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


  • 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


  • 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


32: Continuum of Care: Adult Daycare and Residential Care

Select the best answers from the list of choices following each question.

Click here to open Certificate of Completion
  • 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.