• Adult Day Care Services

When does the individual needing care attend the day program?: Individuals may choose to attend day care programs for only a few hours when a care giver needs time away (this is called respite care) or on a regular schedule. The regular schedule can be one or more set days per week, for either an agreed-upon portion of the day or for the entire day. The individual needing care, and/or his care givers, agree in advance with the adult day program on a certain schedule when the older adult will attend the program.

Transportation: Most often, a care giver will drive the individual to the day program on scheduled days and will escort him or her inside; the care giver will also pick up the individual at the end of their scheduled stay at the day program. Some day programs have their own bus to transport individuals to and from the program. Depending on location, some county social service agencies may have the means to transport individuals who qualify for certain types of benefits. If transportation for the older adult is a problem, ask the adult day program if transportation is available, from whom, and at what cost.

Meals: Adult day programs typically serve nutritious meals and snacks to their clients at appropriate times during the day. With timely notice, they generally can accommodate dietary restrictions. Meals and snacks are usually included in the price for services. One of the greatest benefits of day programs is that the friendly atmosphere of dining with others encourages individuals to eat and helps them socialize at the same time. Everyone enjoys sharing a meal with friends; older adults continue to share that pleasure. Care givers should ask the day program staff what meals will be served while their family member attends the program and should be sure to provide those meals at home that are not eaten at the program.

Dress: Individuals who attend a day program should be clean and dressed appropriately for going out in public (no pajamas or bathrobes, etc.). Clothing should be comfortable and should allow the individual to move about easily in order to enjoy activities. Shoes should be comfortable and have soles that will decrease the chances of falling. Clothing should permit the individual to loosen or remove items easily as needed to use the restroom, so that he or she may be as independent as possible. Items that can easily be laundered are practical so that a spilled drink or a messy crafts class causes no permanent damage to clothing or stress to the individual. It might be a good idea to bring a sweater in case the individual gets chilly. For individuals who are having trouble working buttons or zippers, try sweat shirts, pants with elastic waist bands instead of zippers, or clothing items with velcro instead of buttons. For individuals who have occasional incidents of incontinence, it might be wise to always pack a change of clothing for the day. Even in an individual who has stopped caring about how he or she looks, you may notice that, after a couple of weeks at the day program, he or she takes more care getting dressed and doing hair or make-up. Having some place to go, and friends to see, helps people take more pride in their appearance.

Routine services provided (ask what services the day program you are considering will provide):

• 1. Safe environment. Most day programs will have inside and outside areas for clients to enjoy during the day, but those areas will typically be secured to prevent intruders from entering or clients from wandering away. Ask for a tour when considering a day program.
• 2. Socialization. Individuals who attend a day program interact with the caring staff and spend time chatting, eating and enjoying activities with other clients. This opportunity to get out of the house, to see new faces and to enjoy the day reinforces social and language skills, both of which tend to deteriorate somewhat when someone is isolated at home. It helps keep cognitive skills sharp. The social interaction decreases boredom and improves self-esteem. It feels good to have some place to go and something to do with the day.
• 3. Meals and snacks (see above). When considering a program, ask for a menu for the month.

1. 4. Medications: The day program will need a list from the client's doctor of the client's medications, with the doses and times at which the medications are to be taken. Depending on the individual's needs, staff may remind each client to take the appropriate medications or may administer the medications. Either way, each individual will have assistance in remembering to take the right medication at the right time. Ask your day program what information they need and how they want medications presented to them for the day. They will have procedures in place in order to prevent medication mix-ups between clients.
2. 5. Activities: Day programs generally offer a variety of activities, ranging from games, puzzles and crafts to gardening and outside entertainers. Some programs may also offer occasional "field trips" to shopping, museums or special events. Many programs have periods during the day where clients and staff discuss local and national news and sessions where clients share their memories of the past. Many day programs organize card or board games or have pool tables or other recreational equipment available. Many programs offer an occasional movie, often an older classic with stars most of their clients will recognize. When considering a program, ask for an activities calendar for the month.
3. 6. Exercises for the brain: Many day programs will include in their activities special items designed to exercise and strengthen memory, social skills, language skills and reasoning skills. Ask your day program what they offer.
4. 7. Personal assistance: Adult day program staff should be willing to assist your older family member to and from the bathroom, and on and off the toilet, if necessary. If incontinence is a problem for your loved one, ask the day program staff if they accept clients with incontinence problems and, if so, what kind of support they provide. Staff can often assist clients who have some problems getting up or moving about (for example, a staff member may move a client's walker within reach before he stands up). If your family member has serious difficulties getting up or down or walking independently, discuss this with the staff before deciding to use the day program. Remember that each staff person needs to assist several residents, not just your loved one. Discuss whether the support they can offer is adequate to keep your family member safe. If your family member does have an accident or something is spilled, the staff should help your loved one change into clean clothing, if assistance is needed.
5. 8. Supervision: Many of the individuals who attend adult day programs have some memory loss or experience confusion from time to time. Staff members observe clients throughout the day, try to ease their frustrations and try to redirect them away from unsafe activities.
6. 9. Rest: Adult day programs generally have quiet areas within their facilities where clients can rest, or actually nap, when they become tired. These areas will ideally provide some privacy while still allowing staff to observe the individuals to ensure their safety.
7. 10. Exercise: Many day programs build elements of very basic exercise into their programs, such as "chair aerobics" (exercises done while sitting).
8. 11. Health and wellness checks. The program should have either a registered nurse (RN) or a licensed vocational nurse (LVN) who assesses the needs of individuals in the day program and develops care plans to be used for them while they are at the program. The nurse keeps a medical record of each individual's care while at the program and may perform basic health checks, such as monitoring blood pressure or blood glucose. The nurse is also available if a client begins to feel unwell during the day. The nurse may monitor certain conditions at the request of a client's doctor. The nurse may note items of concern about an individual and ask that he or she follow up with a doctor. Even though a nurse may be available at the day program, please note that, if your family member is feeling unwell, he or she probably should skip the program that day to avoid infecting other clients.

