Selecting an Adult Day Center

The search for an adult day center (ADC) is straining. The task requires close consideration as it concerns the comfort of your loved one. We’re here to help. Families who seek out adult day centers may be in different stages of life and have their own reasons for seeking assistance, but the goal is the same – to allow a loved one to age at home for as long as possible, while being cared for during the days when their primary caregivers are occupied with work. We detail the purpose, services, and benefits of adult day centers. We guide you through the adult day center industry to ensure the best fit for you and your loved one. 

In This Article:

What is an Adult Day Center? 

You may be familiar with terms like “adult day services”, “adult day care”, or “adult day care center” as they are often used interchangeably with ADC. Recipients of care in the adult day centers are known as “participants”. 

Adult day centers are generally for older adults of an age 60 and older and/or people with cognitive disabilities that wish to continue aging in their own homes but require supervision for social and physical activities during daytime hours when their family caregivers are working. 

Adult day centers operate during business hours on weekdays. Some provide evening and weekend programs. With trends of the older adult population increasing from 15 percent in 2010 to an expected 27 percent in 2050, full-time working family members caring for their parents under the same household will become more common. 

Adult day centers provide an environment to support the health, nutritional, social, and daily living needs of a care recipient during the weekdays, which allow family members to remain in the workforce. Not only is it a relief for family members not having to worry about sacrificing their careers for full-time caregiving, but more importantly, adult day centers have shown to improve both the overall well-being and quality of life for both family members and their loved one.   

A variety of adult day centers exist and are growing in number. Currently, over 4,600 adult day centers operate to serve an estimated 260,000 participants and families. Each adult day center set out have a niche and usually has a comprehensive outline of scheduled programs on their website. Before choosing one, how can you be sure it’s the right fit? Adult day centers have three main models:

• Social Model: Social services, nutrition, and help with activities of daily living (ADL) are provided. Consider this option if the care recipient is physically well but can be wobbly at times, feels socially isolated, unsafe to make meals at home, does not need medical attention, or needs help with self-care hygiene. 
• Specialized Model: Similar services as the social model but targets participants with dementia, mental illness, or brain injuries. Consider this option if the care recipient has behaviors that are especially difficult and unsafe if left alone unsupervised, cannot remember to take medication, or cannot reliably reach out for help if left alone during emergencies. 
• Medical Model: Similar services as the social and specialized model but highly trained licensed professionals such as nurses, social workers, physical therapists, and occupational therapists are provided. Consider this option if the care recipient has multiple chronic health conditions that require close attention, needs careful administration of medication, is at fall-risk, or requires close physical supervision for all activities. Progressive decline in health or recent hospitalizations are also indicators that a medical model is most suitable. 

Keep in mind that adult day centers can be one strict model or offer all three. Because definitions are not agreed upon in the industry, different facilities may have their own names for models they use to guide their programs. Fortunately, the principles of the models are more or less the same when choosing the right fit for your loved one.

Demographics of Adult Day Centers

In 2014, a study researching adult day centers established results to help understand how participants look like and what things they need help with. 

How do participants compare to your loved one in age?

• 69 percent are age 65 and older. 
• 21 percent are age 41 to 64. 
• 9 percent are age 40 and younger. 

Physical disability, cognitive disability, and chronic disease are common among participants:

• 40 to 42 percent of all adult day center participants have a variation of physical disability. 
• Dementia impacts roughly 47 percent of participants.   
• Roughly 46 percent have high blood pressure, 34 percent have some form of heart disease, and 31 percent have diabetes. 

How do participants compare to your loved one regarding levels of assistance?

• 45 percent need help with toileting tasks.  
• 44 percent need help managing their medication. 
• 30 percent require help for bathing. 
• 18 percent need help to walk safely without falling. 
• 16 percent need help feeding themselves.  

If your loved one doesn’t fit exactly with the popular or minority description- that’s okay. Adult day centers are known for tailoring their services to fit the needs of participants.

Although proximity to work or home is often times convenient, ensuring the comfort of your loved one can make for a more lasting and meaningful experience. Building consistent and stable relations with adult day center staff is often more important. 

