Adult day centers offer an option to senior citizens who want to stay in their homes, but need additional socialization, emotional support or medical attention during the day.
The centers typically operate from the morning until late afternoon or early evening on weekdays and offer a place for seniors to socialize and engage in various activities. Some offer medical services, some provide free transportation to and from clients’ homes, and some provide one to two meals per day.
About 50% to 60% of the centers nationwide have some level of healthcare services available, according to William Zagorski, chairman of the board of the National Adult Day Services Association (NADSA) and CEO of American Senior Care Centers, Inc.
Not all states require licenses
There is no federal requirement for licenses for adult day centers; many states require them, while seven to nine states don’t, Zagorski says. Some states include approval to offer medical treatment within the primary operating license, he says. Other states only require that healthcare staff on premises be licensed, with the facility not needing its own medical license.
Zagorski, who is also the executive director of Centennial Adultcare, based in Nashville, says some centers offer medical attention to varying degrees and some offer a wider array of activities than others. So, it’s up to seniors and caregivers to do research to narrow down the possible choices before visiting the centers and then visiting the ones that seem to align most closely with their individual needs, he says.
For example, if a senior needs to be reminded to take medication during the day, or needs someone else to administer the medication, they should do research first to find local centers offering medical services and then visit the ones in that category. NADSA and state adult day services associations can help provide that information, Zagorski says.
He says that all three adult day center locations he runs in Tennessee have registered nurses and licensed practical nurses, but Tennessee does not require facilities to have their own medical licenses.
Finding the right fit
NADSA’s website offers the following guidelines on who can potentially benefit from attending an adult day center:
“We suggest that use of a center begin when a prospective enrollee needs supervision and:
- can no longer structure his or her own daily activities;
- finds it difficult to initiate and focus on an activity, e.g., reading, conversation, watching television;
- is isolated and lonely or desires peer interaction;
- cannot be safely left alone;
- lives with someone who works and is away from the home most of the day;
- is anxious or depressed and needs social and emotional support;
- feels uncertain and anxious when left alone;
- requires attention that leads to your own anxiety, frustration, compromised health and/or depression.”
What specific services are important to the person using the center?
- A safe, secure environment?
- Social activities?
- Assistance with daily living skills — walking, eating, taking medications, bathing?
- Therapies — physical, speech, occupational, nursing?
- Health monitoring –—blood pressure, blood sugar levels, food/liquid intake, weight?
- Nutritious meals and/or snacks? Special diet?
- Exercise programming?
- Specialized care such as dementia care or traumatic brain injury care?
Adult day centers also provide respite for caregivers
Seniors and their families should also consider what caregivers need, and how a center may help address those needs. Do caregivers need:
- Occasional free time?
- Coverage while working?
- Transportation for your loved one?
- Assistance in planning care?
Activities should stimulate mind, body and soul
Adult day centers should offer “person-centered care,” Zagorski says. For example, he notes that his three centers in Tennessee offer different types of nutrition programs; a variety of games and activities using cognitive skills and knowledge of current events and technology; exercise programs such as yoga, chair volleyball and Tai Chi (a practice of a series of slow, gentle movements and physical postures, a meditative state of mind and controlled breathing); two meals a day; a snack and a group-based environment that encourages seniors to make friends.
“Participating in an adult day center can help reduce loneliness,” Zagorski says.
Stimulating clients’ cognitive abilities is important because it enables them to continue to learn, even those who have dementia, he says.
Are current clients engaged?
When visiting centers, check to see if clients seem engaged and content, if they’re easily socializing, if there are games and artistic and fun activities for seniors with varying skill levels, if there are any opportunities for indoor or outdoor exercise, and if clients enjoy the meals and snacks (and try them yourself). Also observe whether the staff seems upbeat, energized, capable and interacting with clients in a meaningful way.
Bad signs include seniors parked in front of television sets; many people sitting alone, looking bored; a lot of food left uneaten on plates; no sign of art supplies, books, games, wall or room decorations; and a lack of exercise classes or fun things to do.
Some centers focus on things like celebrating certain cultures or serving those who have dementia or who are developmentally disabled, Zagorski says, adding that for some, those are additional factors to look for in choosing a center.
Questions to ask during center visits
The NADSA website provides recommendations on how to locate an adult day services center, and suggests making appointments to visit any centers that seem to be a good fit. The website also provides questions to ask during the visits and a checklist to use to help decide which centers are suitable. NADSA recommends getting references from at least two to three people who use a particular center and it also suggests trying a center for at least a few days.
Those questions to ask during visits include: Does the center offer physical or occupational therapy? Are participants involved in planning activities? Are special diets accommodated? At what point is a person no longer able to attend the center?
Regarding staffing issues, questions include: What is the staff-to-participant ratio? What kind of training have staff members undergone? Do volunteers supplement staff?
Bring this checklist to site visits
The checklist for site visits includes the following questions:
- Did you feel welcome?
- Were the center’s services and activities explained?
- Was the place easily accessible, clean, odorless and pleasant?
- Did you witness appropriate and meaningful activities?
- Were you provided information about staffing, programming and costs?
- Is the building and site wheelchair accessible?
- Was the furniture sturdy and comfortable?
- Was there a quiet place for relaxing?
- Did the staff and participants interact with each other and seem cheerful and comfortable?
Some financial assistance may be available
Attending an adult day center usually costs an average of $75 to 80 per day, Zagorski says. “It’s the cheapest long-term care for seniors, much cheaper than moving into an assisted living community,” he adds.
Those who want to attend adult day care but cannot afford it should ask any centers they are considering attending for ideas on how to pay the bill because staff there may know of sources for grants or programs. They should also check their state offices on aging (or similar state agencies) to see if they have any grants or financial assistance programs available.
The U.S. Department of Veterans Affairs helps pay for veterans and their spouses to attend adult day centers and clients can also find coverage through Medicaid, Zagorski says. In addition, the National Family Caregiver Support Program, funding through the Older Americans Act, and many long-term healthcare insurance policies pay for attendance at adult day centers, Zagorski says.
Medicare will not provide any coverage for adult day services, Zagorski says, except there may be minimal coverage through certain Medicare Advantage supplements.
Most states have little to no funding to help adult day centers operate, and the federal government, towns and counties do not provide the centers with funds either, Zagorski says.
How to pay for transportation
While some adult day centers provide free, door-to-door transportation from clients’ homes to the centers, others do not. Those who do not have their own transportation and wish to attend centers not providing it should ask the centers if they know of other options. Seniors may be able to get free or low-cost transportation on public transportation or through senior transportation run by towns, counties or states. Information may be available through county or state Offices on Aging or departments of transportation.
According to the National Aging and Disability Transportation Center, seniors should also research other potential funding sources for transportation such as Medicaid and Medicare, the Federal Transit Administration, the Older Americans Act and the U.S. Department of Veterans Affairs.
Denise DiStephan is an award-winning, veteran journalist and communications professional based in New Jersey.
