Adult Day Services: Bridging Home and Assisted Living or Nursing Home Care

Adult Day Services: Bridging Home and Assisted Living or Nursing Home Care
by Mindy Propst, Director, Easter Seals Adult Day Services

Adult Day Services is often the forgotten step between living at home and moving to a more supervised and supported setting. While it's a relatively "young" part of the Long Term Care Continuum, Adult Day Services (ADS) is an invaluable link that allows people to continue living at home while providing nursing care and medical supervision during the day. Who attends ADS programs? Many would be surprised to find people there just like them-people who enjoy spending time with others, creating craft projects, playing games, dining out at restaurants, shopping, reading, volunteering for their community and who also might need a little help getting around, some assistance monitoring their blood sugar or blood pressure, or help with personal care or meal preparation because of memory loss or other medical conditions associated with age. Additionally, there are some programs that meet the needs of adults with developmental disabilities and psychiatric illnesses.
The National Adult Day Services Association defines ADS as, "A community-based group program designed to meet the needs of functionally impaired adults through an individualized plan of care. ADS offers a variety of health, social, and related support services in a protective setting during any part of the day, but less than 24 hours." This definition leaves a lot of wiggle room for the types of services that an ADS may offer. Most ADS centers offer a variety of group activities tailored to the preferences of seniors and adults with disabilities, and nursing staff to assist with monitoring your health status and provide education. Most centers are open Monday through Friday standard business hours, and some are even open on Saturdays and with extended hours modeled after child day care. Some offer transportation to and from the center, community outings, assistance with bathing, nail care, hair care, podiatry services, physical and occupational therapies, assistance with medications, and other "ancillary services." In Hagerstown, most ADS centers are open Monday through Friday standard business hours, provide transportation and a variety of ancillary services in addition to group and community activities and nursing care.
In 2030, Older Adults are expected to make up 20% of the nation's population-up from approximately 13% today. With the number of older Americans and adults with disabilities growing, ADS as an industry will also be growing over the next 20 to 30 years to meet their needs. Why Adult Day Services? First and foremost, ADS allows people to continue living at home despite needing more assistance and care-which is what most people WANT. Additionally, ADS saves families, businesses, and Uncle Sam money-which is what most people NEED. The AARP reports the average daily cost of nursing home care in Maryland is $181-more than $66,000 per year. A recent MetLife study reported the average daily cost of ADS in Maryland is $70-about $26,000 per year. That's a difference of $40,000 each year for each person served in ADS instead of a nursing home! Another MetLife study estimated the cost of employing working caregivers at $11.5 billion annually because of absenteeism, workday interruptions, and replacement costs when they had to quit to continue caring for a loved one at home. ADS provides working caregivers the peace of mind needed throughout their workday as well as the hands on nursing care their loved one needs.
Easter Seals has offered Adult Day Services across the county for decades, and has grown to be the largest provider in the county among both non-profit and for-profit ADS providers. All this experience in Adult Day Services has led Easter Seals to offer families some advice on choosing an adult day services program featured in a recent Medtronic newsletter:
1-Assess your or your loved one's individual needs. Typically a center's admissions representative can help you do that.
2-Determine if a program will meet those needs by finding out what services are offered-transportation, case management or rehabilitation services, for example. Also, see if staff can connect you to other agencies for additional services you may need currently or in the future.
3-Look at other factors like how many participants are in the program, where the center is located, staff qualifications, and the availability of medical staff, therapists, social workers or other specialists you or your loved one may require.
4-Consider asking about a program's staff turnover rate. If it's higher than the average rate of 25 percent, it could signal staff discontent and be a reflection of the overall atmosphere. Further, steer clear of programs not licensed or certified in states requiring a license or certification. Programs also can be accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF) or the Council on Accreditation (COA).
5-An adult day program should feel welcoming, which is why any center you're considering should readily allow you and your loved one to tour and/or attend a "trial day." Once at the center, note if it's clean and if there's enough space to move around easily, especially for someone using a wheelchair, walker, etc. Also, watch the interactions between staff and clients, and observe whatever activities are occurring. If everyone is doing the same activity, it could indicate the program lacks an individualized approach.
When touring an adult day services center, ask:
* Is it clean, homelike and inviting?
* Is there a waiting list? (If so, how long is it?)
* What hours is it open?
* Is it licensed or certified? Is it accredited?
* What are the costs?
* Will Medicaid, state or private funding be available?
* Is there an additional fee for other services, such as transportation?
* Does the staff treat clients/participants with dignity?
* Is there a plan of care for each person, and how is it developed and implemented?
* Is there planned communication with caregivers?
* Are there any special eligibility requirements, such as age or residency?
* What are the written policies on fees and emergency procedures?
* Is there access to medical staff if needed (i.e., a nurse)?
* Are there meals for special diets?
* Is the staff trained in CPR and first aid?
In the end, choosing an adult day program is similar to choosing a college or university; individual priorities and preferences ultimately determine the right "fit." Whether, for example, you'd like a program that's faith-based or perhaps one focused on rehabilitation or dementia, the key is to know what's important to you, and then carefully assess if a program meets your needs.
For more information about adult day services and how to choose the right center for you, contact your local Easter Seals Adult Day Services center at 301-745-3828.