Adult Day Care Centers

This paper explores the community of people who use adult day care center services in King County, Washington. This county was selected because the Full Life network of adult care centers has been recognized for its innovation by the United States Department of Health and Human Services (HHS) in operating six adult day care centers serving thousands of low-income seniors and adults requiring assistance since 1976. Additionally, this paper will discuss the population demographics of King County, the idea behind adult day care centers, profiling the work of one of the largest in the country, concluding with an assessment of the projected demand for adult day care as baby boomers constitute the largest future consumer of adult day care. 

Every day, 10,000 baby boomers turn 65. The baby boomers represent a portion of the population who are expected to consume the most healthcare resources. The goal for care of older adults is to keep them in their homes for as long as possible. This is not only the best place for their care as far as comfort and familiarity are concerned, but it is also much more cost-effective than long-term care facilities. Baby boomers often can get more access to broader programs in larger population centers. 

King County is the largest county in the State of Washington with a population of 1.9 million people.  11.2% of this population is aged 65 or over; 71.9% White, 6.5% black, 15% Asian; 91.9% are high school graduates, 45.7% hold Bachelor’s degree or higher, 125,032 veterans, the mean commute time is 26 minutes, median household income is $70,567, 59.6% own their homes (United States Census Bureau, 2012). The total number of live births in 2012 so far is 22,939, the infant death rate is 4.4, there were a total of 11,213 so far in 2012, and the population density is 859.2 persons per square mile (Publicrecords.com, 2012). Over the next two decades, Washington will see a projected 71% increase in residents over the age of 85, nearly half of the people that age have Alzheimer disease or other dementia, and they are mostly cared for at home -greatly straining the parent-child relationship (Full Life Care, 2011, p. 3). Considering the projected rapid growth of the elderly in Washington, and health factors affecting the population of Kings County shows that adult care will be in higher demand not only for the aging but those who will develop chronic diseases due to a behavior known to increase the rates of chronic illness. 

King County health factors include: Adult smoking 13%, adult obesity 22%, a rate of physical inactivity of 17%, 18% of adults engage in excessive drinking, 13% are uninsured, and 8.8% unemployed according to the Agency for Healthcare Research and Quality (HHS, 2012).  This data supports that the long term individual consequences of these behaviors will increase the likelihood of developing chronic illness requiring extensive care as the population of King County ages. The group of adults engaging in this risky behavior will disproportionately consume more of the healthcare resources. Additionally, the rate of low-income persons and the uninsured make cost-effective solutions for providing care desirable. According to Zelman, Elston, and Weissert, the cost of providing care in an adult care center is 10% of the cost of providing full-time long-term care (1991, p. 27). Therefore, providing more adult day care will keep the cost of caring for these patients at a minimum.  

Adult day care centers are intended to bring relief to the primary caregiver at a much lower cost to the individual. The Department of Health and Human Services defines adult care centers as, 

“Adult Day Care Centers are designed to provide care and companionship for seniors who need assistance or supervision during the day. The program offers relief to family members or caregivers and allows them the freedom to go to work, handle personal business or just relax while knowing their relative is well cared for and safe. The goals of the programs are to delay or prevent institutionalization by providing alternative care, to enhance self-esteem and to encourage socialization” (HHS, 2012). 

The patients using adult day care generally live at home but cannot be left unsupervised for extended periods of time either because they are unable to care for themselves or are often suffering from a form of dementia where they pose a threat to themselves or others. Without Adult day care centers, the primary caregivers would spend 24 hours a day 7 days a week caring for their loved one. This has a terrible effect of burnout for the caregiver causing physical and emotional stress on the caregiver. With the introduction of adult day care centers, the patients remain socially engaged, spend the day with professionals, and give the primary caregiver the ability to work. Adult care is available in many communities but a pioneer in the area of adult care is found in Seattle Washington. 

