Caregiving

Adult Day Centers Help Retirees with Alzheimer's

A center that offers social interaction, along with physical and memory activity, is a lift for those with forms of memory impairment. Their caregivers benefit, too.

When Eileen Roehr's husband, Casey, was diagnosed with Alzheimer's in 2018, she went looking for helpful resources. High on her to-do list was finding an adult day center for him. "The two most valuable things to keep people with dementia functioning as long as possible [are] physical activity and social interaction," says Roehr, 80, a former psychiatric nurse.

Roehr, of Reston, Va., found a center, Insight Memory Care Center, that served only those with Alzheimer's and other memory impairment. Casey attended it five days a week for several years until a recent move to a residential facility. For Roehr, the center was the best option; her husband enjoyed going there and was taken care of during the day, all while still living at home.

Adult day centers (those in the field eschew the term "adult day care" because it's infantilizing) are becoming increasingly popular. In 2018, about 6,200 licensed or accredited adult day centers served roughly 300,000 people nationwide, according to the National Adult Day Services Association, and that's before including several thousand unlicensed centers, such as small church-based groups or those operating in states that don't require licensing, says William Zagorski, NADSA's board chair. The number of centers have grown 35% since 2002, according to the nonprofit organization Aging in Place. Many adult day centers temporarily suspended services during the COVID pandemic, but most have now reopened.

Since the 1960s, adult day care services have been giving families a cost-effective way to care for older adults and people with developmental disabilities who can't be left alone for long stretches of time. But many Americans still aren't aware the centers exist. "One of the most common refrains I hear is 'I wish I had known about this earlier,'" says Joseph Gaugler, a professor of long-term care and aging at the University of Minnesota School of Public Health.

Levels of Assistance

Adult day centers are not senior centers, where you might go for a meal and play some cards. Generally, participants at adult day centers have some physical, mental or intellectual impairment. Typically, it's the spouse who seeks out the centers. "Spouses know they can't manage on their own. They can't keep the person at home all day but are not ready to move into a community," says Kay Bransford, founder of MemoryBanc, which provides daily money management for busy professionals and financial caregivers.

The centers fall into one of roughly three categories. Adult social day centers primarily offer meals, activities and discussion groups but provide only minimal medical help, such as health screenings or medication management. Adult medical or health day centers combine activities and a community with greater medical care, including speech, physical or occupational therapy, and help with toileting, showering or bathing. Often, there's a nurse available; nearly 80% of centers have one on staff, and almost half have a social worker, according to NADSA. Some of these centers also accept people diagnosed with dementia. A third category -- specialized centers -- are meant for adults who require additional care because they have special needs, such as dementia or developmental disabilities.

Research has shown that good adult day centers can reduce stress for caregivers and improve the quality of life for the participants, who otherwise might be more isolated at home or in a nursing facility. "It can make such a huge difference for the participants and their families," says Amy Goyer, who worked at adult day centers in Ohio and is now AARP's caregiving expert.

Rick Lauber, of Alberta, Canada, which has similar adult day services, saw the difference they made firsthand. He says the center was invaluable because it gave his mother a break from caring for his father, who suffered from mild Alzheimer's. He went a few days a week, and "all Mom did was sleep when Dad was away," Lauber says. "Having Dad in a safe, supportive and secure environment was a great comfort to us all."

Adult day centers cost about $80 a day or about $1,690 a month, according to insurer Genworth. That compares to a monthly median of $5,148 for an inhome health aide and $7,908 for a semiprivate room in a nursing facility. Genworth's calculator estimates the costs of different types of care by zip code.

Although the centers are generally open from early morning to early evening during the week, some offer extended hours or weekend care. When looking for a center, "you have to know your options and your needs," says Zagorski, who also owns three facilities in and around Nashville, Tenn.

Finding a Center

It doesn't take much digging to find local day centers, which you can do at two websites: The National Adult Day Services Association and communityresourcesfinder.org. The latter is run by AARP and the Alzheimer's Association. Your doctor or a physical or occupational therapist also may be a good resource. Sometimes the options are limited. Roehr thought highly of the center she found for her husband, but it was also the only place in Northern Virginia that specialized in adults with dementia.

Licensing and accreditation requirements vary so much by state that the best way to know whether a center is licensed -- and what that means -- is to contact your Area Agency on Aging or state office that oversees aging affairs. "There isn't a report card or quality indicators that consumers can access," Gaugler says.

Some day centers are also multigenerational, serving both adults and children, usually in separate areas of the same building with some interaction. There are close to 1,000 of these facilities, says Donna Butts, executive director of Generations United, an organization that advocates for multigenerational programs. "It helps both the adult and child," Butts says of the programs. "If a child is acting out and an adult lethargic, holding the child on [a] lap calms the child down and perks the adult up." Generations United offers a database of such centers nationally on its website.

Once you've identified your options, check out each one, initially by calling the center or viewing its website. Then visit the center unannounced, Zagorski suggests. Don't feel obliged to stick to a set time if tours are offered. "Just knock on doors," he says. "You will be able to see, hear and smell everything and not get a sterilized version." Specify how much assistance your spouse or parent needs so the center staff can tell you if it's suitable. Does the person need a great deal of help getting up or using the toilet? Incontinence may be a deal-breaker. For example, Goyer says her centers accept those with bladder but not bowel incontinence.

The center's staff should be able to steer you toward financial assistance if you qualify for it. Historically, Medicaid was the prime payer for adult day services, and even about 20 years ago, it paid for about 80% of participants. Now that's down to about half, Zagorski says. Long-term care insurance and veterans benefits may cover adult centers partially or fully. Although traditional Medicare doesn't cover adult day centers, a Medicare Advantage plan might, so it's worth asking, says Zagorski, who adds that "currently, fewer than 100 Advantage plans cover adult care services as a supplemental benefit." A center should offer ongoing education and support for the caregiver as well as the participant. Insight Memory Care Center, where Roehr took her husband, not only tailored education to each client's needs but also told her about available resources in the community, as well as the state of research and clinical trials, and provided support groups.

Although Casey is now in a memory care unit, Roehr still brings him back to Insight a few times a week. "He needs the activities," she says.

What to Explore Further

Experts suggest focusing on these areas to learn as much as you can about an adult day center.

  • Basics. Are there a minimum number of days per week that participants must attend, and is transportation to and from home provided? Most centers offer it. What about locked sections so that someone can't wander off? Check out the security.
  • Staff. Compare the center's staff-to-client ratio with the industry standard of six participants to one staff member, not including administrators. Ask about staff training and turnover.
  • Activities. Check out the calendar of activities and look for both physical and cognitive stimulation -- for example, crafts, chair exercises, and music and dance therapy, even aroma therapy.

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