DIMENSIONS Spring 1998


by Julie Cleveland

Adult day centers are structured environments for older people with dementia or other disabilities. These centers give people an opportunity to spend the day engaging in social activities with peers, and to receive care from health professionals and volunteers. Most adult day centers provide simple, sensory related activities, and focus on providing meaningful experiences for people with dementia.

Day centers can sometimes benefit both caregivers and people with dementia. When a person spends time at a day center, his or her caregiver has time to relax, rest and finish tasks that otherwise may be left unfinished. This respite can help a caregiver feel refreshed, better able to meet the needs of the person with dementia, and better able to enjoy the time spent with the person when he or she returns home. In addition, the staff at the day care center can offer new and useful ideas for caregivers to use at home.

People with dementia may also benefit from day centers in several ways. They engage in social activities with other older people in a safe environment. Specific activities may include "chair" aerobics, arts and crafts, looking at picture books, and watching visitors who tell stories, sing, or bring animals to pet. Patients therefore receive care from health care professionals and attention from friendly trained staff and volunteers.

There are many issues to consider when selecting a day center. Day centers vary widely in the services they provide, what type of individuals they accept, how much they cost, and what hours they operate. By asking the right questions, caregivers can choose the day center that will best fit their needs and those of the person with dementia.

Be sure to consult a variety of sources to gather information on day centers (a list of names and numbers is provided at the end of the article). Also, be sure to actually visit the centers you are considering before you choose one. When choosing a day center, consider how the staff assess patient needs, what services are offered, how accessible the facility is, what kinds of staff are available, what type of transportation is offered' how pleasant and clean the facility is, and the cost. Here are some further ideas on how to select a day center.

Assessment: Centers should provide assessment of the individual's needs for care. This assessment typically includes a variety of areas including social skills, medical needs, family history, and cognitive functioning. Ask the center what type of assessment they provide and how often they repeat it. People with dementia have changing needs for care as their condition progresses.

Services: There are many different services that day centers can provide. These include health services, counseling, personal care, nutrition, recreation, therapy (occupational, physical, and or speech), and behavior management. There are few centers that provide all of these services, so make sure that the facility you choose offers the specific services that you and the person with dementia need.

Accessibility: Day centers have varying hours of operation. Most centers are open weekdays, from the morning to late afternoon, usually from 8 a.m. to 4 p.m.. Some have extended or weekend hours. People may attend the center from one to five days per week; some centers require a minimum attendance. Be sure your schedule is compatible with that of the center.

Location and Transportation: Getting to and from the day center may be a long and tiresome process. Don't be discouraged if the center that best meets your needs is not the one closest to you; some centers provide transportation to and from the center. Others may provide transportation to medical appointments and field trips. Find out if these services are included in the basic price, or are an additional charge.

Staff: Staff at day centers range from volunteers to medical professionals. The staff at the day center should be well trained and skilled in their work with older adults. Ask the center what type of training they provide, such as first aid and safety, caring for people with dementia, or working with frail and disabled people. Observe how the staff interact with the day center participants, and the ratio of staff to participants.

Facility: Assess the overall quality and appearance of the day center. Note how much space there is for activities, both indoors and outdoors. Is the center designed to handle events such as wandering or behavioral disruptions? Does the building have accommodations for people who are visually or hearing impaired, in a wheelchair, or have other disabilities?

Cost: Most centers charge by the day for basic services, which can range anywhere from free/donations, to $60. Others may charge by the hour, or month. Many centers operate on a sliding scale, in which the cost depends on income or need for financial assistance. Centers may have additional fees for extended hours of stay, field trips, or transportation. In some states, including Washington, Medicaid will help cover the costs for those with low income and few assets.

When you have finally selected a day center, be sure to allow ample time for the person with dementia to adjust. Some patients may be hesitant at first, but over time actually look forward to the time spent at the center. After using a center for several months, re-assess your needs and the needs of the person you are caring for. Eventually, the person may need more care than the day center can provide. The staff at the center can help you with this evaluation process.

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