LeadingAge Magazine · July/August 2014 • Volume 04 • Number 04

Adult Day Services Fill in the Gaps

June 22, 2014 | by Mary Ruth Johnson

Adult day centers fill a valuable role by offering services and supports that help keep seniors living at home and offer education and respite for family caregivers.

Adult day centers fill a critical gap in the senior-services market, allowing seniors to delay the need for an assisted living facility or nursing home and remain at home as long as possible. Also, they provide valuable support, education and respite for caregivers to temporarily relieve them of their vast responsibilities.

According to the results of the National Study of Long Term Care Providers: Overview 2013, published by the National Center for Health Statistics (NCHS), as of 2012 the United States had an estimated 4,800 federal or state-regulated adult day centers. In addition, the 2010 MetLife National Study of Adult Day Services found that adult day centers served more than 260,000 seniors and family caregivers nationwide, an increase of 63% since 2002.

Medical model adult day provides medical and therapeutic treatment. Social model adult day offers supervised activities, camaraderie with peers and recreation. The specialized model is targeted to specific groups, such as individuals diagnosed with Alzheimer’s and other dementias.

Here’s a look at four distinctive adult day programs, each providing valued and innovative care to seniors.

Natalie Macaro, director of adult day programs at The Francis E. Parker Memorial Home in Highland Park, NJ, has an integrated philosophy of care: “When you enroll the person, you also enroll the family,” says Macaro. “We must think about what we can provide for the participant and the family, especially if the family doesn’t know about community resources and how to prepare for the next step.”

The Parker Home, founded in 1907, recognized a need in its community for services that would enable seniors to stay in their homes as long as possible. In 2008 Parker at the Pavilion opened, offering the first medical adult day services for seniors in Middlesex and Somerset counties.

The overwhelming success of the medical model adult day program prompted the Parker Home to open a social model program in 2010 which caters to seniors who do not require medical or functional support, but who want to socialize with their peers and have access to the many amenities the Parker Home provides. Each individual plans their own schedule: Go to the Parker Theater, the salon, have lunch with friends, work out in the fitness center or attend classes.

Challenged with the knowledge that seniors from local senior housing communities were not receiving important services or were experiencing isolation and a lack of stimulating activities, Macaro was determined to find a solution. She understood the seniors’ reluctance to join Parker at the Pavilion: cost, fear of social acceptance, paperwork, etc. She knew if the seniors would not venture out for the program, then the program must go to them.

The answer came in the form of a LeadingAge Innovations Fund grant. Parker Home was awarded one of the initial four grants in 2013 to develop and present this program, Parker Day Club at Home, to isolated seniors who live in local senior housing buildings.

“We package little pieces of our medical and social programs, along with a hot meal, to bring to the community rooms in each senior building one day a week from 10 a.m. to 2 p.m.,” says Macaro. “We average 20 people a day and serve 100 seniors a week.”

Parker Home embraces the Eden Alternative® philosophy. “Every staff member is trained in this philosophy and several of our staff are certified Eden Associates,” says Macaro.

In 1985 a group of dedicated nurses and social workers from Gainesville, GA, and the surrounding rural areas were frustrated because their area lacked services that enabled seniors to age in their own home. This innovative group realized there had to be something in-between the emergency room and a nursing home so that seniors could age in place with dignity. This prompted them to open The Guest House, Inc., a health care and activities day program for seniors who need daytime medical care, cognitive stimulation, good nutrition and socialization. They also viewed caregiving as a challenging journey in which caregivers need respite, support and services in order to preserve their own well-being as they painstakingly care for someone else.

Dana Chapman, executive director of The Guest House, compares the services they provide for seniors to an Oreo cookie: “The bottom part of the cookie is the solid nursing care the seniors receive, the middle part (the good part) is the fun and activities provided for the seniors, and the top part of the cookie is the respite we provide to our caregivers. We can have 25 clients per day and in reality we will be servicing 50 to 60 people,” says Chapman.

Caregivers who live in rural areas can find caregiving more of a challenge than in urban and suburban areas. Some of the biggest challenges for rural seniors are a lack of medical services, higher poverty levels, geographic dispersion, lack of transportation and an ongoing struggle to retain medical professionals in rural areas. Chapman deals with these challenges every day.

