By Beth Witrogen McLeod
Anybody who met Mable Weaver several years ago would have never guessed she was in the early stages of Alzheimer's disease. As the Berkeley, California, resident entered her 80s, she was alert and active, and she even held a job as a housekeeper. At that time, her next-door neighbor and daughter, LaFrancine Weaver Tate, was the only person who suspected a problem. And as Tate soon discovered, it was a problem that would change her life as surely as her mother's.
Tate started worrying when she noticed her mother was losing weight. The older woman was also having trouble finding the right words, and her memory was clearly failing. The concern turned to panic when Tate noticed a badly burnt cabinet in her mother's kitchen, obviously the result of a cooking accident. Weaver couldn't explain what happened, but Tate knew all she needed to know: Her mother was no longer safe on her own.
But what could Tate do? She couldn't afford to quit her job as a hospital administrator; none of her relatives lived close enough to lend a hand, and she definitely didn't want to put her mother in a nursing home. "After a certain point, I was frantic," she says. "I couldn't manage. It was like I was frozen."
Adult day services
Like thousands of other people in her situation, Tate soon found a solution: adult daycare. For four years, her mother spent weekdays at Alzheimer's Services of the East Bay, a place where she could socialize, sing, eat nutritious meals and get the constant attention of trained staff. A bus from the center picked her up in the morning and dropped her off in the evening. "It was a warm, friendly place, and she loved all of the staff," Tate says. "It was a real life saver for me."
According to the National Adult Day Services Association (NADSA), the thousands of community-based adult day centers in the United States aren't just for Alzheimer's patients. Any older adult who needs supervision, personal or medical care, or even just a little extra socializing during the day can benefit from adult daycare services. (Some in the field view the name "adult daycare" as patronizing and prefer to call the programs "adult day services.")
Of course, family members also benefit. When a person is caring for an aging loved one, a few hours of free time each day can help prevent stress, burnout and depression. Without the extra help, many caregivers would have no choice but to put their loved ones in a nursing home.
If you're looking for adult day services, you'll probably choose between three main types:
"Social adult daycare" centers offer transportation, social activities, arts and crafts, off-site trips, educational programs, noonday meals, support groups, and counseling.
Other centers, known as "adult day health care," add in a medical component. These programs offer various services such as medication monitoring, medical and nursing care, pharmacy and laboratory services, and physical and occupational therapies. In many cases, a physician's prescription is needed before participating in these programs, but Medicaid may cover them.
Still other centers specialize in caring for people with Alzheimer's disease and other diseases or dementia. These programs offer simple, structured activities in a safe environment, and all of the staff members are specially trained to handle the challenges of dementia. Other centers focus on older people who suffer from stroke, alcoholism and other disorders.
The cost for adult daycare centers varies. Some centers have a sliding scale based on the person's ability to pay, and private or government programs may further reduce the cost. A few states allow Medicaid coverage, but usually only if the person would otherwise need nursing home care.
Finding the right facility
To locate an adult day facility in your community, contact your local office on aging. Also, check state departments of health, visiting nurse organizations, care managers, family physicians, social service agencies, hospital discharge planners, and community, religious and civic organizations. Also check the Yellow Pages under "Adult Day Care," "Aging Services" or "Senior Citizens Services." To find adult daycare in another community, call the national ElderCare Locator, 800/677-1116 or visit their web page at http://www.eldercare.gov.
The following checklist from the National Adult Day Services Association will help you find an appropriate daycare center, based in part on how you answer the questions.
- What does your loved one need in an adult day center -- social activities, a secure environment, exercise, nutritious meals, health monitoring, personal care, or all of the above?
- What do you as a caregiver need -- occasional free time, help while working, transportation, support, or help in care planning?
- What are the hours and days of operation?
- Are there a nurse and social worker on staff?
- What is the staffing ratio? (Ideally, it is one care provider for every six clients -- four, if clients have severe impairments.)
- What training do staff members receive? (Daycare workers are not required to have any formal education.)
- Is round-trip transportation available?
- How much does it cost? Is financial aid available?
- What is on the activity calendar? Are there any off-site trips? Are the activities appropriate to the level of the elder's capabilities?
- What languages are spoken?
- What conditions are accepted (such as memory loss, incontinence, limited mobility)?
What else to look for
The licensing and regulation of adult day centers varies among states, since there are no uniform federal standards. Be sure the center you select:
- Conducts an assessment of your loved one before admission to determine his or her range of abilities and needs;
- Spends time finding out what you and your loved one want or need;
- Develops an individualized treatment plan and monitors progress;
- Provides an active program for social, recreational, and rehabilitative needs;
- Has happy, active clients;
- Has volunteers who help out;
- Has a place to isolate sick clients;
- Offers nutritious, tasty meals, and snacks;
- Has comfortable, sturdy furniture;
- Is wheelchair accessible;
- Is clean, pleasant, and odor-free;
- Employs qualified, well-trained, and compassionate staff;
- Is certified or recommended by a doctor or the local office on aging;
- Has safety features all around, such as handrails, sprinklers, and smoke alarms;
- Makes you and your loved one feel welcome.
The National Council on the Aging
Phyllis Brostoff et al. Old Talk New Conversations: A Planning Guide for Seniors and Their Families. Elton-Wolf Publishing. 115 pp.
Trudy Lieberman. Consumer Reports Complete Guide to Health Services for Seniors: What Your Family Needs to Know About Finding and Financing, Medicare, Assisted Living, Nursing Homes, Home Care, Adult Day Care. Consumer Reports. Three Rivers Press, 384 pp.
Joy Loverde. The Complete Eldercare Planner: Where to Start, Which Questions to Ask, and How to Find Help. Times Books, 272 pp.
National Adult Day Services Association. Adult Day Services: the Facts. http://www.nadsa.org/adsfacts/default.asp
National Adult Day Services Association. About Adult Day Services. http://www.nadsa.org/knowledgebase/col.php?pid=29&tpid=15