32: Continuum of Care: Adult Daycare and Residential Care

This program will discuss:

• Issues that caregivers should take into consideration when considering the alternative care options
• Adult daycare and residential care

• There are no easy answer when it comes to the care of another
• Our hope is to offer you useful information and guidelines for caring for someone with dementia
• These guidelines will need to be adjusted to suit your own individual needs

Early stage (2-3 yrs)

• Forgetful
• Declining social skills
• Obsessed, restless, depressed, or apathetic
• Sleep changes may begin

Middle stage (3 to 4 yrs)

• Difficulty functioning at home and at work
• Personality changes and difficult behaviors
• Sleep pattern changes more common
• Able to manage personal care with prompting

Late stage (4 to 7 yrs)

• Greater difficulty with activities of daily living
• Reduced mobility
• Communication difficulties
• More difficult behaviors
• Worsening of sleep pattern disturbances
• Need 24 hour care

End-stage (less than a year)

• Unable to walk
• Unable to recognize people or objects
• Weight loss
• Incontinence
• Need complete care

• Planning care for individuals with a range of programs and services to meet their needs as their illness evolves
• Planning for care should begin soon after diagnosis of the disease
• Goal: transition from lesser to more intense levels of care over the course of the illness
• Placement in a long-term care facility will be a much smoother transition if family members are prepared, and the person is acclimated to settings other than a familiar home

• Plan well in advance
• Involve other family members
• Use a transitional approach to increasing the care
• Make a list of the caregiver and care recipient’s needs
• Caregivers
• Physical and mental health
• Weekly schedule and the time’s that help is needed
• Care recipient
• Wandering issues?
• Capable of performing daily activities?
• List resources
• Financial resources
• Friends and family members

• Factors
• Caregiver’s health, job, and income needs
• Stresses of caregiving could exacerbate these problems
• Knowledge about disease and resources
• Social support

• Safety issues
• Behavior problems
• Availability of services and facilities
• Family’s finances

What should Mary do to begin putting her new plans in place?

• A. Identify and evaluate everyone’s needs and resources.
• B. Research caregiver organizations and support groups.
• C. Visit adult day care facilities.
• D. Research residential care facilities in the area.
• E. All of the above.

Choice A: Identify and evaluate everyone’s needs and resources, is a good start.

Choice B: Research caregiver organizations and support groups, is also another good choice.

• Alzheimer’s Association

Tel: 800.272.3900 TDD: 866.403.3073 Website: http://www.alz.org/index.asp

• National Family Caregivers Association

Website: http://www.nfcacares.org/ Tel: 800.896.3650

• Lotsa Helping Hands (ARCH National Respite Network)

Website: http://archrespite.lotsahelpinghands.com/eldercare/home/ Tel: 919.490.5577

• Administration on Aging (AoA)

Website: http://www.aoa.gov/ Tel: 202.619.0724

• National Council on Aging

Website: http://www.ncoa.org/ Tel: 202.479.1200

• Meals on Wheels

Website: http://www.mowaa.org/Page.aspx?pid=183 Tel 703.548.5558

• Senior Companions

Website: http://www.seniorcorps.gov/about/programs/sc.asp Tel: 202.606.5000

• Religious organizations

Choice C: Visit adult day care facilities, is another way to begin making plans.

Choice D: Research residential care facilities in the area, is another possibility.

• Residential care programs should have a full-time activities therapist, who assesses and plans activities on an individual basis

Choice E: All of the above, is the best answer.

• Provides the caregiver a short break from caregiving
• Delays placement in long-term residential care
• Offers social activities, health services, therapeutic services, physical exercise, mental stimulation, and nutritious meals
• Three types of adult day care
• Alzheimer’s specific adult day care
• Adult day social care
• Adult day health care

• Program members are normally assigned to a group based on their function, cognitive level and sociability
• Find a match between the day care program and the individual’s needs and stage of illness
• Cost for adult day care can vary from $40 to $150 per day

• Area Agencies on Aging (AAAs)

Website: http://www.n4a.org/about-n4a/?fa=aaa-title-VI Tel: 202-872-0888

• National Adult Day Services Association (NADSA)

