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Adult Day Services 101

Three in four Americans wish to stay in their homes as they age. Increasingly, this wish has become a reality for many thanks to advancements in medicine and technology, as well as the generosity of loved ones. Still, aging also brings physical, cognitive, and emotional challenges that can be obstacles to independence. When these issues arise, families may need additional support to allow their older loved ones to stay safe at home. 

Enter Telespond’s adult day center, an on-site service that allows seniors to receive needed personal and medical care in an engaging social environment. Adult day service centers allow caregivers to attend to their daily responsibilities with the peace of mind that their loved ones are safe, comfortable, and well-cared for. Currently, there are nearly 5,000 adult day programs operating across the US—including Telespond here in Lackawanna County, PA—and that number that is only expected to increase based on the country’s growing senior population.

Whether you’re considering adult day center options for a loved one, seeking to volunteer with older adults in your community, or simply want to know more about how adult day center services work, you’ve come to the right place. Below, you can explore the ins and outs of adult day center services—who can attend them, what activities are offered, how much they cost, etc.—as well as how to navigate difficult but necessary conversations about aging with your loved ones. You can also get advice on finding the adult day service center that is the best fit for your family and access resources for caregivers and volunteers that such programs have in place.

Definition of Adult Day Centers

The National Adult Day Services Association (NADSA) defines adult day care as:

A professional care setting in which older adults, adults living with dementia, or adults living with disabilities receive individualized therapeutic, social and health services for some part of the day.

This provides a helpful starting point for addressing some of the main features of adult day care services; notably, who staffs such programs, who is served by them, what services are provided, and when services are provided. These topics are broken down further below. 

Who Staffs Adult Day Centers? 

“A professional care setting…”NADSA

Adult day centers are staffed by trained and credentialed professionals who are well-equipped to deal with clients’ daily personal and medical needs. These can include certified nursing assistants (CNAs), personal care assistants, and health care aides. Programs are typically supervised by directors with experience in business or healthcare administration, an activities director, and either a Registered Nurse (RN) or Licensed Professional Nurse (LPN) to provide healthcare services. Nearly 50 percent of adult day services also have a social worker on staff (Metlife ADS Study, 2010). Social workers are an important resource for families navigating the healthcare system and learning to adapt to their role as caregivers. In addition, physical and occupational therapists may offer services on-site, and other specialty providers such as podiatrists may offer care within the center. 

Who Attends Adult Day Centers?

“Older adults, adults living with dementia, or adults living with disabilities…”NADSA

Adult day centers welcome three primary populations. First, older adults who are not living with disabilities or functional challenges often attend these programs to keep active and build community while also receiving any needed assistance with medication management, ambulation, or other daily tasks. Adults living with dementia and other cognitive challenges can also attend these programs to remain mentally engaged and receive the specialized care they need in a safe environment. Finally, adults with disabilities can receive more intensive therapeutic care and pain management, while also enjoying the benefits of a social group.  Generally, three categories of adult day services have been identified: Social, Medical/Health, and Specialized. 

Social Medical/Health Specialized
Serves older adults needing some assistance with daily tasks of living and a social environment Serves older adults needing higher levels of personal and medical assistance, often living with chronic physical conditions Serves older adults who have been diagnosed with a specific condition which the center aims to support, such as Alzheimer’s or dementia

It is important to note that some centers offer more than one branch of service, and others are blurring the lines as populations shift and become more dynamic. For example, Telespond offers four levels of care appropriate for different clients’ cognitive and physical abilities. By providing multi-tiered care, adult day service centers can more easily continue to accommodate clients even as their condition may changes. In addition, many centers serve as a transitional point for those who have been in the hospital or a rehabilitation facility. Having a day program to go to, especially one that offers on-site therapeutic services, is one way seniors can regain their activity and independence after an illness or surgery. 

What Services are Provided through Adult Day Centers?