Full Life Care, formerly known as ElderHealth Northwest is an example of an innovative and effective adult care center. Located in Seattle, Washington this company operates six adult day health programs that serve elders with significant physical and/or mental health issues (including dementia) and adults with developmental disabilities or an acquired brain injury. “Between 70 and 80 percent of clients served are low income, while 40 percent are racial or ethnic minorities” (HHS-AHRQ, 2012 p. 1). Full life care patient demographics: Average age, 60, 55% female, 45% male, 98% “low income”, 71% Caucasian, 18% African American, 11% other. 49% of their service cost was adult day care with the remaining 51% going to other programs and administrative costs specifically labor. 

  Nationally, the median cost per participant per day was $29.50, one half of this cost is for labor (Zelman, Elston, & Weissert, 1991, p. 30).  Although this information is from 1991, the ratios have remained the same. Regardless, few people know about adult day care. Professors Berber, Paton, and Wishina performed a survey of a sample taken from a geographical area representing 1 million people, 28% of the respondents met the criteria for adult day care, 46% knew of adult day care, from these factors it is estimated that 1.25% of all households have an adult member who would need and use adult day care (1994). In the past 18 years, the focus on adult care and cost containment has increased, therefore, it is likely that many families will be faced with the challenges of making cost-benefit analyses for adult day care. 

As demonstrated in this paper, the demand for adult day care will continue to rise as the eligible population continues to age. The rates of smoking, obesity, drinking, and inactivity, will increase the prevalence of chronic illness among the population. Additionally, the rates of low-income individuals who are also uninsured will require a low-cost solution to providing dignified care to this population. Adult day care centers provide the ideal solution for caring for these individuals because they can remain in their home while their primary caregivers continue to work at a tenth of the cost of full-time care. This prolongs the need to fully admit the patient into a full-time long term care facility. The idea of the adult day care center is a viable and desirable solution. Expanded knowledge of this valuable resource will increase demand for its services. Full Life Care is an excellent example of meeting a critical need for caring for aging adults. Keeping patients in their home for longer saves the entire system a great deal of money.  

(Genogram omitted for preview. Available via download)

This genogram shows that health indicators will contribute to a higher rate of chronic illness for the aging population. This considered with the facts that half of the population over 85 suffers from some form of dementia and that 1.25% of all American households already have a qualified patient living with them will increase the demand for care. The rates of low-income people combined with the rate of uninsured motivate the need for a low-cost solution. Full Life Care provides a model for providing a successful network of adult day care that could be duplicated in other communities. They have shown themselves to be successful as they’ve been operating since 1976. They are closely aligned with their demographic population and properly situated to handle expanding their programs as the need arises. Adult day care is both a desirable and cost-effective solution to the challenges of caring for the aging and partially dependent adults.

References

AHRQ Innovations Exchange | Adult Daycare Program Offers Nursing and Rehabilitative Services, Leading to Improved State of Mind for Low-Income Elders and Disabled Adults. (n.d.). AHRQ Innovations Exchange. Retrieved December 17, 2012, from http://innovations.ahrq.gov/content.aspx?id=2187

Barber, G., Paton, R., & Wishina, G. (1994). Public's Perceived Need for Adult Day Care versus Actual use. Home Health Care Services Quarterly, 14(2-3). Retrieved December 16, 2012, from http://www.tandfonline.com/doi/abs/10.1300/J027v14n02_05

King County QuickFacts from the US Census Bureau. (n.d.). State and County QuickFacts. Retrieved December 17, 2012, from http://quickfacts.census.gov/qfd/states/53/53033.html

Pubrecords.com (n.d.). Pubrecords.com The power of public records in the palm of your hand. Retrieved December 17, 2012, from http://pubrecords.com

Zelman, W., Elston, J., & Weissert, W. (1991). Financial aspects of adult day care: National survey results.  Health care financing review, 12(3), 27-36. Retrieved December 16, 2012, from http://europepmc.org/abstract/MED/10110877