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Freedom for Everyone By Wendi Hope King Greg spent several years caring for his father who had Alzheimer's. He began going to work later each day, calling from work throughout the day and leaving work early in the afternoon, leading to pay loss and hostility within his workplace. Greg was also spending less time with his family and refrained from social activities. He became irritable and frustrated. His father needed more care than he was able to provide. Finally, he decided he needed help. But where could he turn?
Some caregivers take a leave of absence, quit work or rearrange their schedules. Others try to work and care for the person, which often leads to Greg's difficulties. Not only are work patterns disturbed in these situations but private, social and financial lives can experience turmoil as well. Adult day services relieve the caregiver from worry by providing care for a loved one, whether it is for a weekend, a week, a day or a couple of hours. Adult day programs provide services for adults with dementias, cognitive impairments, physical problems, behavioral problems and mental retardation. The age of accepted patients begins at age 18 and continues into late adult life, unless the person is a danger to himself or others, says Susan Rheem, executive director of Adult Care Services, a day-program corporation in Prescott, Ariz. "We don't have a separate facility that would allow us to continue that person's care," Rheem explains. "But people come here for things such as incontinence or behavioral management, so we don't turn those clients away." The length of stay for clients varies greatly depending on the use of the program. "Most clients are here for a long-term stay," says Denise Beveridge, director of day services at Central Adult Daycare Services, a freestanding day program in Warwick, R.I. "One person has been coming here for 13 years. Others are already ill and come for a short time before they move to a skilled-nursing facility. It's a stepping stone for the family to learn to let go a little." Keeping Clients ActiveOne of the first steps to offering an adult day program is deciding which services to offer, although, decisions of which services to provide often develop over time with input from families and clients, explains Beveridge. Clients should also participate in a meeting to discuss what they like and dislike.
According to Life After Diagnosis, a 16-page booklet printed by Partners in Caregiving, services should include recreational activities, social services, nursing services, rehabilitation therapy and medical services. "Services should give clients an extra measure of support and structure so they can remain in that level of care longer," says Rheem. Activities should entertain, educate, arouse senses and stimulate cognitive processes. When clients enjoy an activity, it should be scheduled regularly, says Beveridge. For example, a trip to the library every three weeks was added to Central's schedule because it was in such demand. Beveridge also suggests sending a survey to families to see if a particular service would be useful. Most importantly, don't forget that nothing is set in stone. Activities and services should be convenient and helpful to clients, but don't be afraid to change them upon request. Government SupervisionThere aren't federal regulations for adult day programs, but state regulations and licensure should be adhered to, says Beveridge. For example, in order for a facility to maintain certification, Rhode Island requires nurses at every program. Life After Diagnosis lists the requirements for adult-day-program operations: 25 states require licensure, 24 states require certification and regulations vary from state to state. "More regulations could be great," says Beveridge. "But I also know that increasing regulations adds more costs. We, as an industry, have to be careful not to drive the costs up so high that people can't afford to come to daycare." On the other hand, having no federal regulations makes it more difficult to ensure quality, says Perry. "You want to check with your state association for licensure and regulations, and to compare fees," she says. Challenges to AddressWhile Life After Diagnosis reports that there were approximately 15 adult day programs in 1975, 3,000 were documented by 1994. Although the industry has experienced tremendous growth and improvements, there are three challenges that programs continue to face: 1. Financing of services 2. Public awareness 3. Marketing Financing of services. Running a program can be challenging financially," says Beveridge. "You always have to watch costs." It has been estimated that it costs approximately $200,000 to $250,000 per year to run a day program. Everything from how many people a program will accommodate to which services will be provided and how many hours it will be open determine costs and fees. "We look at our true costs," continues Beveridge. "In other words, we figure out how much it costs us to have someone in our program, and we break it down from there." She says that because her program is not-for-profit, fees are reflected by its costs. In order to finance a program, clients and their needs must be determined. Most caregivers have taken a leave of absence or reduced their work hours. Caregivers need convenient help, so what will be best for them? What hours and days will the program be open? Which ancillary services will be provided? How much are fees? Will they cover all operating costs? Being flexible with hours and services will prove to be a prosperous practice all around. Larger communities can more readily support an adult day program, says Cox, who states that about 1 percent of a 20,000-person community (200 people) would be potential candidates for a program's slots. A small town might not