Adult Day Care

A Practical Guidebook and Manual

Lenore A Tate, Cynthia M Brennan

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781317839897
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Intended for long-term care providers, consumers, and gerontology students, this valuable new guidebook and manual encourages the promotion and enhancement of adult day care as an essential link in long-term care. Since the early 1970s, the number of adult day care centers in the United States has grown from 20 to more than 620. This rapid increase in adult day care programs indicates that it is an important health care and social resource that has begun to fill a necessary gap in the long-term care system. To further meet the increasing needs, this new book provides information regarding the history, definition, and concept of adult day care; models of care; scope of activities; state and national policy; and samples of forms and reports needed for daily operations.

Chapter One

Aging: A National Perspective

America is a nation that is aging. Elderly persons now comprise the fastest growing segment of the population (Dolan, 1980). Since the baby boom of the 1940s and 1950s, the nation has shifted from a youth-oriented society to an adult-oriented culture. Today, 12.2% of the population is over the age of 65. The increase in the over 65 segment of the population is expected to continue well into the year 2035, when the elderly will comprise 18% of the total population. Within the elderly population, the fastest rate of growth is the “old-old.” In this age group, over 10 million persons are over 75 years of age. The number of people aged 85 and over has tripled between 1950 and 1970, increasing from 600,000 to 2 million. The number in the 75 to 85 age group has almost doubled. These are the ages in which hospitalization, institutionalization, and an array of long-term care services are very high (Farber, 1983).

Prior to 1950 many of today’s medical procedures were not available, hence many older persons suffered dependency or death. Improvements in sanitation, public health, disease control, medical care, and general quality of life have enhanced the number and proportion of older people in the general population. At the same time many older persons have one or more chronic conditions such as diabetes, cardiovascular disease, arthritis, and impaired vision and hearing (Butler & Lewis, 1982; Golightly et al., 1984). In addition, they are at risk for further decrements and acute exacerbation of their chronic conditions (Brody, 1980). It is not surprising that the average health care usage and cost for older Americans is disproportionately higher than for those persons under the age of 65 (Butler & Lewis, 1982; Roos, Shapiro & Roos, 1984; Vital Health Statistics, 1980). The maintenance of adequate health care, then, becomes increasingly more significant to the elderly as they continue to grow older, become more frail, and find their financial resources are limited by a fixed income.

During recent decades, recognizable advances in the health care industry and apparent successes in refinements of care have increased demands for service. National policy reflects a need for affordable and improved care that can be subsidized in one form or another. Programs instituted for older citizens are a result of this policy. Medicare and Medicaid programs that began in the 1960s are now an integral part of United States governmental programs. Today, a variety of proposals are before congressional committees to expand these programs and to add modalities for federal participation.

By the latter part of the 1970s and into the 1980s, a number of states instituted legislation to place limitations on federal government spending. Many social and health programs that grew out of early federal support systems are now obliged to find new alternative funding because of diminishing resources. The rigidity of federal and state reimbursement systems has discouraged the development of activities (McCuan, 1973). Although long-term effects of these changes are not known, many programs have been curtailed. On the other hand, the potential of private insurance (third-party reimbursement) or pension plans are being investigated by many programs.

Quite obviously, the reimbursement source influences the nature of programs and services to the elderly. In view of these convergent and growing needs for innovative approaches to treatment/care for the elderly, a relatively new concept has found its place among the long-term care services. Adult day care is a relatively low-cost service that assists the frail elderly and physically impaired adult by providing personal care, supervision, and an organized program of activities, experiences, and therapies in a protective setting. It offers an individualized plan of care designed to maintain impaired persons at, or restore them to, their optimal level of independence (Padula, 1983). Padula reported that a variety of adult day care programs offer services ranging from active rehabilitation to social and health-related care. These programs are usually coordinated with and related to other agencies and services such as senior centers, in-home care, and institutional and hospital care. Padula concludes that it is an innovative way to organize and blend traditional health and social services for the frail adult.

Adult day care offers several advantages and is distinguished from other forms of long-term care primarily in that “ … it allows the participant: (1) to continue to live in the home; (2) to maintain social ties in their community; (3) to relieve the family of the burden for 24-hour care; and (4) to be cost-effective” (O’Brien, 1980).

AGING IN ARIZONA

As a result of the increased numbers of elderly and their need for services, Arizona communities began implementing adult day care programs in the 1970s.

