The long-term care system in the United States is becoming an increasingly importunate policy issue. With the increasing number of the elderly people in the U.S., there is need for policy makers to incorporate policies to take care of their needs. Despite the fact that long-term care receives little attention than health care, long-term is also of equal importance in the U.S. There are challenges in implementing the long-term care system in the U.S. because of many unmet demands and the chronic illnesses of the elderly. The state and the federal government differ on who should finance the long-term care system. The finding for long-term care mainly comes from Medicare, insurance, Medicaid and cash in hand. With an aging population, measures are in place to improve the services of long-term care.
Introduction, history, and findings
Adult day care services refer to the assistance provided to the elderly people and the physically challenged during the day. The first count of adult care center was in 2002 by Robert foundation. The number of adults requiring care that time was less compared to today. Most of the facilities provide the services during the day for about 10-12 hours in a day. There are about 4600 adult care centers in the U.S.A. (Clark, 2001, p.45). Services include meals, recreational exercises, and overall supervision of the elderly people including some health care as and when need arises. These services offer relief to family members and caretakers of the elderly person who are able to carry on their daily activities with an assurance that their relative is safe. The major goal of the adult day care services is to defer or prevent dependency of the elderly through providing alternative care services.
The elderly often take part in the timetabled program and get a variety of services from the facility. Services include recommendation to the seniors on nutrition and diet, and education on exercise. In addition, seniors get meals and participate in physical exercises with certain intervals of resting periods. The seniors have sessions of interaction with their colleagues and they undergo supervision to avoid harm to themselves (Boyd, 1997, p.45). Further, these seniors get medical attention where necessary during their time of stay at the facility. At the end of the day, the seniors get transport back to their homes.
Staffs at the day care centers provide the services during the working hours of the day. These centers are situated in hospitals, churches, at nursing homes, at a school, or in a given area where the elderly meet. The staffs at these centers provide the meals, assist in exercises, and arrange social outings among other services. The day care services benefit those elderly people that have terminal illnesses and do not have anyone to take care of them during the day. For example, a 66-year-old man could be suffering from cancer and lives with relatives that work during the day. The relatives could decide to take him to the day care center where the staff will provide meals and monitor his medication. This program relieves the relatives of the burden and provides a chance for the man to socialize with other elderly people. The costs for the adult care services vary depending on the services provided and the location of the facility (Harris, 2002, p.54).
Types of adult day care services
There are varieties of services offered at an adult day care facility. The services provided are different depending on the care center. There are those centers that majorly focus on providing social services, others focus on medical services, and others focus on Alzheimer’s care (Ritchie, 2003, p.125). Generally, the types of services and activities provided in an adult day care center include physical education and exercise programs. The elderly also get assistance with feeding, walking, and going to the toilet. In addition, there is counseling on a variety of nutrition requirements and the benefits of exercising. Education services are also present, which enable the seniors to excite their mind and relax. Further services include monitoring the health of the seniors such as measuring their blood pressure, and their food intake.
Social activities are the major services provided at the adult day care center. The social services include preparation of simple meals and snacks as a group and individually. Arts and crafts are also part of the social activities done in a team. The seniors also practice gardening at the farms around the care center as part of the social activities. The staff at the care center also organizes holiday parties for the seniors to get an opportunity to socialize. Therapy is part of the services provided. It includes music, pet, occupational, speech and physical therapy (Sanfilippo & Forke, 2003, p.19). In addition, the care centers provide transport facilities for the elderly back and forth the care center and the home of the seniors.
Definitions of adult day care services
Therapy is a service provided at the adult day care center. It refers to the treatment that the elderly get in terms of care to make them less dependent on others. Therapy includes occupational treatment that deals with one’s profession. The staff at the care center assists the elderly in doing something they like as a pastime. For example, the staffs could secure a small land for a person that loves gardening to farm. This service provides the senior with an occupation and lengthens the life of the senior. Speech therapy refers to a situation where the staffs assist the elderly in articulating their words and being able to speak properly. This therapy enables the senior in socializing with others and living normally (Nieves, 2002, p.471). Music therapy enables the elderly in learning songs that help soothe their souls. This therapy is important in stimulating the mind of the seniors.
