In the beginning, families lived close to one another. Children, parents, grandparents, great-grandparents and other extended family members took care of one another. Those who did not have family were cared for by charitable institutions, mainly churches. Government did not care for the financial needs of older U.S. citizens until 1940 for social security (http://www.ssa.gov/history/hfaq.html) and for their medical and custodial needs until 1965, when President Lyndon B. Johnson signed amendments to the Social Security Act, beginning the Medicare and Medicaid programs (http://www.cnbc.com/id/43992654/Medicare_and_Medicaid_CNBC_Explains) In 1965 the average life expectancy was 66.80 years old for males. Now we are living longer and longer. Seventy five point eighty one is the new average lifespan for males today and predictions for this generation of young people reaching the age of 90 seems reasonable (http://www.data360.org/dsg.aspx?Data_Set_Group_Id=195) Medical technologies have improved greatly in recent years and are continually and rapidly increasing.
These blessings come at a cost. In addition to the problem of finding the money needed to live more years and to pay for the medical technology to make that happen, other problems stem from the lack of unpaid care that used to come from family members. Families are increasingly fragmented in the modern U.S., and women, who were the caregivers of the past, have careers that preclude them from the demanding role of care-giving. Who is going to take care of the elderly and frail in America and who is going to pay for it?
State and Federal governments are already experiencing heavy deficits, and with the approaching tsunami of aging baby boomers, the future looks grim. Skilled nursing care homes, the current care giver of choice for the Medicaid program in Kentucky, are the most costly form of care because the care is twenty four hours a day, three hundred and sixty five days a year in an institutional setting. Medicaid home and community based services exist but are not well known, are difficult to implement, and funds are lacking.
To be eligible for government programs, poverty must be established. Impoverishment can happen quickly when one must pay the costs associated with long term care unless adequate insurance has been purchased ahead of time, which will pay for skilled nursing care in a nursing home or in one’s own home, or for care in other settings.
Another form of insurance is for an individual to take care of one’s own health in hopes of never needing custodial or skilled nursing care. That is why Medicare supplemental insurance companies are happy to sponsor the Silver Sneakers program. The more one exercises, the less one is likely to need medical care that the insurance company will have to pay for with our premiums.
Adult day centers may be the vehicle for solving many of the problems we are facing as an aging population and escalating costs. Adult day centers as they now exist are different from senior centers and YMCA’s, or other types of gyms or clubs. Adult day centers are licensed by the state of Kentucky as Medical Models or Social Models. Social Models are strictly for custodial care, as when one has dementia and needs supervision for safety. Medical Models have medical personnel on staff during hours of operation (typically 7:30 to 5:30) Monday through Friday. People who are in need of medical care, and who would otherwise be in a nursing home if not for the services of the adult day center and a caregiver in the home, are eligible for a home and community based waiver from Medicaid to pay for attendance at the adult day center. Most long term care insurance will also pay for attendance at an adult day center. The cost for adult day center attendance varies but is usually based on the Medicaid reimbursement rate of $10.28 per hour. Therefore, even if one must pay out-of-pocket, adult day center attendance costs much less per hour than skilled nursing care in the home. Even a non-medical caregiver in the home costs $16.00 an hour and more through an agency.
The culture of each adult day center is unique and should be investigated thoroughly for a good fit. Not all adult day centers serve only seniors. Some adult day centers serve young mentally disabled and medically needy adults exclusively and some serve younger adults in the same center as seniors. Each center has a schedule of daily activities and menus, which varies widely from center to center.
As with any choice we make concerning expenditures, it pays to do our homework and shop around. Below is a website to help with the process:
These are some questions to ask while shopping for the best adult day center for you or your loved one, taken from a website offered by Genworth, a long term care insurance company:
- What is the staffing structure of the facility?
Ask about the ratio of patients to staff members and the availability of clinical supervision if the center is providing medically related services. Is there a manager or supervisor on staff at all times, even during extended hours? What special training does the staff receive to work with special needs such as dementia?
- Is the adult day care center licensed or otherwise accredited?
If your state offers an adult day care license it’s important that the center has an active license. Some states do not offer these licenses. If this is the case, there may be a great deal of difference between individual centers, therefore it is important to learn more about each of the centers near you. You will probably want to visit the centers closest to you and talk with the staff and other families that use the centers to determine if the facilities and programs available meet your individual needs.
- Are there a minimum number of days per week, or hours per day?
Most centers require a half-day’s participation. Ask how far in advance participation needs to be scheduled and if there is any penalty for unplanned absences.
- What does the center require for admission to the care program?
Some centers require documentation from a recent physical exam or special tests such as tuberculosis. If the center is providing medically based assistance they may require a physician’s order for some treatments. If medications are to be administered they may require the prescriptions be filled directly by the center.
- Can the care center accommodate participants with special needs?
Not all adult day care centers are staffed to serve clients with special physical needs such as blindness or extreme hearing loss. Most centers, but not all, can provide for clients who are incontinent and need hygiene management throughout the day. Wheelchair access is generally considered in the layout of adult day care facilities; however, check to make sure that lack of mobility will not prevent full participation.
- Is there written documentation to instruct staff how to handle emergencies?
Evacuation plans should be well documented as well as procedures to handle medical emergencies of an individual participant.
- How much does adult day care cost?
Costs vary among adult day care centers but are usually much lower than the cost of an in-home caregiver for the same length of time. Costs range from $25 a day to over $100 per day depending on the services offered, type of reimbursement, and geographic region. The median annual rate for adult day health care in the U.S. is $15,600, according to the Genworth 2011 Cost of Care Survey.
- Do I have to pay for this or is some of it covered elsewhere?
Adult day care programs are generally paid for by the client, but sometimes the cost can be offset through Medicare, Medicaid or other community-based subsidies or federal and state programs, such as the Older Americans Act, the Veterans Administration, and others. Some long term care insurance policies have a benefit that will reimburse the policyholder for adult day care expenses.
- My dad has Alzheimer’s disease. Can he participate in an adult day care center?
Some centers have special programs for those with Alzheimer’s disease or similar types of dementia. These programs focus on activities that encourage participation and nurture the special needs of these individuals. Adult day care centers should also be able to provide a stimulating environment to adults with adequate cognitive skills but who suffer from physical limitations. Most adult and senior day care centers have staff members who are trained to focus on the client’s ability to socialize and participate in activities.
- What are the social programs like?
Many centers have well-trained activity specialists who lead dynamic activities programs. These programs might include arts and crafts, intergenerational programs, music, cooking classes, exercise sessions, movies, discussion groups, live entertainment and trips into the community. Some care centers offer programs that are especially designed for physically frail individuals with special medical needs such as diabetes, hypertension and post-stroke disabilities, and those with mental health challenges such as dementia, confusion and Alzheimer’s disease. The goal is to be an extension of the home environment with caring, personalized service.
A good tip to remember: take a tour of a center before you send your loved one there so you can see for yourself what the staff and surroundings are like.
Written By DG Gridley
SPECIAL REPORT: How Adult Day Centers Fit Into The Big Picture was originally published @ Aging With Grace, Aging In Place– » DG’s Weekly Blog and has been syndicated with permission.
Photo by Salvation Army USA West 
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