For the person with Alzheimer’s disease, a few hours at an adult day care center means a change of scenery, social interactions, mental stimulation, and something to look forward to. For the caregiver, it can be wonderful respite from the relentless grind of caregiving. To find a quality center, use these 10 questions from Dede Bonner, author of The 10 Best Questions for Living with Alzheimer’s.
1. Is the center licensed by the state and accredited with a national day care accreditation program? How long has it been in operation? Who owns and runs the center?
Not all states license and regulate adult day care centers. Check with your local Area Agencies on Aging (in the telephone book), the Eldercare Locator (http://www.eldercare.gov), and the Better Business Bureau (http://www.bbb.org).
Because the demand for adult day care services is relatively new and growing rapidly, there are few standards for excellence, regulations, or inspections to help you judge quality. As a result, there may be a great deal of difference between individual centers.
Ask to see the center’s license and latest inspection report. Knowing how long the center has been in operation and if it operates as a nonprofit or for-profit organization will help you assess its reliability and value. If you have choices, visit several centers near you (or near the AD patient) and talk with the staff and other families who use the center.
2. What are the qualifications, experience, and length of service of the center’s administrative staff and aides?
Many centers have limited budgets and must rely heavily on part-time workers or volunteers. As a result, there is often high turnover among employees, low expectations for quality staff performance, and few hiring requirements.
However, you still want to be assured that the staff has been fully checked, including background checks for past criminal records. A policy of regular staff evaluations indicates that employees are being held accountable for meeting performance standards.
Ask what the client-to-employee ratio is to ensure there are enough workers to offer creative activities and one-on-one attention as needed. Expect higher levels of staff professionalism and medical expertise in a medically oriented center.
Here are more follow-up questions to clarify the staff’s credentials. Do staff members have dementia-specific training? Does the center have a physician, nurse, or licensed health care professional on the premises or on call? If the center uses volunteers, are they adequately trained and supervised?
3. How convenient is the center and its operating hours for me/my loved one? Can we make arrangements for transportation?
The convenience of a center is a very important consideration, especially for frequent or daily use. If you work or have other commitments, its operating hours can be crucial, as well as the availability of transportation.
It’s equally important, though, not to choose an adult day care center solely based on its convenience or cost. Overall, quality is more important than location.
4. What services are available? What is a typical day like?
The ideal day care facility for Alzheimer’s patients is specifically designed for them, including their own segregated area away from other seniors using the facility.
Ask if this center offers mainly social or medical services to match your needs. Social centers should highlight games, mental activities, field trips, educational programs, socializing, and exercise classes. Look for therapeutic activities that encourage thinking abilities and help to improve memory, strength, mobility, and dexterity. Some locations even offer hairstyling services, counseling, and support groups.
Medically focused centers offer assessments, rehabilitation, blood pressure checks, and medication reminders. If your loved one requires more medical care, choose a facility staffed by skilled nurses, social workers, and physical therapists with a high staff-to-participant ratio.
Be practical, too. As Clare Absher, an experienced geriatric nurse in North Carolina says, “We all want the place to look like a cruise ship so we feel better about leaving our loved one there. But the physical environment is really not that significant. A homey rambler or ranch- style building with good nursing care and only a TV can be just as good for the person with Alzheimer’s.”
5. Will the center evaluate my/my loved one’s individualized needs and develop an activities plan?
Within reason, you want to choose a facility that will work closely with your loved one to tailor its programs to her specific needs, interests, and cognitive level. If the center does perform client evaluations, ask how it will be done, if you will have access to the results, and how often it will be repeated.
Other smart follow-up questions include, “Are all people required to participate at all times?” Will there be any progress reports?” “How will I know about my loved one’s day and what’s happening in the center (such as video webcams for remote monitoring)?” “Will the staff inform me on a daily basis about my loved one’s well- being and any problems she had today?”
6. How does the center manage Alzheimer’s problem behaviors, including wandering, aggression, improper sexual advances, incontinence, depression, and withdrawal?
