Adult Day Care: We Really Need It

Adult Day Programs: A Reprieve for Families and the Elderly
By PAULA SPAN
The other morning, I stopped by Senior Care, an adult day program near my home in Montclair, N.J. Things were hopping, as usual.

In one room, a self-defense instructor was showing participants how to throw a would-be mugger off balance. “I want you to put the cane around my leg and pull,” he urged — and one by one, with a few self-conscious giggles, his elderly students did. “Pull hard. Just like that! One more time.”

A few doors down, a dozen people were drawing with pastels in the crafts room. The walkers in the Mile Around Club were beginning their third circuit along the building’s hallways. In the dining room, meanwhile, workers were setting up a hot meat loaf lunch.

Though almost 4,000 such programs around the country serve older adults who are frail, isolated, chronically ill or demented, I still think these adult day centers constitute one of the better-kept secrets in elder care.

People who might otherwise sit home alone with the remote, or who might move into a facility because they can’t stay home alone, instead spend several days a week being active, social, stimulated, well nourished and — at health-oriented adult day programs like this one — monitored by nurses. At the end of the day, though, the participants go home to familiar surroundings, and the centers often provide the vans that take them there.

The programs don’t come cheap, at a national average of $67 a day [pdf], but they’re dramatically less expensive than moving into assisted living or hiring home care.

I’ve heard heartfelt testimonials to their importance from weary family members trying to keep their ailing relatives out of nursing homes while also struggling to hold onto their own jobs.

“It gives me peace of mind,” said one woman whose 85-year-old mother with Parkinson’s disease goes to Senior Care three days a week. Adult day programs, the research shows, reduces caregivers’ stress. They also suffer less depression and anger, and report greater overall well-being. (Some key findings from researchers at Penn State are here [pdf].)

What’s been less clear is what adult day services do for the people who attend. A team at the University of California, San Francisco, Institute on Aging, which took the somewhat novel approach of asking the participants themselves, recently published a study in The Gerontologist showing significant benefits. “Their quality of life improved dramatically,” said the lead researcher, Eva Schmitt, now associate director of the Aging Brain Center at Hebrew SeniorLife in greater Boston.

The researchers measured how participants assessed their health and social functioning when they first enrolled in programs around the Bay Area, then again six months later and a year later, compared with a control group.

Because participants typically have multiple chronic conditions, Dr. Schmitt said, “We can’t necessarily assume their health will improve over time.” Instead, this study of 57 people (average age: 77) focused on how well people thought they coped with their limitations and whether their quality of life improved despite them.

The answer from participants, who attended at least two days a week, was clear. “They felt the impact of their dysfunctions, physical and emotional, was lower when they attended adult day,” Dr. Schmitt said. (Some other aspects of their lives were not affected.) “In the control group, people actually felt the impact of their problems on their lives increased.”

It’s a small but important study — and a timely one. Adult day programs across the country rely heavily on funding from county, state and federal governments, and on grants from local charities and social service agencies. At the nonprofit Senior Care in Montclair, for instance, nearly 70 percent of participants receive some kind of financial assistance.

All these funding sources are shrinking as government revenues and private endowments plummet. Adult day centers in many states are limiting attendance days or cutting enrollment; a few have closed their doors altogether. Senior Care, running a deficit, first tried to sell the airy facility it built just five years ago. That didn’t happen, so the program is being acquired by a for-profit health care company.

“About 20 percent of the seniors we care for will have to find alternative sources of financial aid,” said Emma Justice, Senior Care’s beleaguered marketing director.

Dr. Schmitt said, “I hope very acutely that our findings will help convince lawmakers not to make big cuts in adult day services.”

Well, that would be nice. A couple of years ago, adult day directors probably would have said their biggest problem was letting families know that they existed, that they could accommodate old people (and sometimes, younger disabled adults) with many kinds of physical and cognitive problems, and that they could often come up with grants to lower the costs.

Now, despite mounting evidence that they help those on both sides of the caregiving equation, they’re just trying to stay afloat.

For more information contact Senior Solutions at (954) 456-8984 or toll free at 1-800-213-3524