Special Services that may be Offered (ask the day program you are considering what they provide):

1. Bathing. Hygiene is often an issue as individuals age and can create uncomfortable tension between older individuals and family care givers, especially when the care givers are children rather than a spouse. It can be awkward for a son to help his mother bathe, etc. Some day programs, usually for a small fee, can bathe a client while he or she is there.

2. Nail care. It is very difficult for an older individual to care for his or her own nails, particularly toe nails. Many day programs offer nail care and may actually have a podiatrist visit regularly to offer foot care.

3. Hair care. Some day programs have a beauty salon/barber shop. Individuals can attend the program, have lunch with friends and get a cut and perm in the same afternoon. This makes for a fun day and can be a real boost to self esteem, not to mention the convenience for family care givers.

What does an adult day program cost? Ask the program you are considering for a schedule of their rates. For the occasional user, the program may charge by the hour. For regular clients, they may charge by the day or week. While fees differ from program to program, the cost is typically less than bringing a non-medical companion (sometimes called a "sitter") into your home. Fees for adult day programs are among the least expensive costs in health care for an older adult. Don't be afraid to ask about cost early in your conversation with program staff.

Typically, the individual and/or family care givers will agree with day program staff on a schedule of when he or she will attend the program and will agree on a fee based on that schedule. If, for some reason, the individual cannot attend on a scheduled day, he or she may still be required to pay for that day because the day program scheduled its staff for the day (and they must be paid) based on the scheduled attendance expected for the day. Ask your program what their policy is when someone cannot attend a scheduled day.

How do you pay for an adult day program? Most individuals who attend adult day programs are "private-pay" clients, which means that the individual or his or her family pay for the services themselves. If an individual has long-term care insurance (sometimes called nursing home insurance), the policy may include benefits for adult day programs (some policies do not). Some individuals may qualify for financial assistance for adult day programs from Medicaid or through Veterans' Administration programs. If you believe your family member may qualify for Medicaid or VA benefits for adult day services, please ask the day program you are considering if they accept those types of benefits. Because day programs may have to be prequalified by Medicaid or the V.A., your program may or may not accept those types of benefits. Medicare and Medicare supplemental policies do not pay for adult day programs at this time.

Where are adult day programs located? Adult day programs are often located in their own, free-standing secured buildings. Other programs may be located inside assisted living or skilled nursing facility (nursing home) buildings. It is the quality of the program, and not its location, that matters most. If the day care program you are considering is located inside an assisted living facility or skilled nursing facility, be sure you understand what portions of the building your family member will be able to enter and what security precautions each of those sections has; be sure this is adequate for the protection of your loved one if he or she becomes disoriented easily. Compare the staffing levels and activity programs of the stand-alone programs to those located within other facilities. Consider whether your family member will enjoy the larger environment of the facility-based program or the smaller boundaries of the stand-alone program. Neither type of program is necessarily better than the other, but one style may be better than another for your loved one. Where will he or she be the most comfortable?

Staff to client ratio: The day program should have at least one service staff person for each eight clients (1:8).

Licensing: Adult day care programs in Texas are licensed by the Department of Aging and Disability Services (DADS). Day programs are required to run background checks on their employees. The programs are surveyed annually by DADS; DADS will also investigate complaints by individuals or families about services provided by a specific day program. Should you ever need to file a complaint, the number to call at DADS is 1-800-458-9858.

Tip: Enrolling someone in an adult day program can be a bit like enrolling a young child in school for the first time. Attending a day program involves getting to know and trust strangers, adjusting to a new schedule, getting up, dressed and out of the house early in the day, losing some control over activity choices and experiencing many other changes in routine. Particularly for someone who is older and not well, these changes may not be viewed positively at first by him or her. If your family member returns from the first day at the program and indicates he or she does not want to go back, be supportive, but encourage him or her to try again. Try to get him or her to go for several days before making a final decision. There is often a period of adjustment before the day program becomes an acceptable routine, probably even a regular part of his or her schedule to which your family member will look forward. Give the day program a chance before getting discouraged!