The need for and benefit of Adult Day Health Services

Approximately 43.5 million caregivers have provided unpaid care to an adult or child in the last 12 months. Nearly one out of every four U.S. households provides care to a relative or friend aged 50 or older. About 15% of U.S. adults care for a seriously ill or disabled family member.

The Robert Woods Johnson Foundation and Wake Forest University School of Medicine funded a national study in 2002 of adult day care (ADC) centers and found that the current number of centers, 3407, falls severely short of the 8520 needed. Fifty six percent of the counties in the U.S. are underserved due to (1) having no adult day care (2) underutilization of the current day care (3) the need for expansion or another day care in the same county. Underutilization of adult day cares was found to be due to a lack of awareness and understanding of what adult day care centers can do and what services they provide.

The study shows that ADC centers are a viable, cost effective, community-based service option that helps keep individuals in need of chronic care at home, in their community, with family and friends as long as possible.

Services provided at ADC centers normally include: meals, transportation, therapeutic activities, social services, health related services to include medication administration, weight and blood pressure monitoring, blood sugar testing, health screening, behavior management, breathing treatments, wound care, physical therapy, occupational therapy, speech therapy, toileting and incontinence. The two most prevalent participant conditions are (52%) dementia and (41%) frail and elderly. The average age is 72. Many ADCs provide in-home personal care assistance to include: bathing, feeding, hair and nail care, nursing services including tube feeding, wound care, tracheostomy care, oxygen and breathing treatments, IV therapy, injections, colostomy and catheter care, bowel and bladder care, medication administration, and blood sugar testing.

As over 55% of these individuals are living with a spouse or child, ADC and personal care assistant services provide much needed respite for caregivers allowing the individual to age in place, thereby reducing or delaying nursing home placement. In most cases this enables the spouse or child to continue employment while insuring their loved one is in a safe environment.

Research about the social context of ADC reveals that participation in ADC can delay the onset of dementia. Challenging mental activities and deeply satisfying social contacts have been found to protect against dementia and cognitive decline. Research has shown that ADC participation prevents depression in the elderly which is known to exacerbate physical illness. There is also a high prevalence of inadequate nutrition and malnutrition among this age group which leads to physical, cognitive, and functional decline. It is found to be particularly high, up to 85%, among nursing home patients. ADCs provide dietitian-planned meals and frequent snacks, in a family-like environment, promoting friends, relationships, and bonding. Challenging mental activities and deeply satisfying contacts have been found to protect against dementia and cognitive decline.

For the family who prefers to keep their loved one in the home, ADC is clearly the best solution for all concerned. In addition to all of the above benefits, ADC is currently the most cost-effective option. The average cost for in-home care is $44,000 annually. The average cost for nursing home placement ranges from $34,224 to $48,360 per year. Currently two thirds of the nursing home beds in SC are paid by Medicaid. In SC, the cost of ADC is $11,520 per year.

Resources

• Report: Shortage of Adult Day Services in Most U.S. Counties. Robert Woods
  Johnson, Wake Forest University School of Medicine, 2002.
• B. Mion LC, McDowell JA, Heaney LK. Nutritional Assessment of the Elderly In
  The Ambulatory Setting. Nurse Practitioner Forum, 1994.
• Gaugler, JE and Zarit, SH (2001). The Effectiveness of Adult Day Services for
  Disabled Older People. Journal of Aging and Social Policy, 12 (1) 23-47
• Meuser, CS (1997). Why Government and Business Should Take a Look At
  Adult Day Care. Quinnipiac Health Law, 1. 219-255.