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By Teng Vang
Adult day health care is a planned program of therapeutic activities designed to promote wellbeing through social and health related services. Adult day health care centers operate during daytime hours, Monday through Friday, in a safe and supportive environment. Adult day care centers can be public or private, non-profit or for-profit. ADHCs are licensed by the California Department of Public Health and certified for participation in the Medi-Cal program by the California Department of Aging.
Adult day health care centers and other Adult Day Care programs are quite different. For example, a social adult day care setting differs from adult day health care, which usually requires a health assessment by a physician before someone is admitted into the program. Adult day health care centers, which typically use the term “Adult Day Health Care” (ADHC) in their name, often provide physical, occupational, and speech therapy, and are usually staffed with an RN and other health and medical professionals. Another type of day care provides social and health services specifically for seniors/elders with Alzheimer’s or a related type of dementia. While there are similar services, ADHCs offer more intensive health, therapeutic, and social services for individuals with severe medical problems and for those at risk of being admitted to a fulltime nursing home. For more detailed information on ADHCs please visit www.aging.ca.gov/programs/adhc.
The Purpose of an ADHC?
The purpose of an ADHC is to provide unique intervention programs to restore or maintain optimal capacity for self-care to frail elderly persons or adults with disabilities, delay or prevent further health decline or admission to a skilled nursing home or other higher level care facilities, and to give caregivers a much-needed break (respite) to attend to other personal needs or just to rest and relax.
What Services do ADHCs Provide?
An ADHC provides a variety of health, therapeutic, and social services, in addition to other services that may be deemed necessary based on the individual condition of the patient or participants. ADHCs usually provide the following services:
• Professional Nursing & Personal Care Services (all participants are supervised, monitored, and cared for by RNs, LVNs, and other nursing staff): incontinence care, ambulation/mobility/transfer assistance, meal and hydration monitoring, medication reminders, doctor appointment reminders, oral care, health education, and much more.
• Social Services: provide family and participant support, including counseling, help with living arrangements, paper work, mental health monitoring, and provide access to community resources, assistance with other personal needs and more.
• Nutritious meals that accommodate special diets (breakfast and lunch). Most facilities also include snacks.
• Therapeutic Activities: arts and crafts, musical entertainment and sing-a-longs, mental stimulation games such as BINGO, gentle exercise such as stretching or relaxation activities, discussion groups (books, films, current events), holiday and birthday celebrations, local outings.
• Physical Therapy: assess each individual’s lower extremities’ range of motion, mobility, transfer, and other activities of daily living (ADLs) and instrumental activities of daily living (iADLs).
• Occupational Therapy: assess upper extremities’ range of motion, gross and fine coordination, and other activities daily livings (ADLs) and instrumental activities of daily livings (iADLs).
• Speech and Language Pathology Services: a speech therapist will usually assess a participant’s eating, chewing and swallowing habits/problems, and make recommendation for special diets.
• Registered Dietician Services: assess weight, eating, chewing and swallowing problems, nutrition education, and recommend food and diets.
• Mental Health Services: mental health professionals such as a Licensed Clinical Social Worker (LCSW), Psychologist or Psychiatrist should be on staff or available at the center for therapy and counseling.
• Transportation: provide daily transportation to and from the center.
Who is a Good Candidate for ADHC?
Good candidates for adult day health care centers are seniors/elders or adults who:
• Are Frail
• Have disabilities
• Are no longer able to manage activities of daily living independently
• Can’t be safely left alone at home;
• Can benefit from the social and friendship environment, and enjoyable and educational activities
• May be physically or cognitively challenged but do not require 24-hour supervision
• Are in the early stages of Alzheimer’s disease
• Mobile, with the possible assistance of a cane, walker or wheelchair
• Can benefit from other services provided by ADHC (as described above).
How to Get Started
Talk with friends who have been through similar situations, ask your doctor and/or the prospective participant’s doctor and/or look up an ADHC center near you in the yellow pages or on the Internet under Adult Day Health Care, ADHC, or Adult Day Care. Likewise, the California Department of Aging website contains a helpful list of licensed ADHC programs, organized by county (www.aging.ca.gov/programs/adhc). Next, go to that center and talk to the program director. Ask the program director to give you a tour and meet the staff. Stay there as long as you can or schedule a time to stay there for the whole day and see how things really work (activities, meal time, therapy sessions, etc.). The program director or another designated person, usually a social worker, will have you fill out an inquiry/intake form. The inquiry form will ask questions such as name of the participant, address, phone number, Medi-Cal card information, social security number, caregiver’s name and contact number, who referred the participant to the program, who is the participant’s primary doctor, what are the health concerns or disabilities of the participant, why the participant wants to get into a program, and other criterion that the individual must meet and/or need to get into the program.
Once the inquiry sheet is completed, the social worker or program director will tell family members or the participant if they meet the program’s qualifications. If the participant does not qualify, the ADHC you have been considering may refer you to the appropriate agency that can best meet the individual’s needs. If the participant does qualify, the next step is to have the participant’s primary doctor fill out an ADHC health assessment form also called the “H & P form” (health information such as the participant’s medical conditions, medications, TB clearance, etc.). Finally, the center will need to discuss with you how many days the participant wants to come to the center and finalize the remaining paper work (signing release forms, requesting medical records, and arranging payment and for evaluation days—also known as E-Days where multi-disciplinary practitioners assess and talk to the participant regarding their medical conditions/disabilities). A good ADHC will also most likely schedule a home visit before the participant begins attending his/her program. The purpose of this visit is to meet family members/caregivers, talk about the needs of the participant, and fully assess the daily modifications/medical equipment being used by the participant at home (i.e. measuring the restroom or bath tub in case the participant needs special equipment at the facility to complete tasks such as using the toilet, bathing, etc.).
Costs
The cost for an adult day health care center ranges from $76 to $77 or more per day, depending on where you live and the services provided (e.g., meals, transportation, nursing supervision). While Medicare does not cover adult day health care, Medicaid or Medi-Cal will pay most or all of the costs in licensed adult day health care settings. Private pay such as out-of-pocket payment is also accepted.
For the right candidate, ADHC programs can delay or prevent the need for a person to be admitted to a full time nursing home and give new meaning to their life through the valuable social relationships and activities the environment provides. Of utmost importance, however, is making sure that the ADHC of your choice will be able to meet the participant’s medical needs. Remember that choosing an ADHC is like any other investment, and you need to do your homework. But, unlike a traditional investment, this place will be caring for someone you love! Take your time in deciding on the right place, visit as many centers as you can, and don’t be afraid to ask questions. Also remember to talk to as many people as you can about the different options in your area. Seek professional council from physicians, hospitals, friends, and other local resources such as your aging societies or related nonprofit services, etc. Make sure the ADHC of your choice is a place you (and the participant especially) look forward to going and have a good feeling about. As this new place will be a “home away from home” for the participant, ensure that their new environment is safe, supportive, and sustains their sense of independence for as long as possible.
About the Author: Currently, Teng Vang is the program director of ADHC of Fresno and Clovis in Fresno. He has an advanced degree in public health (MPH) with more than 12 years of experience in providing health services to the elderly, multi-cultural groups, and under-served populations in the Fresno community.
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