Education programs are another day care service. They refer to those simple teachings that the elderly learn at the day care center to help stimulate their brain. They enable the mind of the seniors to relax as they go on their daily lives (Powel & Roberts, 2002, p.160). Counseling, on the other hand, is more detailed. It refers to the advice given to the elderly on the right nutritional diets and the benefits of exercising. Counseling is important because it enables the seniors to make the right choices in their life regarding how to prolong their lives. Health monitoring refers to the constant checking of the lifestyle of the individual. It includes checking the amount of food intake for the elderly and checking their blood pressure among other health services.
Social services are the most important in an adult day care center. They refer to those activities that enable the elderly to socialize with their colleagues and perform physical exercises (Beisgen, et al., 2003, p.98). Social activities such as group exercise programs enable the elderly to relax their bones, which tend to shrink because of age. The physical exercises are important because they delay the aging process of the seniors making them more independent. The social services also encompass recreational trips, preparation of simple meals and crafts. These activities keep the elderly busy and defer the aging process.
Difference between adult day care and adult day health care
The two major types of adult care, adult day care and adult day health care, are different in their operations. The adult day care deals with recreational services, offering companionship, support of the elderly from peers among other supervised activities (Clark, 2001, p.101). The adult day care program emphasizes on team activities to stimulate their rather dull minds. Some of these team activities include exercise programs, music, cooking, crafts, and recreational trips among others. The adults in this program may often require help with their eating, going to the toilet, and dressing. However, these people do not often require specialized nursing care. In addition, the adult day care program provides transportation services and meals for the participants. Community outreach services are also part of the adult day care service.
In contrast, the adult day health care does not provide social services. This program instead provides detailed medical attention and therapy including rehabilitation services. This program offers doctor’s visits to the elderly and nursing care. Various rehabilitation activities at the adult day health care include occupational therapy and assistance with speech. Seniors with severe medical conditions are the major participants at the adult day health care program. The medical conditions that often require this care include Alzheimer’s condition (Arnold, 2001, p.67). Other conditions include adults recovering from a stroke, those with diabetes or heart diseases and those with spinal injuries.
Seniors with mental illnesses and some types of disabilities such as the Downs syndrome also participate in the program. In addition, weak adults that require help and nursing care in their daily activities also take part in the adult day health care program. However, the overall aim of the adult day care and the adult day health care program is to assist the elderly including those with chronic illnesses to be independent for the near future.
Adult day care center structure and profile
Different adult day care centers have different structures and profiles in their operations. However, there is general structure and profile that most centers follow in providing their services. A typical adult day care center operates from Monday to Friday beginning its operations at 6:30 a.m. to 6:00 p.m. in the evening (Harris, 2002, p.56). A typical adult day care center rests on 1000-5000 square foot area and a professional in the field of health or social work heads it. The facility has enough floor space for each participant. A registered nurse provides the services at the ground for about 8 hours in a day. In addition, there are professionals that provide specialized services such as occupational and physical therapy to the participants. A direct service staff is also available to provide services for a group of six clients. A maximum of 51 clients are served each day in a typical day care center.
The daily cost to each participant per day is approximately $68.89 for the services provided. Daily external fee from the Medicaid waiver or from a private participant amounts to about $61.71 (Arnold, 2001, p.41). Where there is a shortfall in the amount, the center receives donations or gets the finances through fundraisings. The center provides a wide range of services including social services, counseling, educational programs and assistance in eating and dressing. In addition, a typical adult day care center has a license and certification that makes it operational in a given state.
Definitions
The New York State (NYS) Department of Health (DOH) is responsible for setting regulations on adult day health care services. The regulations act defines adult day health care “as the health care and services provided to a group of registrants with functional impairments to maintain their health status and enable them to remain in the community” (NYS Health Rules and Regulations, 2004, p.9). A registrant is a non-resident person who does not belong to the specific home facility. A program is an authorized adult day health care service situated in a certified facility. Operating hours are the specific hours when the staffs at the facility provide the services required. The minimum number of hours of operation is five and these do not include time spent during transport.