“Individualized therapeutic, social, and health services…”NADSA

Regardless of the category an adult day program falls into, most offer the following services for clients:

Social and emotional support—A major component of adult day services is the development of community. Within a day program, seniors can enjoy socializing while also remaining mentally stimulated. They may play cards and board games with their peers and volunteers, participate in fun activities like arts and crafts projects, and watch performances and demonstrations from community groups. Day centers often have outdoor space and gardens which the clients are invited to care for. Some centers also offer small group outings and field trips out into the community. 

Personal care—Adult day programs assist clients with activities of daily living including eating, toileting, bathing, taking medicine, and walking. They may also offer assistance with personal grooming, including hair and nail care. 

Nutritious meals and snacks—Most adult day programs (85%) include daily meals and snacks at no additional cost to clients (Metlife ADS Study, 2010). Meals are prepared with the consultation of a dietician, and special dietary needs are accommodated. 

Health services—Adult day centers are staffed with clinical professionals who oversee the unique medical needs of each patient. In lower-level (social) facilities, medical services may include blood pressure regulation, vision screening, diabetes monitoring, and diet and weight management. Higher-level facilities may also offer therapeutic services (e.g. physical therapy, occupational therapy, and speech therapy) as well as chronic condition management. Programs caring for individuals with dementia or Alzheimer’s may have additional health specialists on staff to address their unique cognitive challenges.

Transport—In order to accommodate caregivers’ schedules, many adult day centers, including Telespond, provide transport to clients. Drivers typically operate DOT-certified, licensed and insured vans which are outfitted with lifts to accommodate the needs of clients with disabilities. 

What Are Adult Day Services’ Typical Hours of Operation?

“…for some part of the day.”NADSA

Typically, adult day programs accommodate normal business hours, running from 7 in the morning until 6 in the evening. Most operate five days per week, though some are staffed seven. Most do not offer evening or weekend care. Over 80 percent of participants attend full days, and 46 percent attend five days per week. Such frequent attendance enables caregivers to remain in the workforce and engage with other daily tasks. It also provides a sense of consistent routine for the clients who are taking part in the programs.

A final aspect of adult day services is not mentioned in the definition above, but it is just as important to address: 

How Much Do Adult Day Services Cost? 

While rates vary widely by type and location of center, the typical cost of adult day services is between $60 and $70 per day. Adult day services are typically NOT covered by Medicare, but they may be partially or fully covered by Medicaid, private insurance, or VA benefits. Programs with a medical component may offer additional coverage options. 

Benefits of Adult Day Services

Now that you have a better understanding of what adult day services are, let’s turn to the benefits. How do these services meaningfully impact seniors and their families? In short, the benefits can be broken down into two groups: benefits for the senior clients who attend, and benefits for clients’ primary caregivers. 

How Adult Day Services Benefit Seniors

  • Promote senior independence. Having a safe place to stay during the day and assistance with daily tasks can support seniors’ abilities and confidence in their independence. Participating in an adult day program can even delay or prevent the move into a more involved nursing facility. This is a significant consideration for most families, as long-term nursing care is considerably more costly than adult day services.

How Adult Day Services Benefit Caregivers

  • Allow continued engagement in workplace/other daily tasks. As most caregivers are unpaid, and 40 percent of seniors are living on a low to moderate income, continuing to work and support their family is essential for many caregivers. In addition, caregivers may also be juggling the needs of their own children. Enlisting the services of an adult day program allows caregivers to attend to the needs of the other areas of their lives. 
  • Offer helpful resources and community support. Many adult day programs offer additional services for caregivers, such as educational programming, individual counseling, and support groups. Caregiving comes with specific emotional challenges and connecting with other caregivers and trusted support professionals can be very beneficial while navigating the intricacies of caregiving and complex family dynamics. Read more about some of these specific opportunities below.