Website: www.ncoa.org Tel: (202) 479-6682

• ARCH National Respite Network

Website http://chtop.org/ARCH.html Tel: 919.490.5577

• Eldercare Locator

Website: http://www.aoa.gov/naic/elderloc.html or http://www.eldercare.gov/Eldercare.NET/Public/Home.aspx Tel: 800.677.1116

• Alzheimer’s Association: Adult Day Service Topic Sheet

http://www.alz.org/national/documents/topicsheet_adultday.pdf

• Better Business Bureau
• Phone Directory

• Supports independent living in a secure environment with some supervision and monitoring of activities and health
• Easy transition to a higher level of care within the same organization
• Offer a variety of services customized to individual needs
• Personal assistance is available in many assisted living facilities
• Range in cost from $800 to $5,000 a month or more
• May require an initial fee for buy-in/entry/community/endowment/admitting
• Additional fees for varying levels of care and customized services
• Assisted Living Federation of America (ALFA)

• Alzheimer’s Care Facilities
• Free-standing or associated with Assisted Living or other long-term care facilities
• Created with core principles of design and care: safety, security, comfort, love, respect, and independence or autonomy
• Alzheimer Special Care Units (SCUs)
• Specialized facilities within an existing nursing home or hospital
• Quality residential care facilities
• Physical layout and design
• Selection and training of staff
• Program of activities
• Management and administration
• Simple layout, organized, uncluttered, easy access to toilets and common areas, safety features, furniture and facilities that support independence, and secured doors and windows
• Qualities of compassion, patience, and person-centered care
• Trained in dementia care and managing difficult behaviors

• Quality residential care facilities (cont’d)
• Program of activities
• Activities therapist
• Management and administration of staff
• State and federal regulations
• Professionally licensed supervisors
• Training for nurse’s aids and nursing assistants
• Assisted Living Federation of America information for state regulatory agencies

http://www.alfa.org/i4a/pages/Index.cfm?pageID=3685

• Caregivers should ask very specific questions about facility design and staff training

• The longer individuals can be cared for in their own home and by loved family members, the longer they will be able to maintain their functional abilities
• Caregivers should make a list of needs
• Adult day care programs should provide social activities, therapeutic services, physical exercise, mental stimulation, and nutritious meals
• Assisted living facilities support independent living in a secure environment with some assistance and monitoring
• Assisted living programs easily transition to higher levels of service and care within the same organization
• Alzheimer’s care facilities and Special Care Units are specifically designed to accommodate residents with Alzheimer’s disease
• Physical layout and design
• Selection and training of staff
• Program of activities and care
• Management and administration

Written by:
Catherine M. Harris, PhD, RNCS.
Mindy J. Kim-Miller, MD, PhD

Edited by:
Sasha Asdourian

www.LightBridgeHealthcare.com

• Assisted Living Federation of America. (2008). Federal statutes that impact assisted living. http://www.alfa.org/i4a/pages/Index/
• Butcher HK, Holkup PA, Maas M, (2001). Thematic analysis of the experience of making a decision o place a family member with Alzheimer’s disease. Res Nurs Health 24(6): 470-80.
• Gaugler J, Leach C, Clay T, Newcomer R. (2004). Predictors of nursing home placement in African Americans with dementia. Journal American Geriatrics Society. 52:445-452.
• KaganJ. Respite Care. (2006). Wikipedia. Retrieved on March 17, 2009, from http://en.wikipedia.org/wiki/Respite_careARCH National Respite Coalition.
• McClendon MJ, Smyth KA, Neundorfer MM, (2006). Long-term-care placement and survival of persons with Alzheimer’s disease. Journals of Gerontology Series B. 61B(4) p220-7.
• Wang S, Davies E. (2007). [Family caregivers’ adjustment to nursing home placement of older relatives].Journal of Nursing (China). Jun; 54(3): 82-86.
• Schur D, Whitlach CJ. (2003). Circumstances leading to placement: A difficult caregiving decision. Lippencott’s Case Management 8 (5): 187-97.
• Whirrett T. Adult Day Care: One Form of Respite for Older Adults. (2002). ARCH Factsheet Number 54. Retrieved on March 17, 2009, fromhttp://www.archrespite.org/archfs54.pdf.