When I was a kid, the benches along Montrose Beach were always crowded with senior citizens who were dozing, knitting, or staring into space. Nowadays the benches are relatively empty.  People are enjoying adult day care.

A Place to Go When You Can’t Be on the GO

Adult day care is a new development in senior services. It fits with our generation’s demands to live life to the fullest, and include nutrition, mental health, social support, and recreation within the scope of health care. The centers are designed to provide a safe, fun, and therapeutic environment for frail elderly or adults who need supervision during the day due to changes in their cognitive and/or functional abilities.  

Seniors who live alone or with family members, and even those who live in assisted living, nursing homes, or retirement housing participate in adult day care programs. Seniors participate on a regular schedule, depending upon the number of days or hours they need.  It gives them a purpose and a place to go when they get up in the morning; and it gives caregivers freedom to go to work or get some much-needed respite time.

Services Offered

Participants can choose from a variety of activities designed to improve their functional status and offer opportunities for socialization. Breakfast, lunch, and snacks are offered daily. Care is provided by an interdisciplinary staff, including nurses, social workers, and therapeutic and recreation professionals who have experience working with the elderly and adults with disabilities. Support services can range from computer tutors to speech, art, and music therapists. 

Usually the center is managed by a social worker or geriatric professional. Some centers provide transportation to and from an adult's home to the center, and on-site health or medical services. An RN must be on duty if medication is dispensed. Many day care centers also provide respite, education, and support to family caregivers.

Example of a Typical Day

Here’s the schedule for the adult day care center in my neighborhood. Activities are planned to include a balance of up and down time, and transition periods between activities are also planned so participants can come and go. The program includes field trips to museums, sports, musical and theatrical productions, parks, and shopping centers.

7:00-9:00 am Table games, art projects, exercise bike
9:00 am News and current event discussion
10:00 am Morning Circle (Orientation Activity)
10:15 am Exercise/Strength Training
11:00 am Adapted Sports Activity (from golf to modified aerobic)
11:00 am Mental Stimulation Activity (Jeopardy, Who Wants to
Be a Millionaire?) /Alternate Activity (Bingo)
12:00 pm Lunch
1:30 pm Walking Club
1:45 pm Music and Dancing With DJ (Entertainer)
2:45 pm Reminiscing Activity (Trivial Pursuits, scrapbooking)  
2:45 pm Inspirational (guest speaker, presentation by
participant)/Alternate Activity (book discussion group)
3:30 pm Expressive Therapy Activity (art therapy, poetry writing,
journaling)
4:30–5:30 pm Table games, art projects, and exercise bike

Enrollment and Costs

A pre-enrollment visit to the center by the senior and the caregiver are the first step in the enrollment process.

The visit should include a tour of the facility.  Most centers welcome visitors to chat with staff or participants encountered along the tour, but keep it brief.  Prolonged interactions can affect the schedule. Thre will be more time to ask questions at the end of the tour. The process ends with separate interviews for the senior and the caregiver with a social worker who will take a detailed social and medical history.  The interview also provides a chance to ask questions and assess how easy it will be able to communicate with center staff.  A physical exam and TB test are also required.

Costs vary, but some long-term-care insurance provides for adult day care services. Since the programs are designed to serve retirees, costs are designed to meet the constraints of fixed incomes and family budgets that are already strained to the max. Don’t let financial concerns prevent you from looking into adult day care services. Many are not as costly as expected.

What to Look For When you Visit

Licensing requirements vary from state to state and focus on health and safety, food handling, and staff-to-participant ratios. The center needs to be safe and clean. Special architectural features, such as lighting, may be important. Lighting may appear to be too low--when in reality it’s carefully designed to suit seniors with low vision and macular degeneration. (Seniors don’t wear wrap-around dark glasses to be glamorous; they are a practical solution when bright light hurts and interferes with vision). Other things to look for include:

• Electric doors
• Ramps with handrails
• Handicapped-accessible toilets
• Lobby with a receptionist
• Ample seating in the cafeteria
• Evacuation plan
• Off-street entrance for drop off and pick up

My own list of quality indicators focuses on how comfortable I feel with the staff and the ambience of the center. Observing how participants interact and how well the center and participants adapt to individual needs is important. There will be a mixed crowd, with some seniors functioning more highly than others. Most centers invite participants to volunteer and help with chores or assist others who may need extra help. One of my clients enjoys loading and unloading the dishwasher after lunch; another woman, my drama queen, likes to read aloud to others.   

But Dad Isn’t a “Joiner”

The social worker will catch on to your dad’s likes and dislike during the enrollment interviews. They would not invite him to enroll if the staff did not believe he would fit in. The chances are good that Dad will enjoy meeting other men, maybe flirting with the ladies once he feels comfortable. He may not be the most outgoing and social person, but having others around is probably pleasing. Unless he is extremely unusual, the staff has probably met someone like him before and has expertise with these social issues. They know when to leave a participant on his own and when and how to integrate him into the group. 

More and more local governments are investing in adult day care centers. In addition, colleges are offering degrees in senior recreation and leisure management.  They know where the jobs are, a sure sign that these services will become part of the daily culture.  I pass a DC Department of Aging adult day care center on my way to and from work. Seniors are smiling as they enter the building.

One morning I asked a woman if she liked going to adult day care.

“My job?  I love my job,” she said.  “I go to work every day.”  

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