Survey of adult day care in the United States. National and regional findings

‘I shall miss the company’: participants’ reflections on time-limited day centre programming

The social needs of frail or isolated older people are sometimes aided by referrals to day centres in the United Kingdom. Since the late 1940s, day centres have had a role to play promoting socialisation in later life. Additionally, attendance at day centres is often open ended, with participants only leaving due to moving to a nursing home or dying. In this study, the views of those attending time-limited day centre programmes in seven day centres in Northern Ireland have been sought in relation to their thoughts about the service as well as how they feel when it ends. Seventeen participants completed diaries for the programme duration and/or engaged in an interview process. Participants reflected on the social and educational benefits of attending but also recognised impositions in the centres that impinged upon individual choices and also the length of time they could remain. This study reveals that, in order to maintain socialisation, time-limited programmes must have clear follow-on strategies for participants. Additionally, respondents’ experiences reflect that a paternalistic model of care delivery remains in place that, whilst restrictive, reveals that access to the service is more specialised and not universal. Nevertheless, should day centres wish to remain relevant, it is important that service users are fully consulted about their desires and choices within the setting.

Using the Social Ecological Model to Identify Drivers of Nutrition Risk in Adult Day Settings Serving East Asian Older Adults

Adult day care (ADC) centers provide community-based care (including meals) to frail, ethnically diverse older adults, many of whom are at risk for malnutrition. To support the development of interventions to benefit ADC users, the authors aimed to identify barriers and facilitators of healthy nutrition among ADC users born in Vietnam and China. Semi-structured qualitative interviews were conducted among ADC stakeholders to identify barriers and facilitators. Data were analyzed using Braun and Clarke's six-step method and organized within the framework of the Social Ecological Model. Facilitators of good nutrition included adherence to traditional diet at the ADC center, peer networks, and access to ethnic grocers. Poor health, family dynamics, and loneliness all contributed to poor nutrition, as did the restrictive nature of nutrition programs serving ADC users in the United States. Individual, relationship, organizational, community, and policy level factors play a role in ADC users' nutritional status. Targeted nutrition interventions should leverage culturally congruent relationships between ADC users and staff and include advocacy for enhancement of federal programs to support this population. [Research in Gerontological Nursing, 13(3), 146-157.].

Older People, Loss, and Loneliness: The Troublesome Nature of Increased Contact With Adult Children

Older people may experience considerable loss when they endure emotional or social loneliness. Emotional loneliness is related to the loss or absence of a confidant while social loneliness describes the discrepancy between the nature of one’s desired and actual social network. In this article, both concepts are examined in relation to new attendees at time-limited day center reablement programs in Northern Ireland. Using group work activities, reablement programs aim to motivate participants to continue to live independently, often in the face of later life losses. Out of a total of 91 initial respondents (range, 61–94), 13 lived with adult children (10 of whom were lone parents). Those living with, or who had daily contact with, adult children had significantly higher levels of emotional loneliness at the start of their program, but not at the end. For this sample, reductions in emotional loneliness in certain cohorts of older adults who attend these programs have been identified. In conclusion, it is proposed that fourth age losses mediate older people’s living arrangement and may create greater vulnerability to emotional loneliness in those living with adult children. In addition, social groups may be effective in helping reduce emotional loneliness.

Staff attitudes towards the provision of nutritional care to Alzheimer patients

Patients with Alzheimer's disease (AD) are particularly vulnerable to many of the risk factors of malnutrition. The delivery of nutritional care to these patients is an essential component in reversing or averting the development of malnutrition in this population group. The attitudes of the staff involved in the care of these patients may greatly influence the quality of care provided. Staff of special care units (SCU) for dementia patients and of adult day care programs (ADC) filled out a questionnaire designed to determine their attitudes towards the provision of nutritional care to AD patients. SCU staff scored significantly higher (p < .05) than ADC staff in only two of the twenty attitude statements: “Iprefer feeding residents who are restrained” and “I am concerned about the nutritional status of the residents” which may be explained by the possible differences in the severity of the disease of the client population served. Overall, results of this survey indicate that staff of ADC and SCU have relatively positive attitudes toward the provision of nutritional care for those with dementia and that they enjoy situations that allow positive interactions with clients. These results suggest that staff may have the inclination to increase their nutritional care efforts and to participate in training programs designed to reduce or to avert the development of malnutrition in AD.