Services Provided 

As the number of adult day centers continue to grow, facilities strive to make their mark on the types of services provided such as offering writing classes, going on community outings, and offering family caregiver training. The growing and varying number of services can be overwhelming, but the additional services offered may be beneficial depending on your need. Each family has their own specific preferences for services provided by adult day centers. Cost is also a factor. Let us go over the different services provided by adult day centers starting with usual care. Think of usual care as a standard package provided by most adult day centers that include: 

• Activities of daily living (ADLs): Assistance with bathing/showering, toileting/toilet hygiene, dressing, feeding, walking, and personal hygiene. 
• Nursing and medical needs: Regular blood pressure monitoring, weight monitoring, taking medication, blood sugar monitoring for those with diabetes, medication injections, managing wounds, caring for catheter or colostomy, and tube feeding. 
• Meals: Breakfast, lunch, and snacks are provided. If extending into the evening, programs also offer dinners. Make sure you inform the staff of dietary restrictions, special diets (pureed food, thickened fluids, diabetic diet, etc.), and medications that need to be planned around meals. 
• Psychosocial support: Professionally lead programs addressing and supporting the emotional and mental well-being of the family caregiver and participant.  
• Daily programs: Stimulating activities such as discussion of current events, socialization, word games, brain teasers, get fit activities, yoga dance, music sing-a-longs, and more. These programs are continually changed according to the needs and demands of participants. 
• Support groups: Led by a facilitator, family caregivers and participants address any issues that arise. Advice, resources, and information are mutually shared to help all participants to continue aging in the home and community for as long as possible. 
• Transportation: Some programs offer transportation to and from the adult day center. During community outings, reliable transportation is also readily provided. 

How common is usual care provided in adult day centers? 

• 90 percent of adult day centers provide help with walking, toileting, and meals. 
• Over 50 percent help with bathing/showering. 
• Over 80 percent offer nursing and medical services as described above. 
• Over 80 percent have a registered or licensed practical nurse as part of staff. 
• Almost half offer social workers, physical, occupational, and speech therapies. These professionals provide many targeted strategies to battle chronic conditions and improve the overall health of the participant. 
• Over one in ten adult day centers offer job training programs and over seven percent teach sheltered workshops for participants that are younger adults. 
• Over 75 percent offer music, art, and pet therapies. 
• Over 75 percent offer intergenerational programming, a service to assist family caregivers how to best care for their care recipients in the home. 

Looking for something a little extra? Adult day services Plus (ADS Plus) has been regarded as the most effective program. In particular, ADS Plus assists family members with their struggles of caregiving such as depressive symptoms derived from caregiving by giving them strategies to cope with the day to day difficulties they may face. 

ADS Plus includes: 

• Strategies to target stressors of caregiving. 
• Strategies to deal with behavior problems of the participant and the physical, mental, and social health of family caregivers. 
• Learning positive coping strategies to alleviate stressors as a family caregiver.
• Dementia specific programs. 

How does ADS Plus work? Family members meet face to face with a site service director to:

• Identify areas of concerns and needs. 
• Develop a care plan to minimize identified areas of difficulty. 
• Implement an agreed-upon care plan that involves four components: counseling, education, referral, and periodic supportive contact with the site service director. 
• Resources and educational materials are provided during follow-up meetings. Goals and progress are discussed. 

Services have been described. But what benefits do these services provide? Do they work? Overall, research has found: 

• Improved overall well-being and quality of life in participants. Specifically, participants feel less lonely, depressed, angry, annoyed, and impatient.  
• Participants gain autonomy, feel more competent, have higher morale, and have more positive moods. 
• Improved thinking skills in participants with dementia by way of Montessori-based programs and art and music therapy. 
• Family caregivers feel less burdened, have less stressors related to family conflict, and spend less time addressing negative behavior problems in their care recipients. 
• Family caregivers remain employed and have less employment related conflicts. 

