Adult Day Care Centers: A Guide to Options and Selecting the Best Center for Your Needs

With life expectancy continuing to rise, we may need assistance as we age. While help of all types is available, a valuable though not well-known service is adult day care, designed for older adults who can no longer manage independently, or who are isolated and lonely.

What is an adult day care center?

Adult day care is a planned program of activities designed to promote well-being though social and health related services. Adult day care centers operate during daytime hours, Monday through Friday, in a safe, supportive, cheerful environment. Nutritious meals that accommodate special diets are typically included, along with an afternoon snack.

Adult day care centers can be public or private, non-profit or for-profit. The intent of an adult day center is primarily two-fold:

To provide older adults an opportunity to get out of the house and receive both mental and social stimulation
To give caregivers a much-needed break in which to attend to personal needs, or simply rest and relax

There are currently approximately 4,000 adult day care centers nationwide, according to the National Adult Day Services Association (NADSA). The proliferation of centers over the past two decades corresponds to the "mushrooming demand for home and community based services" to meet the needs of a rapidly escalating elder population.

Good candidates for adult day care are seniors who:

Can benefit from the friendship and functional assistance a day care center offers,
May be physically or cognitively challenged but do not require 24-hour supervision,
Are in the early stages of Alzheimer's disease.

Adult day dare center participants need to be mobile, with the possible assistance of a cane, walker or wheelchair, and in most cases, they must also be continent.

A social adult day care setting differs from adult day health care, which usually requires a health assessment by a physician before someone is admitted into the program. Adult day health centers, which typically use the term "Adult Day Health Care" (ADHC) in their names, often provide physical, occupational, and speech therapy, and are usually staffed with an RN and other health professionals. A third type of day care provides social and health services specifically for seniors with Alzheimer's or a related type of dementia.

Services provided by adult day care centers

A well-run adult day care center's goals will focus on enriching the participants' lives, building upon their skills, knowledge, and unique abilities and strengths. Below are some of the activities that may be available:

Arts and crafts
Musical entertainment and sing-a-longs
Mental stimulation games such as BINGO
Stretching or other gentle exercise
Discussion groups (books, films, current events)
Holiday and birthday celebrations
Local outings.

Some centers offer programs that include children. The Friendship Center in California developed The GOLD Project, described as, "An innovative intergenerational program embracing growing older with grace and dignity." Elders visit local classrooms and share their life experiences with the children, educating and enlivening both groups in the process. The Center also has an "Adventuresome Aging" program for people with early stage Alzheimer's disease, to help them remain engaged and active in the community.

Besides recreational activities, some adult day care centers provide transportation to and from the center, social services including counseling and support groups for caregivers, and health support services such as blood pressure monitoring and vision screening.

Benefits of adult day care

Almost Family, an adult day care provider in both the U.S. and Canada, summarizes the benefits well: "Adult day care offers a win/win situation for everyone in the family—not only the client or member who attends the program, but also for the family member who has primary responsibility as caregiver. Adult day care provides a much-needed respite for the caregiver, affording a break from the physical demands and stress of providing round-the-clock care."

For the participant, adult day care's benefits can be extensive:

a safe, secure environment in which to spend the day
enjoyable and educational activities
improvement in mental and physical health
enhanced or maintained level of independence
socialization and peer support
nutritious meals and snacks.

When to opt for an adult day care center

It's usually challenging to admit you need help, especially if you've been a highly independent person used to caring for others all your life! And if you're the caregiver, it may be equally difficult to consider allowing "strangers" to care for your beloved family member.

As with any service, the best time to start exploring what's available is before you actually need it. According to ElderCare Online, you should seriously consider using adult day care when a senior:

can no longer structure his or her own daily activities
is isolated and desires companionship
can't be safely left alone at home
lives with someone who works outside the home or who is frequently away from home for other reasons

Finding the right adult day center for your family's needs

The National Adult Day Services Association (NADSA) recommends you start by asking yourself what specific services both elder adult and caregiver most need. For the day care participant, are social activities primary? Assistance with walking, eating or medications? Mental stimulation? Exercise? As a caregiver, is support what you need most? Some free time? Help with transportation? Answering these questions will help you determine which of the three main types of adult day care centers (social, health-focused, and Alzheimer's/dementia oriented) will best serve you.

In addition to the many references and resources to help locate adult day care centers in your area, you can also try:

Your family doctor
Local social services or health department
Mental health centers
Local senior center
Area Agency on Aging (Call 1-800-677-1116 for the AAA in your area)
Yellow Pages listings under Adult Day Care, Aging Services, Senior Citizens' Services, and similar categories.

When you phone the center(s) you've chosen to consider, NADSA suggests asking the following questions:

Who owns or sponsors the agency?
How long has it been operating?
Is it licensed or certified? (If required in your state)
What are the days and hours of operation?
Is transportation to and from the center provided?
Which conditions are accepted (e.g., memory loss, limited mobility, incontinence)?
What are the staff's credentials, and what is the ratio of staff to participants?
What activities are offered? Are there a variety of individual and group programs?
Are meals and snacks included? Are special diets accommodated?

Next, spend a day at the center that sounds best to you, so that you can get a "feel" for the people and environment. Be sure to bring a site checklist with you (see references and resources below). You may wish to go back a few times to see whether your experience on different days confirms your initial impressions.

Costs and financial assistance for adult day care

The cost for an adult day care center ranges from $25 to $70 or more per day, depending on where you live and the services provided (e.g., meals, transportation, nursing supervision). Professional health care services will mean higher fees. Many facilities offer services on a sliding fee scale, meaning that what you pay is based on your income and ability to pay.

While Medicare does not cover adult day care, Medicaid will pay most or all of the costs in licensed adult day health care settings and Alzheimer's focused centers, for participants with very low income and few assets. Be sure to ask about financial assistance and possible scholarships.

Private medical insurance policies sometimes cover a portion of adult day care costs when licensed medical professionals are involved in the care. Long-term care insurance may also pay for adult day services, depending on the policy. Additionally, dependent-care tax credits may be available to you as caregiver.

References and resources for adult day care

Additional online resources for adult day care

Adult Day Care: One Form of Respite for Older Adults – Provides a comprehensive fact sheet about adult day care including benefits, types, statistics, etc. (ARCH National Respite Network and Resource Center)

Adult Day Care and Adult Day Health Care – Explains the difference between adult day care and adult day health care. (SeniorResource.com)

A Key to Choice for Seniors (PDF) – A guide to help assess lifestyle needs and evaluate the many housing and service options available to seniors. Includes a section on adult day care services. (The Metropolitan Area Agency on Aging (MAAA))

Adult Day Service Centers – A searchable database of adult day care facilities throughout California (State of California/California Care Network)