Characteristics of Alzheimer's Versus Non-Alzheimer's Adult Day Care Centers

This study distinguished the unique characteristics of adult day care (ADC) centers serving victims of Alzheimer's disease (ALZ) as compared to centers without a substantial proportion of Alzheimer's victims (non-ALZ). A set of hypotheses regarding expected differences in the characteristics of ALZ versus non-ALZ centers along with the rationale for these hypotheses are presented. The measures of ADC characteristics are then described. The results of two types of analyses are presented: t tests and discriminant function analyses. The results indicate that the major discriminating factor was increased support for families in ALZ centers. Alzheimer's programming also placed more emphasis on therapeutic recreation, personal care assistance and training, and entertainment rather than on the provision of clinical and personal services. ALZ centers tended to have higher morale with the perception of being more caring and pleasant. They had longer hours, greater provision of transportation, and more amenities for the disabled. Implications are drawn for practice and research in ADC.

Family Caregiver Perceptions of Benefits and Barriers to the Use of Adult Day Care for Individuals with Alzheimer's Disease

To determine the perceived benefits and barriers to the use of adult day care (ADC) by family caregivers of individuals with Alzheimer's disease (AD), 104 family caregivers (52 users of ADC and 52 nonusers) were interviewed by telephone using a semistructured interview protocol. Comparisons were made between users and nonusers of ADC. Analysis of the qualitative data identified seven categories of barriers to ADC and seven categories of benefits to ADC. Both quantitative and qualitative analyses revealed no significant differences in reported barriers to ADC use by users and nonusers. Both users and nonusers reported barriers; more users overcame the barriers to use the service. Both users and nonusers saw benefits to the caregiver from using ADC; only users saw ADC as primarily benefiting the patient. ADC users also used other respite services more than nonusers.

Racial Differences among Users of Long-Term Care

A representative sample of 317 adult day care (ADC) participants from most ADC centers in Missouri in 1990 is analyzed to determine whether there are different patterns of ADC use by African-Americans and Whites. The data show that African-American elderly use ADC at twice the rate of older Whites. No racial differences were found in the functional or cognitive need levels of participants, but African-American participants are much more likely than Whites to depend on children as primary caregivers and to rely on Medicaid. Multivariate analysis shows that caregiver variables are as important as need, predisposing, and enabling variables in explaining the number of days per week of ADC used. African-American elderly will be especially affected by incorporating caregiver needs into research and policy.

Rural/Urban Differences in Adult Day Care

A review of the literature indicated that rural areas tended to be disadvantaged relative to urban areas in community-based health services, but no studies had been done on adult day care (ADC). Using data from a national survey of 822 ADC centers, this study found significant differences between urban and rural ADC centers on 23 of 42 structure, process, and client measures. Rural ADC centers tended to have lower enrollments, with a client population that was significantly less impaired. These findings were further reflected in services and activities provided in rural centers that were less clinical, a finding that is consistent with a less impaired clientele. Rural centers also reported less involvement of the family and community in activities. Rural ADC was clearly different from urban and deserves further study as a distinct entity.

Prevalence and Predictors of Burnout Among Adult Day Care Providers

Over the past decade, an extensive research literature has focused on stress, burden, and coping among family caregivers to improve the quality of care to dependent elders. Although a better understanding of the prevalence and predictors of burnout among formal service providers could be expected to produce similar benefits, little is known about stress and burnout among paid caregivers. The purpose of this study was to examine the extent to which paid care providers in adult day care (ADC) experience burnout and to examine the relationship between employees' perceptions of their work environment and burnout. Participants (N = 102) were staff from a random sample of ADC centers in California. Using the Maslach Burnout Inventory, burnout was found to be low for the depersonalization and personal achievement aspects and moderate for emotional exhaustion. Hierarchical regression indicated that after controlling for demographic differences and daily hassles, work environment measures were significant correlates of each of the three aspects of burnout. Findings are discussed in terms of their implications for organizational-level work design issues and macrolevel policy decisions.

Correlates of service delivery and social environment in adult day service programs

The objectives of this study were to better describe adult day service (ADS) programs and determine how various structural and case mix characteristics of ADS were empirically associated with the services provided in and the social environments of adult day programs. All directors of ADS programs in Minnesota (United States) were contacted from 2011 to 2012 to complete a detailed online survey that collected information on ADS structure, client case mix, services and activities, and social environment (n = 83; 67.5% response rate). Several structural characteristics and case mix indicators (e.g., number of clients attending) were significantly associated (p < .05) with specific types of ADS service provision, such as health monitoring. Programs that were adequately staffed and perceived as pleasant appeared to also have a more vibrant social environment. The results suggest the potential need for bolstering staffing and enhancing the physical environment of ADS programs.

The role of attitudes and culture in family caregiving for older adults

This study evaluated cultural differences in attitudes toward caregiving and the stress levels of family caregivers. Participants included 98 Japanese American and 86 Caucasian American family caregivers caring for frail elders. Analyses using MANOVA and multiple regression analyses revealed that the Caucasian caregivers had more positive attitudes and provided more hours of care than the Japanese caregivers but that both groups had elevated levels of caregiver stress. The stress that family caregivers currently experience could lead to a future generation of care recipients who enter old age in worse condition than their predecessors. Professionals need to work together to develop culturally appropriate, evidence-based interventions to address this issue.

