Respite Care and Adult Day Care for Elders

Respite care and adult day care provides breaks to those who care for the elderly.

Respite care and adult day care are important to the millions of Americans that provide unpaid in-home care for elderly relatives, friends, or neighbors. Respite caregivers and adult day care programs monitor and provide companionship to elders and seniors for a short period of time, so that their regular caregivers can take a break or deal with other responsibilities.

This article discusses the different types of respite and adult day care available, how to find and pay for these services, and how to choose a caregiver or program.

Respite Care

Respite care is designed to give both caregivers and seniors a break from the usual routine. It allows caregivers to have some free time, take care of other responsibilities, and obtain (often much-needed) mental breaks. It also allows seniors to talk and spend time with someone other than their usual caregiver.

Respite caregivers provide monitoring and companionship to seniors for short periods of time. In addition to watching over the elder, providers and programs might also prepare meals, provide personal care (for example, assisting with bathing, toileting, and exercising), and, in some instances, tend to the elder's medical needs by administering medication, for example.

Care can be provided on a scheduled basis, or just occasionally. Often, the people providing respite care are volunteers friends, other family members, members of the community, or church members. But you can also hire someone (either on your own or through an agency) to provide respite care. Respite care can take place in the home, in a church or community center, or in a nursing facility.

Adult Day Care

Adult day care centers are formal programs that take care of elders during the day. They provide companionship, social activities, meals, personal care services, exercise, various forms of recreation, and social services including referrals to other agencies and services. Although adult day care centers may be located in a church or community center as some respite care programs are, they differ from respite care in that the programs are more structured and provide more services.

If a day care center is affiliated with a hospital or nursing facility, it might also provide medical services administering medication or providing physical therapy, for example. However, most day care centers provide minimal or no medical services. Some day care centers allow drop-ins. Others require that participants pay for scheduled attendance.

Paying for Respite Care and Adult Day Care

The cost of respite and adult day care varies greatly, depending on the facility offering the services and the skill level of the caregivers. Often, in-home respite services are free or low-cost. At the other end of the spectrum, adult day care centers that provide medical care will cost quite a bit more. For help paying for respite care, consider the following:

• Long-term care insurance. Some long-term care insurance policies will cover part of respite care expenses.
• Supplemental Security Income (SSI). SSI is a federal program that provides benefits to disabled and elderly people whose income and assets are very low. SSI may cover costs for home health care administered as part of respite care. To learn more about SSI, see Nolo's article Social Security Disability Benefits.
• Government programs. Federal and state programs may help pay for respite care. To find out what services and funds are available in your area, contact your local Area Agency on Aging (AAA). (See the "Finding Respite and Adult Day Care Programs" section below to learn how to locate your local AAA.)

Choosing a Respite Caregiver or Adult Day Care Center

Start the process by thinking about what types of services you want, the ideal schedule, whether you want regular or occasional care, whether the elder would benefit from group interaction or just one companion, and whether the caregiver will need to provide any medical services.

Finding Respite and Adult Day Care Programs

One of the best ways to find good respite care or adult day care is by word of mouth. Ask your friends, family members, and acquaintances if they have any recommendations or warnings about certain programs.

Here are some other ways to get information about programs and caregivers in your area:

• Contact your local Area Agency on Aging (AAA) for referrals and information about respite and day care. You can find your local AAA through the U.S. Department of Health and Human Services (HHS) website at www.eldercare.gov. You can search by city, county, or zip code.
• The National Adult Day Services Association (at www.nadsa.org) provides referrals to adult day care centers.
• ARCH National Respite Network and Resource Center has a respite locator that provides links to respite providers in your area. Visit their website at www.respitelocator.org.

Choosing a Quality Provider or Program

A referral to respite or adult day care is not necessarily a guarantee of the program's quality. Once you obtain several referrals, do some homework to find out if the care is good and will meet the elder's needs (and yours).

If you are hiring an individual in-home caregiver, do the following:

• Interview each candidate in person.
• Specify the following: all duties, schedule of care, compensation, and payment schedule.
• Ask about the candidate's background, training, work experience, special skills, and experience with medical conditions that might be relevant to the elder's care.
• Present the caregiver with situations that they may encounter with the elder, and ask how they would handle them.
• Find out if the candidate has insurance.
• Ask if the caregiver has someone else that can fill in if the caregiver is unable to make a session.
• Request references and then check them carefully. Ask about the caregiver's competence, honesty, ability to handle the job, punctuality, and anything else that is important to you.
• Consider hiring a professional service to conduct a background check. You may be able to get referrals from your local police department, or from the Internet.

If you are considering an out-of-home respite or adult day care program, here are some questions to ask the program director:

• What is the ratio of caregivers to elders?
• Can we meet and interview the caregivers in the program?
• Do you keep a file on the elder's medical condition and other needs? Is there a written care plan?
• What training and experience do the caregivers have? Have you run background checks on the caregivers? Have you spoken with caregivers' references?
• What training do you provide to the caregivers?
• How do you supervise and evaluate the caregivers?
• What is your method for evaluating the program?
• Do you ask family members for feedback? Can I see that feedback?
• Can I speak with the families of elders that have attended or are currently attending this program?

To understand all the alternatives to nursing facilities including a comprehensive discussion of how to get and pay for home care get Long-Term Care: How to Plan & Pay for It, by Joseph Matthews (Nolo).