Adult day care centers provide a community-based way to care for physically or mentally impaired adults providing a safe, social and helpful environment designed to increase physical, emotional, and cognitive functioning. Participants are provided care at a central location, usually during the day, and participants return home at night. Adult day care centers are an alternative to institutional long-term care, total in-home care and assisted living. It prevents isolation for older or disabled individuals, providing a socialization environment with numerous activities. It also provides a safe environment with proper personal care, nutrition and hydration during the day. This service also offers respite while the primary caregiver goes to work, takes a vacation, needs to be relieved to manage the household or is in need of some 'time off.'
Types of Services
Social and some health services are offered in a day care center. The hours and days of operation will vary from center to center, but most are open at least 5 full days each week. Some centers keep weekend hours to meet the needs of family caregivers who work non-traditional hours. Some caregivers will use both adult day services and home health care to care for their loved one during the hours they are working. In most cases, an adult day care center has transportation to transport the loved one from the center to the person's home.
Before enrolling your loved one, you and your family will work with staff at the adult day care center to discuss the needs of your loved one and to develop a written care plan. During this time, it is important to talk openly with day care staff about your loved one's special needs. This will help staff at the day care determine the services that best meet the needs of your loved one. Typically, the services at an adult day services center include:
- structured and unstructured therapeutic activities,
- assistance with the activities of daily living,
- meals and snacks, including special diets,
- health screening or monitoring,
- information and referral.
Centers may also include as a part of their program:
- caregiver support, one-to-one and/or support group meetings,
- transportation or help arranging it,
- counseling or support groups,
- nursing care,
- physical therapy,
- occupational therapy,
- speech therapy,
- personal care (i.e., showers, baths, help with shaving or grooming),
- case management, and
- memory impairment care.
Cost and Coverage
Daily rates for adult day care centers in Virginia vary depending on organization providing the service, length of stay, and activities covered. Many public or non-profit organizations provide financial assistance to those that qualify, or reduce fees based on a daily sliding fee scale, which is adjusted to the client's ability to pay. Adult day services can be an economical alternative for those who must pay out of pocket for long-term care. For those who itemize, adult day services are a qualified medical expense when filing federal tax returns.
Like with most long-term care services, Medicare does not cover the costs of adult day care centers. Medicaid pays for adult day health care and transportation, alone or in combination with in-home personal care, for those who meet financial and Uniform Assessment Instrument (UAI) nursing home criteria and if the program is Medicaid certified (NOTE: Adult Day Health Care is the term used for Medicaid-certified adult day care services).
Long-term care insurance policies also cover adult day care center services. The veterans administration and local departments of social services, through their adult services or adult protective services units, also may be able to assist with the costs.
It may be helpful to contact the adult day care center first to learn more about paying for the services. Often, staff will be able to guide you through the process of what to do and who to contact.
Licensure and Accreditation
The Virginia Department of Social Services (VDSS) licenses adult day care centers in Virginia. VDSS issues four types of licenses for adult day services, including a conditional license, provisional license and a one, two or three-year license.
DSS issues a conditional license (for no more than six months) to new facilities, in order to give them time to become fully operational and demonstrate compliance with stated standards. If a facility is temporarily unable to comply with the standards it will be issued a provisional license which is also issued for no more than six months.
The type of license a center has can be a good indicator of the center's quality standards. For example, a center who obtains a three-year license exceeds minimum standards, while centers with one or two-year licenses meet minimum or just above minimum standards.
When rating adult day services, the Department of Social Services rates staffing qualifications, patterns and ratios, facility management, and the program itself. Centers are also rated on emergency preparedness. The VDSS website now posts a searchable database for finding adult day care centers by name, locality, zip code and centers that accept non-ambulatory participants. Once a facility is located, one can click on the name to see basic information about the center, then click on an inspection date to view the findings of that inspection.
A voluntary accreditation program for adult day services has been established jointly by the Commission on Accreditation of Rehabilitation Facilities (CARF), and the National Adult Day Services Association (NADSA). There are only a few centers nationwide who have completed this accreditation process. However, when selecting an adult day services program, inquire about the program's philosophy towards accreditation and ask the administrator to discuss the meaning of the accreditation and licensing standards with you. While it is a very expensive process to apply for and achieve the accreditation standard, administrators of the program will have some idea of how their program does or does not meet the accreditation standards.
- Adult Day Care Centers serve a wide variety of needs. Staff at centers can work with families to determine the best care for their loved one. They may also be able to discuss with the family ways to talk with a loved one who may be hesitant about attending. When talking with day care staff, it is important to talk openly about your loved one's special needs. This will help staff at the day care determine the services that best meet the needs of your loved one.
- In Virginia, licensing is not required of non-profit adult day care centers. However, most non-profit centers voluntarily adhere to licensing requirements and become licensed by the Virginia Department of Social Services. All licensed adult day care centers are required to have their license clearly posted in the center. If you visit a non-profit adult day care program, ask whether or not they are licensed. If they are not licensed, ask them why not and whether they intend to become licensed.
- Most adult day care centers accepting patients with dementia will have procedures in place for deterring participants from wandering (i.e., alarms on doors, etc.).
- An adult day care center must be Medicaid certified in order to accept Medicaid for payment. Medicaid-certified adult day care services are termed Adult Day Health Care. Medicaid certification designates a higher level of caring and medical services such as nursing and rehabilitation. Regardless of whether or not Medicaid is your payment method, knowing if the center is Medicaid certified will tell you more about the activities, staffing and programming of the agency.