1. Who
Will
Care?
Genworth United Way Presentation
November 5, 2009

2. Adult Day Services (ADS):
community-based, non-residential programs
 Meet the assessed needs of
adults with impairments
through an individual plan
of care.
 Provide essential health,
social, and related support
services in a protected
congregate setting.
 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.”
Caregiver

3. Adult Day Services
Goals
Maintain or improve
the highest level of
independence and
health.
Provide respite and
support to caregivers.

4. 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.

5. Families provide 80% of eldercare
• 44% of non-
institutionalized frail
older adults get care
from spouses.
• 49% get care from at
least one child.
• More than 1 in 5
spouses have
disabilities of their
own.

6. Long Term Care Services:
Services are based upon individual functional ability
Adult In-
Bathing Day Home Toileting
Services Services
Meals
On Wheels Respite
&Transportation
Dressing Transferring
The ideal long term
care system is
Emotional/
flexible to meet the Life
functional abilities & Care
Psych. Support preferences of the Communities
individual.
Eating
Congregate Adult Foster
Mobility Meals Care
Nursing
Assisted
Home
Living
Care

7. BARRIERS
Internal
• Family caregivers think
adult day services =
babysitting
• Lack of awareness
• Denial, guilt, worry
• Fear of financial burden
• Have heard it is too
expensive
• Concerns about
transportation

8. BARRIERS
External
• Public/provider awareness.
• Inadequate resources to fund services.
• Adult day services are not a public policy
priority.

9. What does the future hold?
– Estimated 1/2 of boomers
will live to 90.
– 40% of workers will also be
family caregivers.
– Increased financial strain
– Increase in specialized
programs (aging-in-place)
• Early-onset Alzheimer’s
• Brain injury 53 million boomers expect to
• Autism care for parents who are in their
• Mental retardation 70s & 80s.

10. Future ADS Needs
146 additional day care centers
will be needed in Virginia
(Robert Wood Johnson, 2002)
Barriers: capital, operating
support, public awareness

11. Recommendation
Change policy and funding to make home-
and community-based services a
priority.

12. Recommendation
Build Adult Day Services
Infrastructure.

13. Recommendation
Increase
Medicaid waiver
reimbursement to
cover cost of care.

14. Recommendation
Advocate family-friendly
employment policies & practices.

15. Recommendation
Develop a statewide program for
increased public awareness.

16. COMPONENTS OF ADULT DAY HEALTH CARE
SERVICE COORDINATION
• 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
NUTRITION SERVICES
• 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

17. 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
Monitoring intake/output
Continence programs
Catheter management
•Assistance with dressing
NURSING CARE
•Daily RN or LPN-B supervision
•Skilled nursing services
Coordination with primary and specialist medical care providers
Medication management/administration
Monitoring vital signs, changes in condition, response to treatments/medications
Tube feeding, wound care, blood glucose monitoring

18. NURSING CARE –cont.
• Emergency response
• Health education for participants and caregivers
• Referral to other services, coordination of appointments, reports to other
providers
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,
Mental Health)

19. THERAPEUTIC ACTIVITIES
• Assessment of activity skills, abilities, interests, needs
• Development of activity plan to maintain interests, physical/cognitive/emotional
skills
• Structured opportunities to develop/maintain interaction, relationships, peer group
support
• Structured opportunities to improve/maintain physical functioning through activity
participation
• 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

20. FAMILY SUPPORT SERVICES
• Respite
• 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
• Referrals
STAFFING
• 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