Relief for Caregivers

About one-quarter of the adult population, approximately 44.4 million Americans, is providing unpaid care to an adult loved one (National Alliance for Caregiving, AARP and the MetLife Foundation, 2004). These caregivers are present in an estimated 21% or 22.9 million households. In a world where more and more adult children are taking care of their aging parents, the stress of caregiving for a senior loved one is felt wide and far.

In addition to supporting a senior loved one, caretakers often have other responsibilities, such as a family or job. Caregivers report their own emotional stress, physical strain, or financial hardships as a result of care-giving responsibilities.

Fortunately, good options for caregiver support are popping up. The senior care industry is seeing an increase in a couple of respite care opportunities. In-home care providers and adult day care centers, also called adult day services, deliver much needed assistance. Providers, some of whom are specially trained or skilled, care for the senior when a caregiver and senior need additional support.

While in-home care is a viable option for some, adult day services are a growing trend for supportive care outside the home without the commitment of an assisted living or nursing home.

According to the National Adult Day Service Association ( and a study done by MetLife Mature Market Institute, “Adult day services are a growing source of long-term care. More than 260,000 participants and family caregivers are serviced through a range of interdisciplinary professionals meeting the physical, emotional, and social needs of participants and family caregivers.”

With more than 4,600 adult day care centers in the United States (MetLife Mature
Market Institute
, 2010), caregivers are turning to this kind of support because the services they provide align with what a caregiver is able and required to provide for their loved ones.

Key findings of the 2010 MetLife Mature Institute study about adult day care centers

  • Almost 80% of adult day care centers have professional nursing staff and 50% have social worker and physical, occupational, or speech therapy.
  • Direct care worker-to-participant ratio is 1:6.
  • Over 80% of participants attend full days and 46% attend five days per week.
  • Centers are serving populations with higher levels of physical disability and chronic disease.
  • Adult day service centers are leaders in providing care to individuals with Alzheimer’s disease and other dementias.
  • Approximately 90% provide cognitive stimulation programs.
  • Most centers provide caregiver support – 70% offer educational programs for caregivers and 58% offer caregiver support groups.

How to reduce stress for both caregiver and patient
Stress is often part of a caregiver’s job. Caregivers are often charged with managing a loved one through a tough daily routine, which takes emotional and physical tolls on the care provider. This is in addition to the caregiver’s personal responsibilities with work and family. Finding the time, energy, and mental capacity to support such a schedule would test even the most capable provider.

The Gerontological Society of America published a study by Penn State and Virginia Tech researchers concentrating on giving a break to caregivers of dementia patients because of the higher stress levels related to this type of care. Researchers enlisted the services of adult day care centers to provide that break.

The team evaluated the stress levels of 150 caregivers and the person they provided care for prior to using an adult day care service and after the caregiver started taking their loved ones to adult day care.

The team's results revealed that caregivers generally reported greater levels of stress prior to the use of an adult day care service and on days when their relatives did not attend adult day care programs.

The more astounding news that came out of the study was that dementia patients also gained stress relief from the break. The study showed that dementia patients who attended adult day care centers had fewer behavior problems, and they slept better at night. Behavior problems and poor sleep were more likely to occur on days when dementia patients remained at home.

“The changes we have seen are as large as you’d get with medication, but with no side effects,” said Steven Zarit, PhD, a professor and head of the Department of Human Development and Family Studies at Penn State and the study's lead author.

Revolutionized adult day care
Caregivers are often solely responsible for providing a senior’s complete health and safety needs each day. Adult day care centers are making sure that they are expanding their services in ways that align with what is taking place at home. The benefits are two-fold: (1) Caregivers get peace of mind knowing that their loved ones are supported in the same way that they would be at home, and (2) Seniors can remain in their homes while getting beneficial care during the day.

