WHAT IS “ADULT DAY CARE”?

Adult day service (day care) meets the needs of frail and functionally impaired adults of all ages by providing a supervised and secure setting. Services include a wide range of options such as stimulating recreational group activities to increase or maintain independent living skills and overall self-sufficiency in a Social Model Adult Day Care Program to extensive assistance with activities of daily living and/or medical, therapeutic, or rehabilitation day treatment in a Medical Model Adult Day Care  Program. The goal of both models is to assist individuals, whether older adults or those with chronic conditions, to remain as independent as possible, for as long as possible. Nationally, almost half of all adult day service (day care) participants have some form of dementia. The balance of participants has chronic diseases such as hypertension, physical disability, cardiovascular disease, diabetes, a behavioral health challenge or a developmental disability.

The National Adult Day Services Association’s Institute on Adult Day Care defines adult day services (day care) as: “Adult day services provide a coordinated program of professional and compassionate services for adults in a community-based group setting. Services are designed to provide social and some health services to adults who need supervised care in a safe place outside the home during the day. They also afford caregivers respite from the demanding responsibilities of caregiving.”

An interdisciplinary team of both professionals and paraprofessionals deliver health, social and supportive services to meet the physical, cognitive or psychosocial needs of the participant in a secure cost effective group setting in the community allowing families to maintain relationships and lifestyles. The caregivers also benefit from these programs as participation of a loved one will allow them to continue working and/or provide a needed break or “respite” from the many caregiving responsibilities as well as offering emotional support or counseling in the form of caregiver support groups.

Despite the lack of stable public funding, the number of centers continues to increase, reflecting the demand and public awareness of adult day services (day care) as an essential community based service to prolong independence and delay institutional placement.

Adult day care centers can include many of the services listed below:

•  Social activities

•  Therapeutic activities

•  Nutrition (meals and snacks)

•  Transportation

•  Education

Adult day service (day care) programs can vary widely from provider to provider. Most centers feature several common elements:

•  They are offered at a central program location.

•  They are open several hours per day.

•  They provide a midday meal and snacks.

•  They have no overnight stays.

•  They offer a set of core services, always including socialization, watchful oversight, supervision/monitoring and nutrition.

•  They provide, or arrange for, other services, depending on the needs of the persons served.

While most adult day service (day care) centers operate programs five days a week during normal business hours, some programs may offer evening and weekend services. Adult day service (day care) centers operate under a variety of auspices, and with varying levels of professional services.

ADULT DAY CARE GRANTS

Social Services Block Grant

The Social Services Block Grant is a federal program that awards funds to states for the provision of social services. Although states determine which agencies and projects can receive the funds, the United States Department of Health and Human Services reports that one type of program supported by these grants is adult daycare. Furthermore, the grant is intended to help individuals become independent, self-sufficient and to reduce neglect. Organizations starting an adult daycare center can learn more about opportunities through their states by contacting their state departments of social services.

Administration on Aging Grants

Because many people consuming adult daycare centers are the elderly, the Administration on Aging offers a number of grants that can be used to fund adult daycare centers where the elderly reside. For example, in 2011, the AOA made funds available to State Units on Aging for the creation of a statewide services network capable of caring for dementia patients. The administration also offers grants to nonprofit, educational and academic organizations for research and services in the area of respite care and caregiver support, nutrition, research and the prevention of elder abuse. Organizations and states wanting to create adult daycare facilities may be eligible for some of these funds, depending on what kind of residents they will serve and what types of services they will provide.

Related Reading: What Operating Funds Are Needed to Start Up a Daycare?

Robert Wood Johnson Foundation Grants

The Robert Wood Johnson Foundation offers grant funds to public universities, nonprofit organizations and other public agencies for the improvement of health-care services, including adult daycare. Although the foundation prefers to grant programs that can be easily assessed, such as research and training initiatives, organizations that want to start or reorganize adult daycare facilities may be eligible for grants to fund a part of their projects, such as staff training or innovative programs.

Department of Veterans Affairs Grants

Since many veterans are in need of adult day services, the U.S. Department of Veterans Affairs offers project grants for the creation of community programs for eligible veterans. Adult daycare centers that will offer services to veterans and agree to receive per diem compensation from the VA may be eligible, as long as they offer all of the medical services required by the federal agency. Organizations interested in creating such a program should visit the VA website for more information.

Compare National Healthcare Costs

Compare Senior Care Costs

Care Type	National Average Daily Cost	National Average Monthly Cost	Five Year Increase
Adult day care weekdays only	$61	$1,322	1.67% 1 year increase
Assisted living	$110	$3,300	5.71%
Home care 44 hours per week	$162	$3,432	1.09%
Nursing Home double occupancy room for one person	$200	$6,083	4.50%
Nursing Home single occupancy room for one person	$222	$6,753	4.28%

Adult Day Care helps Dementia patients and Caregivers

Regularly using adult day care services for a family member with dementia may help reduce stress for caregivers, a new study suggests.

"Caring for someone with dementia often involves high levels of daily stress," Steven H. Zarit said. "This amount of stress exerts wear-and-tear on the body."

Zarit led the new study at The Pennsylvania State University in University Park.

Some researchers have thought that adult day care may actually increase stress, because of the extra effort of getting the person ready to go in the morning and transitioning back in the evening. But based on this and a previous study, that doesn't seem to be true, Zarit said.

"What we found is that each day a caregiver uses adult day care interrupts a part of the body's stress response, and leads to a more normal level of a key stress hormone, DHEA-S," he said.