How are the benefits of adult day care services different than other services for older adults? Check out this infographic to compare adult day centers with home care, assisted living, and nursing homes: 

When Adult Day Care Services Might Be Right for Your Family 

Ensuring your older loved one is safe and happy during the day is your top priority. But it’s often difficult to tell when it may be time for some extra support. This checklist from NADSA describes some warning signs which may help determine when an adult day program may be the right choice for your family. 

A senior may benefit from adult day services when they:

  • Can no longer structure their own daily activities
  • Find it difficult to initiate and focus on an activity (e.g. reading, conversation, watching television)
  • Are isolated and lonely or desire peer interaction
  • Cannot be safely left alone
  • Live with someone who works and is away from the home most of the day
  • Are anxious or depressed and need social and emotional support
  • Feel uncertain and anxious when left alone
  • Require attention that leads to their caregiver’s own anxiety, frustration, compromised health and/or depression.

It is important to note that adult day services are not the right fit for all families. While exploring the options, you should also consult with your loved one’s medical care team to ensure you make the best decision for you and your loved one. Things that may indicate adult day serves are not right for your family include:

  • Your loved one is bedridden or needs around the clock medical care
  • Your loved one has minimal medical issues, is still independent (i.e. can still drive, perform activities of daily living) and is just seeking some socialization

Adult day programs are also often used in the transition from the hospital back to home care to establish routine and new way of life after major surgery or medical challenge. If your loved one is currently hospitalized or recently released, ask their care team if adult day service could be a beneficial next step in their recovery process.

Whatever the outcome, having these conversations early and often is essential so your loved one can contribute to the conversation before it is “too late.” When an accident or medical issue occurs, things often move very quickly, and emotions and tensions run understandably high. As a result, having a plan in place early and communicating about it often can save families time, stress and unnecessary guilt. Many experts recommend having the first conversation about aging at the 40/70 split—when adult children are around age 40 and parents are around 70—to ensure a plan is in place even if its implementation is far in the future. AARP offers a comprehensive planning guide with assessment guides, checklists, and discussion prompts for approaching difficult conversations about aging.  

Engaging in Conversation about Adult Day Services with Older Loved Ones

After doing some research and consulting with your family and trusted medical professionals, you may be considering adult day services to supplement your loved one’s care. Before you go too far into the process, however, there is one thing you must do: discuss the issue with your older loved one. Though you may feel a great deal of responsibility for your loved one’s care, and indeed may have to make some difficult decisions at the end of the day, involving your loved one in a conversation about the options will help them maintain their dignity and independence, which is especially important when talking about their need for additional support. Of course, every situation is different, and your family will need to make decisions that best suit your loved one’s unique circumstances and challenges, but in most if not all cases having a conversation about care options is essential before moving forward. And as mentioned above, the earlier these conversations happen, the better. Ensure everyone involved has the opportunity to make their wishes known.  

What should conversations about adult day services look like? Again, every situation will be different, but below are some practical tips you can employ before, during, and after any conversation to ensure discussion goes as smoothly as possible and you are prepared for any concerns or resistance that may arise. 