The best answer to this Best Question includes a description of the special training that the staff has received in coping with Alzheimer’s patients’ behaviors. Even if you or your loved one doesn’t display any of these bad behaviors, you still don’t want to be exposed to an overabundance of them in others because they are being ignored or mishandled.
Ask about the center’s polices on disciplinary methods and if food is ever used as a punishment or reward. Make sure that an occasional incident of incontinence isn’t grounds for punishment or exclusion from the center. If possible, visit during a late afternoon when AD patients are likely to be “sundowning” (agitation or restlessness) to see for yourself how well the staff routinely handles people with late-day confusion and problem behaviors.
7. What precautions are in place to ensure safety and to deal with emergencies?
Safety and security are paramount concerns. Look for safe wandering areas indoors and outside (such as a secured courtyard or garden), well-marked hallways, quality lighting, privacy areas, accessible bathrooms, and a nurturing, comfortable ambiance.
Ask about fire and safety policies, including a posted fire escape route, fire extinguisher, regular safety inspections, a sprinkler system, and a written emergency preparedness plan. Inquire about specialized staff training to help disabled or confused people escape during an emergency.
Find out if the staff has been trained in first aid and CPR at a minimum. Ask if a doctor is always on call and what are the procedures when there is an accident on the premises.
8. Does the center provide meals or snacks? If so, what are the center’s nutrition policies? How will my loved one’s nutritional needs be met?
Ask if you can sample a meal or a snack yourself. Ideally, return another time unannounced to try the food again.
Request to see a typical menu or food plan. Ask how the center will accommodate special dietary needs, such as a culturally specific menu or food allergies. Inquire about any extra costs for certain foods or special menus.
9. Are the costs, eligibility, admission, and discharge standards spelled out in writing and clarified in advance?
Since Alzheimer’s disease is a progressive disorder, you want to know in advance how the center will deal with someone’s worsening condition. Most centers exclude late-stage AD patients with severe problem behaviors. Get the specifics now.
In addition to daily charges, ask if you must pay anything in advance. If so, ask about the center’s policies for paying during absences, holidays, and illnesses. Discuss transportation costs and any possible hidden fees (craft supplies, field trips, etc.). Inquire about fees for initiation, deposits, late arrivals, or late pickups. Do you have to pay for any programs booked but not actually attended?
10. What are the names and contact details for three clients/AD caregivers whom I can talk to?
This request is common practice and the center should already have made prearrangements for client referrals. When you talk to the referrals, ask them for the center’s strengths, weaknesses, and past performance in handling problems ranging from daily difficult AD behaviors to medical emergencies. Focus especially on their impression of the staff, including qualifications, turnover, and their responsiveness to individuals’ needs and interests.
ABOUT THE AUTHOR
Dede Bonner, Ph.D., aka “The Question Doctor” and author of The 10 Best Questions for Living with Alzheimer’s (Copyright © 2008 by 10 Best Questions LLC), specializes in creative breakthrough and money-saving Best Questions for corporate clients and CEOs. She is on the graduate business faculty of Curtin University in Perth, Western Australia, and is an internationally acclaimed expert in questioning skills and management. A former political analyst for the federal government, Dr. Bonner is the owner of New Century Management, Inc, and 10 Best Questions, LLC. She has a doctorate of education in executive leadership.
MORE ARTICLES BY THE AUTHOR
- 10 Best Questions to Ask to Find a Top Alzheimer’s Specialist
- 10 Questions to Ask if Your Spouse Has Been Diagnosed with Alzheimer’s Disease
- 10 Tips on Treating Your Fibromyalgia
- How to Spot a Bad Nursing Home: The 10 Questions You Should Ask
- How to Talk About Your Fibromyalgia Diagnosis With Those You Love
- When Should Dad Go to a Nursing Home?
LEARN MORE
- Read Chapter 1 from The 10 Best Questions for Living with Alzheimer’s
- See the book’s Introduction
- More articles by Dede Bonner, Ph.D., “The Question Doctor”
- Browse more books by the author