Even though tens of thousands of retirees make Arizona their Winter home, the year-round proportion of people 65 and over has been about the same as the national average. Currently, nearly one out of five (20%) Arizona residents are 55 years of age. Eleven percent – more than 307,000 persons – are over the age of 65 in Arizona (see Table 1). The number of elderly people between the ages of 75 to 85 years is increasing rapidly. This age group comprises 38% of the elderly and will rise to 44% in the next 16 years. While the elderly share common problems, persons 75 years of age and older are the most vulnerable to physical, mental, and social problems that lead to requests for health care and related services.

Approximately 80% of all persons over the age of 65 have at least one chronic disease, 30 to 40% of those over 65 have significant hearing or visual impairments, and 25 to 30% of those over 65 have some evidence of dementia or depression. As these statistics indicate, the state of Arizona, and Phoenix in particular, is in urgent need of a coordinated care program. An effective program consists of a balance of appropriate social and supportive services; acute and long-term care (skilled, intermediate, and supervisory); and innovative, preventive, diagnostic, and rehabilitative services (e.g., adult day care, home health care, nutrition, live-in care, social activity, and hospice).

Table 1. 1980 Census Population 65 Years and Over.

	United States	Arizona
White	22,948,193	285,664
Black	2,086,858	5,087
Native American, Eskimos, and Aleut	74,919	7,135
Asian/Pacific Islander	211,736	1,084
Other	227,721	8,393
Total population 65+	25,549,427	307,362
Spanish Origin*	708,880*	19,797*

*May be any race.

Source: U.S. Department of Commerce, Bureau of the Census. (1983).

The providers of long-term care, acute care, and supportive, rehabilitative, and social care in Arizona are involved in developing networks and health care delivery systems to increase their share of the elderly market and related reimbursable health care services. The state of Arizona and leading employers (Arizona Coalition for Cost-Effective Quality Health Care) as well as health care insurers are stressing the importance of cost containment and/or responsible and efficient management by health care resources.

Currently, there is no licensing of adult day care in the state of Arizona. Programs which receive federal dollars go through a certification process authorized by the Department of Economic Security. The Arizona Association of Adult Day Health Care is supportive of “some kind” of licensing requirements and standards for adult day care centers in Arizona. A study committee formed by the Department of Health Services (DHS) has submitted a draft of proposed recommendations for the licensing of adult day care/adult day health care to the Director of DHS. This committee was represented by people throughout the state who had knowledge of adult day care and who worked for 10 months on these recommendations.

In Arizona, families of the elderly and disabled provide approximately 80% of the support services necessary to maintain the elderly in their communities. Various studies indicate that families today are smaller, and often both husband and wife are employed away from home. Care for the elderly at home becomes increasingly difficult without proper community support and resources.

In Arizona, most community programs for the elderly are provided by nonprofit groups such as the Foundation for Senior Living (FSL), incorporated in 1974. FSL’s founders believed that support and advocacy services for older Americans should be provided to meet the steady increase of elderly in the population. FSL provides a complete range of programs, services, and facilities to meet the varied needs of older Americans. These include community service activities, live-in care, nutrition programs, Retired Senior Volunteer Program (RSVP), retirement housing, nursing homes, home-maker services, home health care, and adult day care. FSL has over 8,500 senior participants in five counties within the state of Arizona: Maricopa, Mohave, Yavapai, Yuma, and Coconino. It employs approximately 400 persons on a full- or part-time basis to administer, staff, and provide a wide range of health and community services to the elderly of Arizona. A professional staff manages FSL under the guidance of a volunteer board of directors consisting of 30 members who are elected on an annual basis.

A portion of FSL’s funding comes from federal, state, and local government grants. Agencies providing funding for FSL’s programs include the Area Agency on Aging, Department of Economic Security, Maricopa County Human Resources, Department of Action, and City of Phoenix. The balance of the funding is received from contributions, private grants, United Way, corporate gifts, individual fees, rental income, and management fees.

Adult day care centers were one of the Foundation for Senior Living’s original programs and FSL has gained respect from the community for its effort in preventing premature or inappropriate institutionalization. FSL’s adult day care programs are among the finest in the country and have been so mentioned in national publications (Leonard, 1978). Despite recent funding reductions, the Foundation opened four new adult day care programs in areas of need, and continued to provide the highest quality of adult day care services.

HISTORY

Adult day care was initially associated with psychiatric patients and began in the U.S.S.R. in 1942. By 1946, day care facilities opened in London and Montreal. In the United States, the Menninger...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Introduction
• Chapter One: Aging: A National Perspective
• Chapter Two: Programs, Interventions, and Strategies
• Chapter Three: Foundation for Senior Living Operations Manual
• References
• APPENDIXES: FSL Adult Day Care Operations Manual