Comparison of Adult Day Services in Atlantic Canada, Maine, and Vermont

In both Canada and the United States, adult day services (ADS) are an integral component in the array of long-term care services available. We compared characteristics of programs and participant characteristics in Atlantic Canada, Maine, and Vermont. Directors of 47 ADS programs responded to a mailed survey. Individual ADS programs in each province and state exhibited unique program and participant characteristics. ADS programs in the two countries differed with respect to: affiliation, location, levels of government support, participant fees, organizational sponsorship, hours of operation, months of attendance, and hours attended per day. Participant characteristics that varied between the two countries were educational level, physical needs, and cognitive status. The results of this study provide new comparative information that can be used in guiding future research and program development of ADS.

Outcomes of Adult Day Services for Participants: A Conceptual Model

Adult day programs provide nutritional, health, social, and recreational services for older adults during daytime hours. The heterogeneity of programs, participants, and funding sources creates challenges in defining and measuring participant outcomes of adult day services. There appear to be two main domains of influence that adult day programs can have on participants: physical health functioning and psychosocial well-being. The study of the psychosocial benefits of adult day services to participants has been neglected. The purpose of this article is to review current empirical literature and to propose a new conceptual model for examining the participant outcomes in adult day services programs, taking into consideration the variability in participant needs and program design and delivery. The model includes service elements that are related to psychosocial well-being and physical functioning, and these elements relate to specific physical and psychosocial proximal and distal outcomes. Further areas for research are suggested.

Health status of participants of adult day care centers

This study compared the medical conditions found in 183 participants of 5 suburban adult day care programs to the medical and mental health status of community-dwelling elderly persons. Analysis revealed that adult day care center participants are very similar to the community-dwelling elderly population in most health indicators, but suffer from much higher rates of dementia and associated functional disabilities. Moreover, those day care participants who do not suffer from dementia tend to suffer from a psychiatric disorder (e.g., major depression, adjustment disorder). These results show that adult day care has become a facility with a primary mental health function.

The effectiveness of adult day services for disabled older people

Adult day care has attracted a considerable amount of attention among researchers, practitioners, and policymakers. However, there have been few efforts to synthesize empirical results. This paper reviews research that determines the effectiveness of adult day services in improving client functioning, alleviating caregiver stress, and delaying nursing home placement. In addition, the strengths and limitations of the research are considered. This paper concludes with a discussion of policy-relevant issues that must be addressed when determining the effectiveness of adult day services.

The Provision of Staff Development Programs in Adult Day Care Centers

BACKGROUND

Little is known about staff development activities in adult day care (ADC) programs. Therefore, this descriptive study was used to compare existing center programs with research- and practice-derived "model staff development program" for orientation, inservice education, and continuing education opportunities.

METHOD

A multi-step mail survey design was used to study licensed adult day care programs in Virginia (n = 38). The design produced a 92% (n = 35) response rate among eligible respondents.

RESULTS

Thirty-seven percent (n = 13) of the responding administrators described staff development activities that met the criteria for a model program. Despite limited financial support, Virginia centers are making an effort to provide comprehensive staff development opportunities for their staff.

CONCLUSION

Centralized or regionalized programming may be two viable solutions for addressing unmet staff training issues for these community-based agencies. Moreover, because their staff tend to be interdisciplinary in nature, educational programming for an interdisciplinary audience will be in order.

Reporting source bias in estimating prevalence of cognitive impairment

Reporting source bias was examined using cognitive data from a probability sample of adult day health care (ADHC) clients. Data were obtained from four sources: client, family, staff, and chart. These data suggest that prevalence estimates are influenced by the reporting source and method of assessment, with chart diagnoses yielding the least convergent estimates. Examination of agreement summary statistics and bias indices show that both staff and family underreport prevalence of cognitive impairment, but that more bias is associated with staff than is with family sources. Such bias should be considered in studies of prevalence estimation of cognitive impairment.

Assessing the influence of adult day care on client satisfaction

Using data collected from 74 adult day care centers, this study measured various program characteristics from four different categories of respondents--clients, caregivers, staff members, and administrators. The perceptions of these respondents were examined for their associations with each other and with client satisfaction. Three program characteristics, as perceived by clients, were significantly associated with client satisfaction (staff caring, general morale, and interior environment). The caregivers', staff members' and administrators' perceptions were not significantly associated with client satisfaction. In addition, most of these program component ratings were not significantly associated among clients, caregivers, staff members, and administrators.