A visit refers to the incident when the registrant attends the day health care center and receives the needed service. An individual visit can be less than the minimum five hours or more depending on the needs of the client. Registrant capacity, on the other hand, refers to the maximum number of clients that a day health care center can handle in a day of 24 hours. The operator of the program is the facilitator at the facility who coordinates all the activities of the program. The practitioner at the facility is the nurse or doctor at site. Department refers to the “New York State Department of Health” while commissioner is the “Commissioner of the New York State Department of Health” (NYS Health Rules & Regulations, 2004, p.12).
Area Agency Responsibilities
The area agent has a variety of responsibilities in the adult day health care program. The responsibilities include developing and implementing policies and rules consistent with the required standards of the day health care program. These policies should consider the rights of the participants in the health care program. The agency also ensures that the policies are in harmony with current standards and where necessary, the agency revises the policies to meet the current standards.
The agency is responsible for ensuring that practitioners provide the right services according to the needs of the participants at the day health care program. The agency is also responsible in delegating duties to practitioners to coordinate services at the care center. The agency also provides each registrant with a copy of their rights that are specific to a particular health care program.
Service Standards
The State of New York regulations have specific service standards that regulate the day health care services. The service standards state that the practitioner should provide a range of services according to the registrants’ requirements. These services should include social activities, nursing care, and assistance with daily live activities such as dressing or going to the toilet. In addition, health education services and nutritional care are in the service standards. The services provided should be professional from the practitioner. The registrant should get better after receiving the service. Only qualified and licensed practitioners can provide the services to the participants in a day health care center.
Administration standards
These are the governing principles at the center. The health care center must have a license and certification to operate. In addition, the provision of the day care services happens at a health care facility or a site of similar nature. The facility maintains clinical records for its clients and produces it as and when required. In addition, the information is confidential to the specific participant at the day care center.
Present and future of adult day care
The current adult day care system is more elaborated than it was several decades ago. The services provided at the day care center are not only the social services of recreational activities, games and exercises. The services presently include care for people with diabetes, cognitive disabilities or those that require rehabilitation services. In addition, the services provided currently focus on each individual’s needs at a time. Each client has an opportunity to participate in his or her own care through the specialized nursing care provided. The current environment of adult day care is collaborative where participants, doctors at the facility and family members take part in the system.
The future of adult day care is promising depending on many factors. One factor is the ability of the industry to join its services with those of other care systems. With a technologically perceptive generation, the day care systems will need to transform their services to fit in that society (Arnold, 2001, p.45). In future, there is a possibility of formal and informal ties with other services such as case management and home health. In addition, the future holds a more personal approach to service delivery in ensuring effectiveness. Internet based programs for service delivery and caregiver support will be the norm for the future.
References
Adult Day Health Care, (Title 10, Part 425). NYS Health Rules and Regulations. [Effective
3/17/2004] http://resources.nyahsa.org/adult_day_health/documents/Sec425_Regs.pdf
Arnold, D.T. (2001). Better Elder Care: A Nurse's Guide to Caring for Older Adults.
Philadelphia: Lippincott Williams & Wilkins.
Beisgen, B. A., Kraitchman, M.C., & Ellis, A.C. (2003). Senior Centers: Opportunities for
Successful Aging. New York: Springer Publishing Company.
Boyd, B.L., ed. (1997). Long-Term Care: Knowing the Risk, Paying the Price. Washington,
D.C.: Health Insurance Association of America.
Clark, C.L. (2001). Adult Day Services and Social Inclusion: Better Days. London: Jessica
Kingsley Publishers.
Harris, P.J. (2002). The National Directory of Adult Day Care Centers, 3rd edition. Silver
Spring, MD: Health Resources Publisher.
Nieves, E. J. (2002). The Effectiveness of the Assertive Community Treatment Model.
Administration and Policy in Mental Health, 29(6), 461–480.
Powell, J., & Roberts, H. (2002). Identifying 'Value' in Day Care Provision for Older People.
Journal of the Royal Society of Health, 122(3), 158–164.
Ritchie, L. (2003). Adult Day Care: Northern Perspectives. Public Health Nursing, 20(2), 120–
131.
Sanfilippo, J. G., & Forker, J.E. (2003). Creating Family: A Holistic Milieu at a Geriatric Adult
Day Center. Holistic Nursing Practice, 17(1), 19–21.