DHEA-S, short for dehydroepiandrosterone-sulfate, is produced by the adrenal glands. Some studies have shown that high levels of this hormone can help protect the body against the damaging effects of stress.

But prolonged exposure to stress can deplete DHEA-S levels, the authors write in The American Journal of Geriatric Psychiatry.

Their study included 151 people caring for a family member with dementia who used an adult day care service at least twice a week. The caregivers were an average of 62 years old, and their family members with dementia were an average of 82.

For eight days, caregivers reported their stressors and mood levels by phone once daily and collected their own saliva samples to be tested for DHEA-S five times per day.

The researchers found that caregiver DHEA-S levels were higher on the day following an adult day care day, suggesting that a break from caring for their family member allowed their body to restore this hormone level.

Caregivers who used the day care service more often tended to have higher average mood scores for the eight days than those who used it less frequently. Their mood levels tended to mirror their DHEA-S hormone levels, with better mood on days with higher DHEA-S scores, but there was no connection to symptoms of depression.

"For years researchers have amassed a large literature on the emotional stress and strain of caregiving," Susan T. Charles, who was not involved in the new study, told Reuters Health in an email.

Charles studies emotional processes across the adult life span at the University of California, Irvine.

This study offers a solution on how to lessen the effects of stress, she said.

"Given the rise in the number of people caregiving for a family member with dementia as our population ages, this issue is becoming more central to our public health," Charles said.

"Stress related to managing a relative's challenging behaviors, helping a relative complete daily tasks or assisting them with their medications can lead to stress that spills over to other parts of a caregiver's life such as family conflict and disruption, lost wages due to fluctuations in employment and difficulty in maintaining important friendships outside of the caregiving situation," said Joseph E. Gaugler. He researches community-based services for caregiving families at the University of Minnesota School of Nursing in Minneapolis and was not involved in the new research.

"This accumulation of care-related and life-related stress can then lead to negative mental or physical health outcomes on the part of family caregivers, including depression, impaired health or immune system response or even mortality," Gaugler said.

Many family caregivers either do not know of adult day care services, or think that the services are only "babysitting" and do not take advantage of them, he said. But a good program includes therapeutic activities that can help people with chronic illnesses like Alzheimer's disease maintain function at a higher level, Zarit said.

"Activities such as exercise, cognitive stimulation and social programs can be very helpful for maintaining functioning, and can be carried out in a respectful way," he said.

Area Agencies on Aging can be found throughout the country and maintain a list of community resources. That would be a good place for caregivers to start looking for information on adult day care programs, Zarit said.

Gaugler recommends the National Adult Day Services Association homepage (nadsa.org), which has a "find a center new you" search tool, and the eldercare locator at eldercare.gov.

How Adult Day Care Helps the Aging to Live in Place

Adult day services act as an alternative or supplement to home care and an alternative to moving to assisted living or a nursing home to receive care. The centers enable continued community-based living for individuals with physical and cognitive limitations and provide respite for their caregivers.

In recent years, adult day services centers have played and increasing role in providing long-term care services, as evidenced by the rapid growth in programs from 2,000 in 1989 to over 4,600 in 2009.

While this increase is partially due to the aging of our society, much of this growth can beattributed to the benefits offered through adult day services. First, adult day services centers allow individuals toremain in their home settings rather than an institutional setting, which is what the majority of caregivers and care recipients desire.

Adult day services are also far less expensive than nursing home care. The national average daily rate for ADS was estimated at $67 compared to $198 for a semi-private room in a nursing home. (Note: the average daily rate for adult day services among respondents in this study was under $62). Finally, new evidence from case-controlled study suggests ADS can improve health-related quality of life for participants. In addition, ADSare effective in improving caregiver well-being and reducing burden, role overload, worry, anger, and depression

Grants for Starting an Adult Day Care Center

Construction and Renovation Grants

Federal grants are available for financing the construction and renovation of adult day care facilities in urban and rural areas. The U.S. Department of Housing and Urban Development funds the Community Development Block Grant program. These grants fund the construction and rehabilitation of adult day care and other health care and community facilities in cities and counties with more than 50,000 and 200,000 residents, respectively. The U.S. Department of Agriculture, sponsors the Community Facilities Grant Program. Grants are awarded to counties, towns and districts with less than 20,000 residents to build senior day care centers and equipment necessary to run the operations.

Food Services Grants

Senior day care operators can apply for grants to help with providing healthy meals. The Special Programs for the Aging, funded by the Department of Health and Human Services awards grants covering the expenses of purchasing and providing nutritious meals to the elderly in day care and other congregate settings. The USDA also sponsors a grant program called the Child and Adult Care Food Program, which provides healthy meals and snacks to adults while they’re in day care.

Nonprofit Grants

National and regional grants are also available from nonprofit organizations to start senior day care center businesses. The Kresge Foundation awards grants over $300,000 on for major capital projects such as facility construction and renovation and equipment purchases. These are challenge grants, which means applicants are required to raise capital from other sources to match the foundation. In North Carolina, the The Kate B. Reynolds Charitable Trust organization provides grants funding capital projects and equipment purchases for non-profit senior day care centers in rural areas throughout the state.

Health Equipment Grants

Grants from regional and national programs are available to owners of senior day care centers for the purchasing of medical equipment for their facilities. For example, the George S. and Dolores Doré Eccles Foundation awards grants to senior day care centers and other health care-related facilities in Utah to purchase equipment for their operations. The National Emergency Medical Association awards grants on a national scale for the purchase of health care equipment.