7 Keys to the Right Senior Day Service

New study provides insights into daytime services that help disabled people remain in their homes.


Deciding that a parent or elderly relative needs care that you can no longer provide is hard for everyone involved. Adult day service (ADS) centers may provide an effective transitional solution that allows a loved one to continue living at home, gives them needed care, takes a lot of stress off of family caregivers, and is much cheaper than full-time institutional care.

A new study of the ADS industry provides solid benchmarks to help evaluate centers. The study was backed by MetLife's Mature Market Institute, in partnership with the National Adult Day Services Administration and the Ohio State University College of Social Work.

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ADS centers generally provide daytime care for people who need help with one or more activities of daily living (ADLs). These include eating, dressing, bathing and personal grooming, using the toilet, continence, and help getting in or out of bed and other basic "transference" tasks. ADLs are widely used as the basis for triggering public benefit programs or private long term care insurance. Nearly all of them have state certification.

About half the people using the nation's estimated 4,600 ADS centers suffer from some form of dementia, the study found. Increasingly, they also have chronic illnesses and conditions, such as hypertension (46 percent), physical disability (42 percent), cardiovascular disease (34 percent), and diabetes (31 percent). Most ADS center occupants are 65 or older and female.

In connection with the study, MetLife also issued a consumer guide to ADS center services. It suggests that consumers identify the most suitable centers near them, and that a local area agency on aging can provide helpful referral services.

By surveying more than 500 ADS centers throughout the country, the study provides an authoritative portrait of what consumers and caregivers should consider when evaluating a center. Here are seven areas of center activities that deserve a close look:

Hours. Most ADS centers offer Monday through Friday services and are open from early morning to early evening. Only a small percentage provide Saturday or seven-day services, so you'll need to look carefully if you need more than weekday support. More than 80 percent of ADS center users attend for the full day. Nearly half of center users are there five days a week, 29 percent attend three days, and 19 percent are there two days a week.

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Staffing. Nearly 80 percent of centers have a registered nurse or licensed practical nurse on duty. Half have social workers as well. Including all care workers, the average consumer-employee ratio is six consumers for every center employee. Larger centers may have higher ratios. Make sure you understand how a center is staffed before seriously considering it.

Services. Beyond help with ADLs, more than 70 percent of centers provide music, art, or pet therapies. Nearly all centers provide some form of cognitive therapy or other dementia-related programs. About half offer physical, occupational, or speech therapy. Expect a center to develop an individual care program for participants; most also update care plans every three to six months. A typical center also provides support programs for at-home caregivers.

Size. There is a broad range of facility sizes but most centers occupied between 1,000 and 5,000 square feet, or nearly 200 square feet per user. On average, 34 users are in a center each day, and the average maximum capacity is 51 participants per center. The average participant uses a center for 32 months.

Costs. The national average daily rate for a center is about $67, although the centers surveyed for the study had a full-day average of only $61.71. This compares with $198 a day for a semi-private room in a nursing home, according to the study. For people who use centers for shorter periods, the average hourly rate is $10.92 and the average half-day rate is $37.18.

Getting there. Most centers offer transportation services but they cost extra, from a few dollars per round-trip to about $20.

Business models. More than half of all center funding comes from government-paid fees and about a quarter is provided by privately paid fees. Most centers serve all types of participants but more than a third deal exclusively with private-pay or publicly funded users. "This lack of diversity may leave these ADS centers particularly vulnerable to economic shifts and changes in public policy, in particular on the state level," the study said.