Genworth United Way Presentation
November 5, 2009
Adult Day Services (ADS):
community-based, non-residential programs
Meet the assessed needs of
adults with impairments
through an individual plan
Provide essential health,
social, and related support
services in a protected
Support families and other
caregivers and enable
“I can continue to work because [my
participants to live in the
parents] are receiving reliable care
community. during the day at the Center.”
Adult Day Services
Maintain or improve
the highest level of
Provide respite and
support to caregivers.
ADS are important to Virginia
Provide Quality Care & Delay Institutionalization
• By supporting informal caregiving
– The National Conference of State Legislators estimates 746 million
hours of informal care provided in Virginia per year.
– Value of $6.6 billion.
– Caregivers who experience stress and burden are more likely to
institutionalize relatives suffering from dementia.
• By reducing health care costs
– Health monitoring & preventive health care.
– Timely provision of primary care.
– Control excess disability.
• By supporting the workforce
– American businesses can lose as much as $34 billion each year
due to employees’ need to care for loved ones 50+.
– 77% of Virginia caregivers report being employed.
– 96% need support services to maintain their job.
Families provide 80% of eldercare
• 44% of non-
older adults get care
• 49% get care from at
least one child.
• More than 1 in 5
disabilities of their
Long Term Care Services:
Services are based upon individual functional ability
Bathing Day Home Toileting
On Wheels Respite
The ideal long term
care system is
flexible to meet the Life
functional abilities & Care
Psych. Support preferences of the Communities
Congregate Adult Foster
Mobility Meals Care
• Family caregivers think
adult day services =
• Lack of awareness
• Denial, guilt, worry
• Fear of financial burden
• Have heard it is too
• Concerns about
• Public/provider awareness.
• Inadequate resources to fund services.
• Adult day services are not a public policy
What does the future hold?
– Estimated 1/2 of boomers
will live to 90.
– 40% of workers will also be
– Increased financial strain
– Increase in specialized
• Early-onset Alzheimer’s
• Brain injury 53 million boomers expect to
• Autism care for parents who are in their
• Mental retardation 70s & 80s.
Future ADS Needs
146 additional day care centers
will be needed in Virginia
(Robert Wood Johnson, 2002)
Barriers: capital, operating
support, public awareness
Change policy and funding to make home-
and community-based services a
Build Adult Day Services
cover cost of care.
Develop a statewide program for
increased public awareness.
COMPONENTS OF ADULT DAY HEALTH CARE
• Individual functional and service assessment as intake, and ongoing
• Development of individualized Plan of Care; quarterly or more frequent update
• Coordination of care with other service providers, including transportation
• Daily monitoring and documentation of status and care provided
• Coordination of daily routines with family caregivers
• Coordination of discharge/transfer
• Nutritional assessment
• Noon meal and 2 snacks
• Therapeutic diets and counseling
• Coaching, assistance with eating or total feeding
• Evaluation for adaptive eating utensils/positioning while eating
• Supervision for safety while eating
• Monitoring weight and hydration
PERSONAL CARE ASSISTANCE
•Daily evaluation of ADL status and needs
•Assistance with ambulation
Falls risk assessment
Monitoring of ambulation devices/safety
Regular ambulation to limits of tolerance to maintain strength and endurance
Referral to rehabilitative services
•Assistance with toileting
•Assistance with dressing
•Daily RN or LPN-B supervision
•Skilled nursing services
Coordination with primary and specialist medical care providers
Monitoring vital signs, changes in condition, response to treatments/medications
Tube feeding, wound care, blood glucose monitoring
NURSING CARE –cont.
• Emergency response
• Health education for participants and caregivers
• Referral to other services, coordination of appointments, reports to other
REHABILITATION SERVICES COORDINATION
• Monitoring for rehabilitation needs
• Referral/coordination of rehab services
• Collaboration for on-site rehab services
COGNITIVE AND EMOTIONAL MONITORING AND SUPPORT
• Continuous monitoring of cognitive and emotional status
• Individualized plan/implementation to maintain/improve function
• Crisis intervention (Adult Protective Services, Emergency Medical Services,
• Assessment of activity skills, abilities, interests, needs
• Development of activity plan to maintain interests, physical/cognitive/emotional
• Structured opportunities to develop/maintain interaction, relationships, peer group
• Structured opportunities to improve/maintain physical functioning through activity
• Structured opportunities to participate in activities that support cognitive
functioning, provide validation and life review
• Structured wellness programs to delay debilitation and encourage highest level of
independence and function (daily exercise, strength training, brain health, diet, etc.)
• Recommendations to family about meaningful activities at home
FAMILY SUPPORT SERVICES
• Support for working caregivers
• Support groups and/or counseling for caregivers
• Long-term care planning
• Consultation and skill training about home management and safety, adaptive
equipment, home modifications, activities of daily living
• Continuous on-site care by professional staff
• Cost-effective use of staff with one trained aide or CNA under professional supervision
providing care to 6 individuals or one RN caring for 50
• Limited turnover
• Continuity of care
• Reliable team care approach