Adult Day Programs: Pt. 2

By Anne Pott, Gerontologist

ReGenerations Adult Day Club Director

Have you reached the point in your caregiving experience where the days are long, the nights are short, and your nerves are frayed? Maybe you find yourself in the middle of a storm with little help to be found. Perhaps a friend has advised you of the care options that adult day services may provide, or you are just curious.”

Adult Day Service (ADS) centers exist to benefit adults living with functional and cognitive impairments, their care partners, and the health care system by providing social, health, and therapeutic group activities and supporting adults’ daily living needs in community-based non-residential settings. The overarching goal of ADS is to help prevent or delay the need for long-term residential care by supporting the desire of adults to continue to live in their communities. In this three-part series on adult day services, we will explore facts and stories that describe the need for ADS, the types of programs and their services, and provide a general profile of its participants.

History

Unlike nursing homes and home health care for older adults, which have existed in the United States since the 1850s, Adult Day Services are a relatively new source of long-term care. Inspired by the Geriatric Day Hospital model in England, the United States began to explore the idea in the early 1970s, with the earliest being in North Carolina and Pennsylvania. The Social Security Act’s 1972 amendments authorized several pilot programs across the United States, leading to the development of over 300 Adult Day Service programs by the late 1970s.

Anderson & Dabelko-Schoeny described how the number of adult day services has grown to address emerging societal pressures such as the rising costs of nursing homes, the increased prevalence of chronic conditions such as Alzheimer’s Disease and related dementias, Parkinson’s Disease, Heart Disease, Diabetes, Traumatic Brain Injuries, and Intellectual and Developmental Disabilities. Additionally, social research uncovered the substantial impact of these conditions on the individuals living with the disease/condition, their families, communities, and the overall health care system. Further, among Baby Boomers who are now turning 65, the desire to age in place is substantial. This style of living often requires community-based support services to achieve its long-term goals. The number of Adult Day Services, estimated by the Met Life study to be 4,600 in 2010 (approximately 20 licensed Adult Day Care facilities exist in Nevada), must increase to adequately address the changes in adults’ long-term care needs and preferences today and in the future.

Types of Programs

Over decades, the concept of Adult Day Services (ADS) has evolved into many different forms to adapt to the diversity in the adult population, the policies of funding sources, and the needs within their communities. ADS centers may be community or hospital based. Some affiliate with larger parent organizations, such as the American Red Cross. Such connections often provide additional services, resources, and stability. Yet, it may limit an ADS’ choices in their center’s location, operational policies, and target population demographics. In addition to one’s location and potential affiliations, tax status also impacts how different ADS function.

Most ADS centers exist as private, not-for-profit organizations. The status as not-for-profit helps many ADS centers to increase their likelihood of qualifying for grants and foundation monies. Regardless of the ADS’ operational status as a not-for-profit, for-profit, public, or government, diversification of revenue streams is critical to provide financial stability for ADS. Fiscal crises impact federal and state funding sources, diminish private grants and foundation monies, and decrease revenue through lower client attendance, threatening the financial welfare of ADS centers. COVID-19 brought this sobering reality to bear, causing many ADS centers to shutter across the U.S. In addition to the location, affiliations, and different tax statuses of ADS providers, the type of services varies.

The National Study of Long-Term Care Providers recognizes five different service models. The first is designed to meet the social needs of those who attend (16%). The second provides primarily social and some medical services (31%). The third’s focus is equally social and medical (40%). The fourth is primarily medical and some social (13%). Finally, a select few offer medical services only (1%). The goal of all ADS centers, regardless of the model, is to help prevent or delay the use of residential long-term care. To this end, ADS centers provide standard services such as social and recreational activities, meal(s) and healthy snacks, medication management, assistance with activities of daily living, and respite care. Additional services may include nutritional, therapeutic (physical, speech, or occupational), social work, and skilled nursing services. The state of Nevada explains that most ADS centers are usually open Monday through Friday for 8 to 10 hours a day, with some programs offering extended and/or weekend services. Adult Day Services are a cost-effective alternative to long-term residential care.

Funding

Adequate funding is crucial to achieve and sustain ADS’s varied models, goals, and services. States have begun to receive matching funds and block grants for supportive and nutritional community-based services, such as ADS, through the passage of Section 2176 of the Medicaid Waiver Program, Title XX of the Social Security Act, and Title III of the Older Americans Act (OAA) and title 38, United States Code, which provides qualified veterans with Adult Day Health Care services.

Financial assistance may be available for qualifying individuals and their families to help afford the costs of ADS services. In Nevada, for example, the Alzheimer’s Association, the Home and Community Based Waiver Program (HCBW), the Independent Living Grant, Community Options Program for the Elderly (COPE), the VA grant, Veteran’s Aid and Attendance, and Seniors in Service offer grants to eligible adults.

While Adult Day Services may vary in characteristics, their shared goal is to maintain the independence of community-dwelling adults living with functional and cognitive limitations. This is good news for individuals who need additional support to remain living in their own homes and community. It can also provide a source of respite for their care partners who may be struggling to balance their many personal commitments with ongoing care responsibilities.

For more information or to visit ReGenerations at the Continuum, 3700 Grant Drive, Reno, NV 89509, contact Anne Pott at (775) 221-8052.

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