A lot of options are available but don’t feel the need to find a program that includes ADS Plus. Most families do well with usual care. As more services are offered, the more expensive your daily rate can be. Have a discussion with yourself and loved one. Decide which services will be most helpful. The most important thing for you and your loved one is to find a program that meets all the basic needs for your individual situation. Start with that, then as your comfort grows with adult day centers, you can begin to look at additional services that would improve your loved one’s quality of life. If stressors continue to run high at home despite usual care, ADS Plus would be an option you should seriously consider. 

Caregiving Stress and Burden

Family caregivers have many expectations to fulfill such as holding full-time jobs, providing meaningful care to their elderly and/or loved ones with a disability, and balancing their social life with friends and family members, that accomplishing a work-life balance may seem impossible. 

Caregiver stress is a real phenomenon that many people face. It has gained so much traction that researchers have coined a formal term for it known as ‘caregiver stress syndrome’. Caregiving stress develops through chronic neglect of your own social activities, personal health, and role as a family member surrounding household duties.  

For perspective how common caregiver stress is, a study in 2012 by World Health Organization found: 

• High amounts of physical and psychological distress in family caregivers.  
• Up to 75 percent of family caregivers will develop some form of psychological illness. 
• Between 15 to 32 percent experience depression. 
• Family caregivers have difficulty staying employed and have low productivity in the workplace.  

Family caregivers are faced with guilt when they feel they have chosen employment over the care of their loved one. Roughly 15 percent of people 50 years of age and over provide care for a dependent family member or friend. People between the ages 50 to 65 are also at the peak of their careers. Retirement plans, financial gains, and job promotions are put on hold due to caregiver strain. Family caregivers are often faced with: 

• Work-related struggles. 
• Unpaid leave. 
• Continuous rearrangement of work schedules. 
• Decreased work hours to meet their caregiving responsibilities and emergencies. 

Having a care recipient become a participant in an adult day center can help lessen the need to give up employment. Adult day centers can help provide respite for family caregivers, meeting the needs of both family caregivers and their loved one. Family caregivers can focus on their work endeavors, maintain full-time employment, and take promotions or new job offers free of guilt while their loved one gains fulfilling days of socializing and activities that keep their mind and body engaged. 

Family Caregiver and Participant Satisfaction with Adult Day Centers

The task of choosing the right facility can be daunting. A helpful consideration in alleviating any apprehension you may have about adult day centers is to ask about the experiences of past and current participants. How do care recipients feel about their experience in an adult day center? A study looking at consumer satisfaction of participants in a dementia-related adult day center found that participants: 

• Preferred adult day centers over long term care facilities because they prefer to stay in their own homes and ‘age in place’.  
• Enjoyed the cleanliness of the facility. 
• Felt they had a lot of autonomy about their choices.  
• Felt respected by the way staff communicated.  
• Liked the food and snacks. 
• Recommended adult day centers to friends. 
• Were satisfied with the planned activities, safety, and companionships. 

How do family caregivers feel about adult day centers? A separate study looked at family caregiver satisfaction with their adult day center experiences and found that family caregivers: 

• Expressed high levels of satisfaction with most aspects of adult day center programs. 
• Felt that they and their care recipient were treated with respect.  
• Felt at peace knowing the care recipient is safe, cared for, and engaged in stimulating activities.  
• Spoke highly about the benefit gained by the care recipient such as opportunities to socialize, keeping active, and getting out of the house. 
• Expressed gratitude for respite and the ability to work.   

How long do participants remain enrolled in adult day centers? 

• On average, participants remain enrolled for approximately 2 years. 

What are the main reasons participants disenroll in adult day centers? 

• Transition of a participant into a nursing home. 
• Unfortunate passing of a participant. 
• Needs of the participant and family does not match with the services that are provided by the adult day center.  

Find the Right Adult Day Center

Step 1) Sit down with your loved one and determine both your needs. Develop a comprehensive list and ask:

• Which type of model would be best – social, specialized, or medical? 
• Which services will absolutely be needed – ADLs, medical monitoring, management of behaviors?
• Which services will be nice to have – learning how to manage behaviors, receiving therapy, staying active and engaged? 
• What is our budget?
• Will you need help with transportation?
• How important is proximity of the adult day center to work or home?