Before the Conversation

  • Consider who should be involved. If you are your loved ones’ primary caregiver, you obviously need to be involved in making decisions that will impact your life. That your loved one will be there is also a given. However, is there anyone else that is impacted or has a stake in your loved one’s care? Spouses, siblings, or other close relatives may be invited into the conversation, especially if they will be significantly affected by the introduction of adult day services into your loved ones’ care. Depending on how open your relationship with your loved one is, a third party—e.g. a doctor, a family friend, a pastor—may also serve as a neutral facilitator to propel the conversation in a positive direction.
  • Consider the right time and environment. When bringing up the topic of adult day services, a calm, familiar environment is key. Depending on your relationship with your loved one, it may be a good idea to “test out the waters” first to see how open they would be to the conversation. Perhaps they will welcome a direct approach—in that case, you could set aside a specific time and place to discuss adult day options. In other cases, a more indirect approach is easier; in this case, look for a time where everyone is gathered in a relaxed atmosphere to broach the topic of the future. 
  • DON’T spring a conversation on your loved one at a holiday gathering. Care guides from AARP, A Place for Mom, and the Home Instead Senior Network all agree: Thanksgiving dinner might not the appropriate place to start a conversation about senior care. Even if all parties are gathered in the same place, mixing high-pressure conversations with the stress of the festivities could lead to a volatile situation. That doesn’t mean you shouldn’t talk about aging during the holidays; instead, find a time to gather after the activity has died down, whether that is a few days or even just a few hours, where you can come together and focus on the topic at hand. 
  • Consider what you should bring. You may have already gathered some research on the costs and activities typical to adult day services, or even identified a few local senior day programs that might be a good fit. Bringing this tangible information to the table may help the conversation flow more easily than it would if you only have an abstract idea about what services are offered and aren’t sure of there they exist in your community. In addition, preparing research beforehand may help you address any concerns you or your loved one may have about these services as the discussion gets underway. Of course, you should gauge your preparation based on your unique situation and to what extent your loved one is willing and able to participate in the research process. For example, instead of preparing a list of adult day centers ahead of time, you could integrate a collaborative search using an elder care locator into the conversation.
  • DON’T prepare research to overpower your loved one’s thoughts and opinions. While it is important to be informed, keep in mind that the focus of the conversation should be on generating dialogue, not delivering a lecture. Share what you have learned, but don’t overwhelm, and leave your loved one plenty of space to voice their own considerations. When disagreements do arise, don’t use your newfound knowledge to try to “win” the debate. More tips to prepare for conversations about senior living can be found here.    

During the Conversation

  • Open the discussion naturally and invite dialogue. When the time comes to discuss senior care options, it can be difficult to know when to start. Segueing gently into the conversation is recommended; for example, you may say, I know you get really lonely and anxious when I’m out. Let’s talk through some options to help you feel more confident during the day. Here is a more comprehensive list of elderly care icebreakers from The Conversation Project. However you choose to begin the conversation, establish early that your concerns are coming from a place of love, and that your older loved ones’ opinions will be heard and valued as you begin to make a collaborative plan for the future.
  • DON’T start with blunt criticism. Saying something like “You know, you really aren’t able to do [this task] on your own anymore” will likely push your loved one into immediate defense mode. Don’t compromise on the real problems and issues at hand but frame them in as loving a manner as possible. Instead of the starter above, try something like, “I’ve noticed some tasks take up a lot of your energy. How we can make it easier for you to navigate during the day?” Remember: this conversation should promote your loved one’s continued independence even as you are seeking to engage additional care. 
  • Listen and affirm. When discussing adult day services with a loved one, it is important to make sure you understand their thoughts and recognize any concerns that may arise. Before you dive into what you think the options are, allow them to share how they have felt and what they’re worried about regarding the future. When talk turns more specifically on day care options, ask what your loved ones’ priorities are, what they’re most hesitant about, and what questions they have about the service. Don’t be afraid to recognize how big this step is going to be for both of you and focus on how you can work together to make the best decisions. 
  • DON’T monopolize the conversation. You’ve likely been preparing for the discussion for a while, and nerves may make you want to lay everything out on the table as quickly as possible. However, dominating the conversation may overwhelm your older loved one or make them feel less comfortable with sharing their thoughts on the matter. Instead, go into the meeting with a plan to listen. Active or reflective listening—the practice of fully engaging with one says, asking questions, and rephrasing their point to ensure your comprehension—is an especially effective technique for difficult conversations. 
  • Respond calmly to resistance. Exploring adult day options is a monumental step, and it is natural for both caregivers and older adults to feel upset, angry, afraid, or even guilty about the lifestyle change it signifies. Oftentimes, this will manifest in a reluctance to even consider the service. As a caregiver who believes an adult day program is a positive choice for your family, you should respond to the resistance of older loved ones with respect and patience. Try to identify the heart of the issue, whether it is cost, fear of a new environment or having to make new friends, or a general panic about losing independence. Discuss some of the positive aspects of the program, such as the community atmosphere and the opportunity it offers to allow loved ones to stay longer in the home. The Mayo Clinic also suggests these tips for dealing with pushback from elderly loved ones. 
  • DON’T give ultimatums whenever possible. While you hope the conversation is a productive one, there are some cases where you may hit an impasse. In those cases, giving an ultimatum (i.e. “If you won’t consider a day program, we’ll have to [do something]”) will only further strain the conversation and take away seniors’ sense of agency. Instead, if you hit an impasse, change the subject for a while. The process will likely span several discussions. Continue to research, listen, and enlist the advice of trusted family members, friends and advisors to help navigate your loved one’s concerns in future discussions. 
  • End on a positive note. Just as the conversation should open with an encouraging tone, you want to move forward with a positive mindset. Thank your older loved one for having this difficult conversation with you and emphasize its aim (e.g. making sure they have the support they need to stay safe, comfortable and happy). Reaffirm your plan moving forward, whether that is investigating local senior care centers, scheduling a tour, or simply having another conversation to continue discussing the options.
  • DON’T expect to figure everything out on the first try. Having a conversation with a loved one about adult day services is a great step forward, but after it’s over you may still feel overwhelmed—and that’s okay. Take a deep breath, take things one step at a time, and take advantage of the resources available to help you moving forward.  

