Adult day care: a good option for working adult children

Few people want to--or can even afford full-time memory care. A great, affordable option that few know about is adult day care.

Posted 1:00 p.m. Jan 13, 2018 — Updated 1:40 p.m. Jan 13, 2018

Liisa Ogburn

One of my kids recently told me their teacher was really struggling because the mother she cared for in her home had taken a sharp turn for the worse due to dementia. This teacher was taking such good care of my child, I wanted to do something for her in return. They did not have the savings to afford full time memory care. Who does at $5,000 to 10,000/month.? She had no assets and furthermore, the mother’s monthly income from social security, at $1600, was just above the cutoff for special assistance.

One day, I asked her, “Have you considered adult day care?”

“Adult day care?” she said.

North Carolina has over 160,000 people– five million in the United States – living with Alzheimers. The majority are being cared for by family members at home, many who also work outside the home. What can a family, like my child’s teacher, do? Often the answer is paste together help as best they can. This teacher starts her day really early, knowing that her mom will sleep the first four hours while she’s at work. She paid a neighbor for a midday check-in and also gave her mom a phone to call, if she needed anything—which worked until it didn’t. When the neighbor stopped being able to help, things fell apart. The teacher tried home care which, at the four-hour minimum/day at $23/hour added up to $460/week or $1840/month, but she was still worried about the hours mom was unattended.

Another option is adult day care. There are over twenty adult day care centers located across the Raleigh, Cary, Durham and Chapel Hill area. Most—though not all—specialize in memory care. Options can be roughly divided into three categories: public (subsidized by the state), private and churches. Each has their own personalities, service offerings, operating hours, and costs. Most serve meals. Some provide additional services, like showers or nail-clipping, for an additional cost. Some have nurses on staff fulltime for medication administration or wound or tracheotomy care. Some even coordinate transportation there in the morning and home at night.

If funds are limited, start with looking at the county-sponsored programs. For example, Total Life Program offer multiple locations, at a cost of $45-75/day (depending on needs). They serve breakfast, lunch and a snack. Some, like the Bond Total Life Center in Cary, also have a fulltime nurse on-site. Some, like PACE, have a whole constellation of services, many covered by Medicare and Medicaid.

I’ve been impressed with two programs housed in churches: The Ruth Sheets Center (at Edenton Methodist) and Millbrook Enrichment (at Millbrook Methodist). Millbrook is only open Mondays, Wednesdays and Fridays from 9 to 1. The costs are comparable to county-sponsored programs. A nice perk is that there is often other programming, like listening to the preschool give a Christmas concert or the choir practice, that add warmth and stimulation.

A third option is private care. Linda Kim, RN, who founded Evergreen in Cary, says that their monthly rates cost from $312 to 2014, depending on the needed level of care and the number of days per week. As a Medicaid approved provider, the cost for Medicaid beneficiaries is $0. Sarah Care, in Raleigh, is another excellent option.

When I asked Ms. Kim what to look for when visiting places, she said,

What is the staff to participant ratio. Evergreen is a combination social/health model and must maintain a 1:6 ratio at minimum.
Is there a nurse on site to provide medication and assess for illnesses? Having a nurse on site is truly valuable not only because they are able to give medications as needed, but also because a nurse is able to spot an onset of illness. Many a times, we notice someone acting “off” and take their vitals to find a low blood pressure or hear crackling in their lungs. We share the info with the family who can follow up with their primary care provider.
Are the staff trained in caring for aging adults: dementia, impaired sight, impaired hearing, level of aphasia, impaired motor coordination and strength. chronic illness. Our CNAs keep a detailed flow sheet throughout the day and are on the lookout for signs of dehydration, infections or changes in appetite and we make sure we address it with the families and come up with plans for care.
Is the facility equipped to evacuate quickly in case of an emergency and run regular drills?
What kind of activities are provided to keep participants engaged and stimulated. A variety of activities should be offered daily to serve participants with various levels of needs and capabilities. We address social, cognitive, memory, gross and fine motor issues using games, art, and music.
We serve a hot catered lunch and two snacks minimum. These are state mandated. We found an excellent caterer so that the meals are not only healthy, but delicious.

In closing, Ms. Kim said, “The quality of our adult day care program is in the staff. We have staff who are sincere, attentive, respectful and good at communicating with people who often need extra care to feel safe and engaged in their surroundings. We try to make sure our participants feel we are available to hear their needs and meet them where they are.”

When choosing what might work for your loved one, ask for a tour and see if they offer a free trial day.

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