By Lindsay Goldman, MSW
What’s a Social Adult Day Program?
A social adult day program provides structure, support and stimulation to older adults living in the community, as well as a break for their caregivers. Social adult day programs, when coordinated with additional supportive services, often enable older adults to remain in their homes for as long as possible.
How Does a Social Model Differ from a Medical Model?
In a social model, medical services are not provided, and there are no medical personnel on-site. In the event of an emergency, social programs call 911. Social programs cannot administer medication but can cue a client to take medication independently. Medical models are more appropriate for clients who require medical attention throughout the day, for example, a diabetic client who needs an insulin shot every few hours.
Factors to consider when selecting a program
Population: What is the composition of the group? Some programs are designed strictly for people who have been diagnosed with dementia; other programs serve people who are physically frail but cognitively intact, while others serve a mixture of the two. Even groups with the same client of people may serve participants in varying stages of a certain condition.
Ask the program staff for population specifics prior to your first visit so you know what to expect. You may also be interested in the program’s clients by gender, ethnic and economic diversity, and languages spoken.You definitely want to know how many people the program accommodates per day. Programs vary in size. There are benefits to both smaller and larger groups, but ultimately it is a matter of personal preference.
Schedule: What time does the program start and end? The length of a day program often replicates that of a typical work day, and for many participants, this schedule elicits familiar feelings of productivity. Ask if there are there a minimum number of hours a participant must stay or a minimum number of days a participant must commit to. Generally, programs are open during the week, but some programs may be open or may offer special trips on weekends.
Affiliation: Is the program affiliated with a larger organization? For example, is it affiliated with a hospital, settlement house, or senior center? What additional services are provided by the overarching entity? Some organizations serve as “one-stop shopping centers,” offering services such as case management, caregiver support, legal assistance, and/or home care.
Funding: Who funds the program? A program that is publicly funded (even partially) must comply with standards set forth by the governing body (usually state or city) issuing the funds. Privately funded programs must comply with standards set forth by the funding foundation; however, these standards vary from foundation to foundation.
Environment: Where is the program held? Factors that facilitate an optimal environment include ample natural light, a separate room specifically devoted to the program, sufficient space between participants, supportive chairs with arms, minimal audible distractions, and a home-like rather than institutional feel. Programs specifically designed for people with dementia should have a locked door to inhibit wandering.
Programming: Programming distinguishes the exceptional from the mediocre group. Get a copy of the schedule and ask questions about anything that may be unclear. The program’s goal is to provide social stimulation and to reduce social isolation. You want to find out how this goal is actualized. Schedules range from highly structured to extremely flexible. You want a program that best suits a participant’s needs and temperament. Ideally, each day should blend physical, cognitive and social activities.
Additionally, you want the majority of activities to require active rather than passive participation. Active programming facilitates interaction between participants. Examples include low-impact exercise, expressive therapies (i.e. art, music, drama, or animal-assisted), and cognitive challenges. An example of a passive activity is watching a movie.
Programming should focus on capabilities rather than deficits, and all activities should be failure-free. In a good program, participants will find new opportunities for creativity and will develop alternative standards of productivity. Perhaps most importantly, day programs can provide participants with a renewed sense of purpose and belonging during later life.
Staff: How many full-time, part-time, and per diem staff members are there? What educational and professional training does the staff have? What is the ratio of staff to clients? Does the program utilize volunteers or students, and if so, in what capacity? You should meet as many staff members as possible to ensure you are comfortable with the program’s leadership.
Personal Care: What personal care needs does the program address? Personal care refers to assistance with one or more of the following: eating, toileting, transferring out of a wheelchair, and walking. If the prospective participant requires additional assistance, inform the staff and inquire if they are able to meet the specific need.
Home Attendants: Some programs welcome privately-employed home attendants to sit, and in some cases, participate in activities. Other programs do not allow home attendants to be present.
Fees: How much does the program cost per day and what is included in that cost (i.e.: meals, transportation, trips, etc.)? Are there subsidies available for clients demonstrating financial need? How and when will you be billed? Some private long-term care policies will reimburse you for the fees; find out if social adult day programs are covered under your policy.
Transportation: Is transportation offered to and from the program? Is the vehicle wheel-chair accessible? Does the driver have a commercial driver’s license? In addition to the driver, is there a bus monitor/escort to assist clients with boarding and disembarking the bus? When and where is the client picked up, and how long is the bus ride?
Final Thoughts
Day programs provide critical assistance to both consumers and caregivers, but remember that not all programs are created equally. Visit several so you can compare and contrast, and make an educated decision. Don’t hesitate to ask questions and to raise any concerns. Ask if a caregiver can accompany and remain with a participant if he or she appears extremely anxious in the beginning.
Keep in mind that the length of time needed to acclimate to the group setting varies from person to person. Some people may never have been comfortable in groups so this may be a completely unfamiliar experience. Others may have always been at ease in groups but may have become withdrawn due to current physical or cognitive difficulties.
You may need to visit a program a few times before you can determine if it is a good fit. If, after numerous attempts, a day model does not seem appropriate at this point, don’t lose hope. Keep the program’s contact information because you can always try again later.