After the Conversation

What happens following your conversation is up to you and your family. Some may be comfortable diving right into an exploration of local adult day programs and setting up tours of several facilities. For others, the next step may look like another conversation—or two, or three—to continue to discuss what options will be best for the family. You may want to even contact a local senior day center near you and ask to speak to some of their existing clients and caregivers to gain some outside perspective. 

In any case, don’t rush into a decision, but keep things moving forward. It is a good idea to keep your loved one’s medical provider informed about decisions regarding their care, and continuing to communicate with your loved one’s themselves is essential even if most of the next steps fall on you as the caregiver. In addition, perhaps your conversation revealed that adult day services is not the best option for your loved one; in that case, you may want to look into in-home personal care or senior companion programs which offer varying levels of personal and medical service while allowing older adults to remain in the home.   

Finding the On-Site Program that Fits Your Family’s Needs

Before You Look

When starting to search for an adult day center, the National Adult Day Services Association recommends that you first identify your family’s specific needs. What is most important that your loved one have access to in a center—staff trained to deal with specific medical issues? A robust activity schedule? Further, consider what as a caregiver do you need from the center—daily coverage so you can work? Transportation services? Some common topics you may wish to make part of your evaluation are below. 

Location—Can this location become part of your morning commute? Or are there affordable bus/transportation services to and from your home?

Level of care provided—What medical and social needs does your loved one have, and how will they be addressed? Is a social center (few medical services) appropriate, or is a medical (more intensive therapeutic services) or specialized (cognitive care) center required?

Cost—Will it be covered by Medicare or private insurance? Is its price comparable to other similar services in the area?

Hours—Do they offer care five, six, or seven days of the week? Do their opening/closing times accommodate your family’s schedule?

Size—How many people are in facility, client-wise and staff-wise? Will your loved one get the level of personal attention they need? (The average ratio is six clients to one provider.) Will it be too big or too small for them to be comfortable socially?

Past ratings/recommendations—What are other people saying about it? Is it credentialed in your state and/or a member of the NADSA? Does your medical provider know about it? Do you know others who have used the services? Even checking public reviews on social media and Google are good places to start.

Where You Should Look

Searching for adult day services can take many forms. Using a national care center locator like Eldercare Locator will pull from all available records and deliver user reviews alongside data sorted in proximity to your location. County-wide Area Agencies on Aging also provide information about senior care programs in the surrounding community. You may also want to use word-of-mouth to get a more robust picture of a center. Read reviews posted on social media and Google and ask family and friends and your loved one’s medical provider to see which centers they have heard of and what their experiences have been. AARP recommends choosing two or three centers in your area that you would be interested in touring.