be able to support a program based on sheer numbers, but Cox suggests expanding service populations to include children, for example. Grants are the main government source for adult day programs; however, many programs accept donations, too. "There are a variety of funding sources for clients, and Medicare is not one of them," says Rheem. "In some states Medicaid will pay." Although private insurance and limited government aid is available, many clients will pay for services out of pocket. Public awareness and marketing. These go hand in hand. According to Perry, NADSA is involved in promoting adult day services as an option for seniors and caregivers. Partners in Caregiving reports that only 46 percent of households with a family member 60 years or older knows about day programs; however, with marketing efforts, the number is rising. Each program must maintain an effective marketing regimen. "We are always present in the community," says Beveridge, whose program works with the Alzheimer's Association, and participates in educational programs and support groups. She adds that all of their advertising is through word of mouth, magazine and newspaper articles, and public speaking, which are all common marketing tools. Partnerships
Being affiliated with an assisted-living community or skilled-nursing facility can give an adult day program a promising start. Assisted-living and skilled-nursing facilities can offer referrals, giving the program a jump on clientele. Central Adultcare Services maintains a lot of ties to the community, explains Beveridge. "We get referrals from assisted-living communities and hospitals," she continues. "We all work together. We don't feel overly competitive. We see it as giving the consumer more choice." Rheem says assisted living and adult day programs make a natural partnership. She says, "If assisted living has a married couple, one of whom is declining in health, function or ability, they can remain an intact family unit longer. This is not a stand-alone service, though. There also has to be someone at home to provide service during the other hours of the day." However, one concern is that being associated with a skilled-nursing facility sometimes brings negative images for the family or client. "Some people may not want to be connected with a skilled-nursing facility," states Beveridge. "There is a fear--especially with dementia patients--of being put away and not going home." In most instances, assisted-living and skilled-nursing facilities are not in competition with adult day programs. Most operators resolve that concern by providing referrals. Other states, such as Rhode Island, eliminate competition by offering regional transportation procedures, says Beveridge. Transportation is available to a person if the person goes to a day program in the region where he lives. Although day programs can service statewide, many people don't have transportation or can't drive to get to a program outside of their region. "I am not sure that any programs should be a part of another," concludes Beveridge. "I think they all have specific personalities and joining them isn't necessarily good." Programs are growing in presence, but so is the demand. Marketing a program appropriately and then providing quality care, intriguing activities, reasonable fees and flexibility will set an adult day program on the right track. "I encourage a market analysis and a business plan with consultants that are already successful in the field," suggests Rheem. "This is not something to go dabbling in." Remember that a program's main goal should be relief for the personal caregiver, and quality care and attention for the client. "I think adult day programs are really only now coming into their own," concludes Rheem. "I think they continue to bridge the gap between institutional care and the home. They certainly allow the family to remain intact in the home." Ten Essentials for a Premier Adult Day Services Program
Reprinted from Respite Report, Winter 1994, with permission from Partners in Caregiving: The Dementia Services Program. More Information About Adult Day ServicesPartners in Caregiving National Institute on Adult Daycare National Association of Area Agencies on Aging National Alzheimer's Association
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This is not an
uncommon scenario. According to Susana Perry, program manager of the National Adult Day
Services Association (NADSA), an association that promotes adult day services, programs
began in the 1940s in psychiatric hospitals, which sparked negative images in the public's
eye. Since then, adult day programs have undergone many changes that put them in a
positive light. Programs are in great demand and many communities are discovering they are
a prosperous business opportunity.
Services
range from respite services for short periods of time to weekends and overnight options,
says Nancy Cox, deputy director of Partners in Caregiving: The Dementia Services Program,
a program created to test the notion that adult day services is a viable alternative to
skilled-nursing facilities. (The Robert Wood Foundation funds the program.) Each program
provides different ancillary services; transportation, personal care and meals are only a
few. Art therapy, hairdressing services, field trips, escorts for medical appointments,
physical therapy and counseling services should not be overlooked, says Beveridge.
Rheem believes
adult day programs are distinct enough to stand on their own. A freestanding program can
be profitable and a wise business if it is run as such. "If used improperly,"
she says, "it becomes a feeder service for institutional care. If used properly in
conjunction with another service, it acts, as it should, as an alternative choice to that
next level of care."|
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