The Guest House is a self-sustaining non-profit organization and receives donations from civic groups, businesses, churches, fundraising events and people in the community. “Employees from local businesses, members of civic groups and people in the community help in numerous ways,” says Chapman. “We are able to provide our seniors with quality medical care, two nutritious meals, and meaningful activities because of the generosity of people in our community.”

Christian Care Communities was founded in 1884 and is Kentucky’s largest not-for-profit provider of affordable senior services through its multifaceted network of senior communities. The organization has three adult day centers, two in Lexington and one in Louisville, and plans to open a new memory care adult day center in Hopkinsville by the end of 2014. They also manage an intergenerational center in Louisville.

Christian Care Day Centers serve over 100 individuals:

  • Central Adult Day Center in Lexington: Christian Care’s original day center began in Central Christian Church and due to program growth, moved to a larger free-standing building.
  • Best Friends™ Adult Day Center in Lexington: An internationally recognized care model, celebrating 30 years, is a specialized program designed to care for older adults with Alzheimer’s disease and memory disorders.
  • Christian Health Center West Day Center in Louisville: Opened in late 2012 as a renovated wing of a skilled nursing community and specializes in care for older adults.
  • Oak and Acorn Day Center in Louisville, managed by Christian Care Communities: an intergenerational center for seniors and young children.
  • Cornell Memory Care Center in Hopkinsville will be a freestanding day center nestled in the heart of Christian Care’s 40-acre existing CCRC.

Tonya Cox, Christian Care’s director of home and community based services, and her team are guided by the principles of The Best Friends™ Approach to Alzheimer’s Care, which was developed in the 1990’s by Virginia Bell and David Troxel when they both worked at the University of Kentucky Alzheimer’s Disease Research Center. This philosophy recognizes the value of friendship in all aspects of life, particularly in caring for those with Alzheimer’s and other dementias.

“The Best Friends approach allows our participants to feel valued,” says Mary Lynn Spalding, vice president of innovation and growth at Christian Care Communities. “Staff knows each participant’s life story, treats each participant as an individual and provides them with meaningful engagements based on their life story.”

The Cornell Memory Care Center in Hopkinsville is expected to open by the end of 2014. “Hopkinsville has a population of less than 50,000 people,” says Spalding, “and this community has remarkably raised $700,000 towards the construction of the memory care center.” The center will be an integral part of the existing CCRC.

Mary Lynn Spalding has learned valuable life lessons from the individuals who receive services through Christian Care Communities. “I have learned to focus on what an individual has and not what they’ve lost,” says Spalding. “I’ve deepened my faith and recognized the gift we receive when we care for others.”

The vision of the Saint Elizabeth Community in Rhode Island is to provide a full spectrum of innovative services for the growing numbers of seniors who live or participate in their 10 communities. “We make sure our seniors receive the right care in the right place at the right time,” says Steve Horowitz, president and CEO.

“When Cornerstone Adult Day Services became a member of the Saint Elizabeth Community in 2009,” continues Horowitz, “we were able to provide a full continuum of care for seniors in Rhode Island.”

Cornerstone has five adult day centers that serve a little more than 200 participants per week. The Memory Care Center in Warwick is a specialized program geared to support mild to progressed memory loss, and the first memory care adult day center in the state.The other four—Apponaug, Coventry Center, Bristol Center and the Nancy Brayton Osborn Adult Day Center—are medical/social model programs.

With the support of a grant from the Tufts Health Plan Foundation, exercise and nutrition classes (under the supervision of a personal trainer, physical therapist and dietician), are being offered three times a week at all five centers for people with early memory loss.

“Falls are a major concern for seniors,” says Dottie Santagata, administrator of Cornerstone Adult Services, “so we also created a fall-prevention program. We see significant improvement in our participants’ strength, balance, endurance, cognition and confidence through these programs. Families are so excited with the improvements, they ask us for exercises they can do at home with their loved one."

The staff at Cornerstone is trained to help each participant feel productive. They don’t look at the individual’s disability, but look at what they still can do and what is meaningful for them. “We incorporate a person-centered approach,” says Santagata, “and provide the best day possible for each participant.”

Saint Elizabeth Community has incorporated The Wish Project, an idea staff came up with which recognizes that at any age we wish and dream. “At all our locations we ask those in our care what they wish for and we try to make those wishes come true,” says Santagata. “One of our men always wanted to make a potter’s bench for his wife and one of our women always wanted to go to the opera. We made both of these wishes come true and deeply touched the lives of these participants.”