While each center is different, they generally offer these services:

  • Personal care – assistance with Activities of Daily Living such as toileting, grooming, and eating.
  • Meals and snacks – access to nutritionally balance food.
  • Social engagement – interaction with other day care center attendees and staff in planned activities.
  • Therapy – access to exercise, skills training, and physical and occupational therapies.
  • Nursing – availability of health-related care such as administering medication, taking blood pressure, monitoring diabetes, and conducting health assessments.
  • Counseling – assistance with depression and separation anxiety.
  • Transportation – transit to and from the private residence and the center
  • Recreation and Education – some centers offer programs for exercise and education.
  • Alzheimer’s and dementia – some centers specialize in caring for patients with cognitive challenges.

Adult day care has come a long way in supporting the needs of caregivers and seniors. Most often used as a preferred source for chronic disease management, the role of adult day service centers has also evolved into an emerging provider of transitional care and short-term rehabilitation following a hospital discharge. The environment of an adult day care center is interactive, safe, and secure for participants requiring supervised daily care.

However, adult day care is not for everyone. If your loved one needs care outside of the normal business day or needs one-on-one attention, this may not be your best option of care support. Facilities have a number of care providers, so the senior will be cared for by many different people during the course of the day and different care workers on different days. Some seniors are more comfortable with one person in charge of their care. Lastly, not all geographic areas have access to a facility, so there may not be one that is close enough to the senior’s home.

Anatomy of an adult day care center
Because seniors require different kinds of care, caregivers are able to discern which center would best align with the needs of their loved ones. Generally, three types of adult day care exist:

Adult social day care – offers social activities, meals, recreation, and some health-related services.

Adult day health care – offers more intensive health, therapeutic, and social services for individuals with severe medical problems and those at risk of requiring nursing home care.

Specialized – provides specialized services to patients with specific disabilities such as those with dementia or developmental disabilities.

The key to locating the right match for a senior loved one is finding one that fit the needs of the caregiver as well as the senior. Some adult day care centers are stand-alone centers with kitchens and special rooms for various programs and activities that the center coordinates and runs. Other centers may be under the same roof as a community center or a senior center but have their own spaces and activities. At times, the adult day care center may combine activities with the community or senior center.

An assisted living or skilled nursing facility campus may also have adult day care centers. This includes facilities that specialize in different conditions such as Alzheimer’s; therefore, the adult day care center is meant for individuals with this disease. Even some hospitals or medical centers have adult day services, and while the activities offered would most likely be separate, services such as physical or occupational therapies may be shared.

On a national level, about half of all adult day care participants have some level of dementia. Other chronic diseases that are common among participants include chronic hypertension, physical disability, cardiovascular disease, diabetes, mental illness, and developmental disability.

Average costs in the United States associated with adult day care services are $64/day, which typically includes meals. Financing options vary from private pay, Medicaid, long-term care insurance, and veterans benefits.

Caregivers – How do you know when you are ready?
It can be challenging to know when the right time is to enroll a loved one into adult day services. A good starting point is to monitor the stress the caregiver is feeling about the requirements of the caregiving job while also trying to manage everyday life.

Here are some guiding questions from The Essentials Of Adult Day Services Booklet by MetLife:

  1. Do you need help with caring for a relative?
  2. Are you worried about his or her safety when you can’t be around?
  3. Are you leaving your relative alone too often when you need to work or run errands?
  4. Are you taking frequent time off from work to care for your relative?
  5. Would you feel better if you knew your relative could have a meal, get some exercise, receive assistance and supervision, and enjoy social company during the day?
  6. Has your relationship with your loved one become strained as care requirements have increased?
  7. Is your family member feeling isolated by not having the company of other people?

MetLife suggests that if you answered “yes” to even one question, you might start considering adult day services as an option. Guilt is a normal part of the process and asking for help is not a sign of weakness or incapability as a caregiver. It is also normal to be met with resistance from the senior family member. There is certainly a period of transition for both people involved. Remember that your health as a caregiver is just as important as the person you are providing care for, and you will provide better care and support when you are less stressed.

Resources for finding an adult day care center near you:

The Eldercare Locator, a public service of the Administration on Aging

The National Adult Day Services Association is a good source for general information about adult day care centers and programs. They can help you link to a state adult day care association.