When You Visit 

Once you have narrowed your options, it is a good idea to schedule a tour with each program. Here are some things to keep in mind when going through the visiting process.

  • Before You Go: It’s a good idea to research the hours of the program and see if they have any structured visitation options such as guided tours or open houses. You may also want to just “drop in” for the day to see how activities are typically conducted. Once you have set up a date, prepare a list of questions to ask while at the center. NADSA offers a helpful list here, broken down into categories including operation, staff, services and payment. 
  • While You’re There: While touring the center, make sure to take note of everything you observe and compare it to the list of your family’s top priorities. Take in the physical space—how large is it, how comfortable, and how clean? See if you can sit in for an activity or a meal. Note the attentiveness of the staff and talk to the seniors and caregivers there. In addition, talk to the staff who will be interacting with your loved ones and become familiar with their credentials and qualifications. Overall, gather as much information as possible and don’t be afraid to ask lots of questions, like these from the Alzheimer’s Association
  • After You Visit: Review your observations from the visit—NADSA offers this checklist for reflection—and discuss it with your loved one, other family members, and your loved one’s medical provider. Feel free to reach out and ask any follow-up questions over the phone. You may also ask the center for references from current clients and families, or to be connected with them for a brief conversation. And remember, this is a significant family decision; don’t forget to take deep breaths and accept that this time of chance may not be easy, but it might be necessary.

When You Decide 

Once you have determined which adult day service center is best for your loved one, try it out gradually. The Alzheimer’s Association recommends taking your loved one to the facility for lunch or an activity, then having them attend a few times per week for a month or so before making a final enrollment decision. It may take a little while for your loved one to get adjusted, so be patient with any resistance you may encounter and focus on the center’s positive attributes (i.e. fun programming, special personal care like nail grooming). Learn what the center’s policy is for caregivers to drop by or even stay the whole day so that loved ones can feel more comfortable in the beginning.

Discover tips for interacting with loved ones resisting day services. 

Finally, when you make the decision there’s one more thing to do: take another deep breath and celebrate. Your older loved one has found a community where they can socialize and receive the care they need, and you have also gained time for work, other family responsibilities, and needed self-care so you can continue to be the best caregiver you can be.

Resources for Caregivers Offered by Adult Day Programs

Along with its many benefits for seniors, adult day programs offer valuable respite time for caregivers. Some centers also offer caregiver services, including:

  • Virtual and in-person support groups
  • Overnight respite care
  • Individual counseling
  • Educational programming

Source: Metlife ADS Study, 2010

Along with providing additional resources for caregivers as they navigate the multifaceted nature of elder care, such services can also offer a valuable sense of community. Websites to link you with local and national support groups and other resources for caregivers include: 

Opportunities to Volunteer with Adult Day Programs

If you enjoy connecting with the elderly, have weekday flexibility, etc. you may be interested in volunteering with adult day programs in your area. Volunteers can take on a number of roles, including:

  • Playing cards or board games
  • Helping with activities
  • Sharing a special skill or talent
  • Meal setup and cleanup 

Organizations may also play a role, offering their services (performance groups, yoga or health activities, etc.) or designating days to send volunteers. Hours are often flexible, and you can do it once a week, month or year at Telespond. There may also be special events or items you can donate if you are not available on weekdays. Depending on your level of involvement, some programs even offer a small stipend for individuals looking to volunteer with the elderly.

Ultimately, adult day services are a valuable resource for families, helping older adults maintain their independence, manage daily needs and connect with a community of friends, while also supporting the loved ones who care for them. If you are interested in learning more about adult day programs, check out the additional resources below. If you or a loved one is living in Lackawanna County and think adult day services might be the right fit for you, visit Telespond’ website to learn more about our program and to connect with our team. 

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