Step 2) Locate an Adult Day Center. 

Adult Day Centers are licensed through a nationally recognized association known as National Adult Day Services Association (NADSA). Using NADSA’s navigation system, you can easily input your zip code to identify licensed facilities. Because not all states are license and regulate adult day centers, some programs will not be found through NADSA. 

• Search NADSA’s data base using city name or zip code. 
• Contact your local Area Agency on Aging (800-677-1116). 
• Contact your state’s Adult Day Services Association.  
• Contact a local senior center and ask for recommendations and personal experiences. 
• Perform a google search of ‘Adult day centers’ and write down all names, contact information, and take notes of the reviews. Make sure to check out their website if applicable. A good sign is that their website and information is up to date and easy to navigate. 

Step 3) Make an appointment to physically visit the centers

• It is helpful to visit at different times to see the daily activities, behaviors that may arise due to fatigue in the afternoon or early evening, and how staff handles escalating situations. If you are not restricted on time, it is advisable to do so. 
• Seeing adult day centers in the morning, afternoon, and early evening can give you a better idea of what to expect regarding your own standards for staff, food, programs, and cleanliness. 

Step 4) Know what to ask during your visit

Operation: 

• How many years has the center been operating? 
• Is it required for the center to be licensed, certified, or accredited? If not, how are you ensuring that your facility is up to standards? 
• What are the days and hours of operation? 
• Are there late arrival or late pick-up policies? 

Services: 

• What assistance is provided if needed – eating, toileting, walking, transfers, medication? 
• Do you offer special programs for people with dementia, memory problems, or specific diagnoses? 
• What amenities are offered – transportation, bathing, community outings? 
• Are therapies such as physical, speech, and occupational therapy available?
• Is there a social worker or case manager available? 
• Do you have a hard copy of your daily schedule? 
• How involved are participants in planning activities?
• What types of meals or snacks do you provide? Can you accommodate for special diets? 
• How involved can family caregivers be?
• How do you determine if a participant is no longer appropriate to receive care at the center? 

Staff: 

• What is your staff to participant ratio? 
• What training and licensure does staff receive? 
• Are volunteers also available?

Payment: 

• What are the fees – hourly, daily, or monthly?
• Are there additional fees for meals, snacks, transportation, outings?
• Is there a deposit fee? 
• Are there policies for a missed day?
• Are there financial assistance programs available?
• If pulling out early of the program, are there prorated policies? 

Site Visit Checklist:

• How welcomed did you feel? 
• How clear were the services and activities explained?
• Was the facility accessible?
• Was the facility clean, odorless, pleasant? 
• Is the building wheelchair accessible? 
• How did the furniture and set-up look? 
• Was the noise level appropriate for your care recipient and participants? 
• How did the staff and participants interact with one another? 

Step 5) Check references

• Ask two to three people if they are willing to share their experiences with adult day centers. 

Step 6) Try it out

• When an adult day center is selected, give it a few days to a couple weeks. 
• A warming up phase will need to take place for the participant to feel welcomed and comfortable.
• Continually check on your loved one to see how they are enjoying it. 

Step 7) Practice taking care of yourself

• You are also part of this journey. Make sure to take the extra time to find yourself again, rejoice in things that you’ve given up, and relax.
• Don’t feel the need to care for your loved one alone. Adult day centers are available as a new outlet for social support and long term companions. 

Payment

Costs can vary depending on the types of services chosen. Most recently, the national average cost for an adult day center is $70 daily and $2,100 monthly. Numerous options are available to pay for adult day centers, with the most common being: 

• Medicare
• Medicaid
• Veteran’s programs
• Self payment options

Before trying to figure out the payment options yourself, check in with your care recipient’s primary doctor to see if a referral can be made. In addition, if a case manager or social worker can be assigned, use this to your advantage. Case managers or social workers will look into detail about creative ways to help you pay for an adult day center. Additionally, if an adult day center already has a case manager or social worker on site, inquire about their services to assist with payment options.