwide. The country’s older adult population explosion has seen that number increase to more than 2,100 such centers by the 1980s and more than 4,000 today, according to the National Adult Day Services Association.

Adult day services have proven essential for providing caregiver respite, as well as therapeutic services and social activities for older adults faced with diagnoses such as Parkinson’s disease, diabetes, and Alzheimer’s disease. Adult day care permits caregivers to maintain their jobs and escape the guilt often associated with placing a loved one in a residential facility. At the same time, older adults who are the beneficiaries of adult day services enjoy the opportunities for social interaction, engaging activities, a range of healthcare services, and assistance with the activities of daily living.

The demand for adult day services continues to escalate as the aging demographic balloons. “Adult day centers are becoming more popular due to their cost-effectiveness compared to nursing homes and in-home care,” says Sandra Timmermann, director of the MetLife Mature Market Institute. “The trend toward older persons desiring to stay in their homes or age in place has increased the demand for in-home care and other programs and services available during the day.”

According to figures released last fall by the MetLife Mature Market Institute, costs for adult day services continue to trend upward. Despite the trend, however, costs for adult day services don’t begin to approach those for residential facilities. The hourly rate for home health aides is currently $20, representing a 5% increase from the 2007 rate, according to the survey. Homemaking aides make $18 per hour.

The average daily rate for adult day services is $64, reflecting an increase of $3 over 2007. The highest costs for adult day services, $141 per day, were recorded in Vermont compared with the lowest in Montgomery, AL, at $27 per day. Shreveport, LA, reported the lowest homecare rates at $12 per hour, while Minneapolis, MN, and Rochester, NY, reported the highest rates at $26 to $28 per hour.

Although Medicare doesn’t cover adult day care services, Medicaid pays most or all costs if licensed medical professionals provide the care. Depending on the terms of the policy, long-term care insurance may pay for adult day services, and dependent-care tax credits may apply to some caregivers.

Critical Care
Day care services additionally integrate meaningful social interaction and a variety of activities that can include trips, crafts, classes, and even opportunities to volunteer. Another objective of such services is to provide families with respite services, as well as support groups, medical services, and other community services.

“Older adults are living longer and using nursing home services less,” says Beth Meyer-Arnold, RN, MS, who serves as director of adult day services at Luther Manor in Wauwatosa, WI. “Consumers are more and more aware that they have options for receiving services and continuing to live in their homes.”

In addition to older adults and their families, community agencies, senior services programs, and Older Americans Act programs seek more cost-effective services. “All these factors are putting a bigger demand on adult day services to develop and provide services to meet the needs that the community is asking for,” says Meyer-Arnold.

Kathy O’Brien, RN, MS, a senior gerontologist at the MetLife Mature Market Institute, agrees that adult day services provide an essential cog in the wheel that fosters aging in place. She says such services “serve as an alternative to needing residential care for individuals who require assistance and/or supervision throughout the day.”

She notes that adult day care services offer an “important resource for working caregivers.” These services provide peace of mind for family caregivers while they’re at work or performing other necessary functions. “Adult day services offer a cost-effective model for delivering care in a therapeutic group setting,” she says.

Respite care is a significant aspect of adult day services. “To be a caregiver 24/7 is just incredibly difficult,” says Frankie Aggers, program director for WISE and Healthy Aging Adult Day Service Center in Santa Monica, CA. She notes the importance of even a five-hour stretch during which caregivers are relieved of their unrelenting responsibilities. Many programs provide specialized support groups for caregivers. “That’s a huge part of adult day care,” she says. “We do a lot of educating with family members.”

Aggers notes that many family caregivers remain reluctant to acknowledge the need for adult day services, often believing an elder’s care by others may be inadequate or feeling guilty for turning over caregiving responsibilities to “strangers.” She says, “There’s a ton of people needing our services” and she feels a certain satisfaction in “winning a family over” and providing them with complete confidence in the organization’s caregiving capabilities.

Enter the Boomers
The baby boomer wave is cresting, and we’ll soon feel the surge of the changing demographic landscape where “the percentage of retirees will grow at a faster pace than the workforce” that will provide their care, according to O’Brien. “Adult day services are well positioned to become a leading player in helping individuals manage the impact of chronic illness and maintain as much independence as possible,” she says.

Within her organization, Meyer-Arnold says officials are already thinking about programs and services necessary for the larger population of persons with dementia and disabilities who will need services in order to continue to live at home.

Medical and wellness interventions designed to improve the health of older adults with chronic illnesses and creative programs that improve the quality of life and recognize elders for the individuals they are remain the focal points of programming strategies, according to Meyer-Arnold. “Reimbursement needs to improve so that adult day services can employ professional staff to develop and provide these needed services,” she says.

Flexibility will be key for preparing effective programming for the boomer generation, according to O’Brien. It will also be essential to develop partnerships with other community resources to meet needs that may not typically be addressed by adult day services. For example, it may be cost-effective to include such services as physical or occupational therapies.

Meyer-Arnold says her organization will look to partner with pharmacists, home health agencies, hospice services, and rehabilitation services to provide support for health maintenance and improvement. Additionally, she says, she’ll seek advanced degree health and business professionals who can provide program development services as centers grow their businesses.

Meeting needs will require “a lot of creative resource finding,” says Aggers. “Baby boomers will know how to use computers,” she says, adding, “Everything that’s going on in the outside world we’ll have to bring in here—and adapt it to people with memory loss.”

Even food enters the modification equation, Aggers says. Specialized planning goes into snacks and meals provided by her organization. “Baby boomers are into eating healthier and lighter. We have to provide a diet that’s something they’re interested in.” Menus heavy on the meat, potatoes, and gravy will give way to whole grains, salads, and fresh fruits. Caterers have integrated cultural cuisine into the menu with such items as Mexican and Persian dishes, she says.

To cater to the baby boomers, in adult day care services “everything is going to have to be more active,” says Aggers. “The activity level is going to be higher. That generation will have done [activities like] yoga and will have been more active.”

The secret lies in being able to adapt quickly, says Aggers. “The programming element is going to have to be the thing that changes,” she says, adding that programming for the future will necessarily include more activities and more outings. “The future is always in programming.”

Preparing for the Future
Looking ahead at addressing adult day care needs also involves partnering with local healthcare training programs, providing internships and clinical placement for all related fields of study, and educating students about the future of older adult care and services. “Adult day centers also need to communicate and share best practices and begin to develop national models for adult day services,” says Meyer-Arnold.

Reimbursement issues create no small stumbling block as adult day services plan for the future. Meyer-Arnold says it’s imperative for adult day services to work with the legislature to examine ways adult day centers can provide choices for individuals receiving Medicare-authorized services following hospitalization. She notes that adult day centers can save the healthcare system money by providing services that support transitions for older adults from hospital to home with less cost for rehospitalization and medical procedures.

The financial advantage is obvious to adult day care center officials. In addition to fostering a greater sense of dignity and respect for older adults, adult day centers “can provide care at a lesser cost than nursing homes or assisted living facilities,” says Aggers. “Our big goal is to keep people out of institutions before it’s necessary. We’re trying to stay ahead of the curve.”

— Barbara Worthington is editor of Aging Well.