Adult Day Care - Selecting a Quality Center

Caring for a family member who is unable to safely stay at home while you work can be a challenge. Fortunately, Montgomery County has many quality Adult Day Care centers. For tips on choosing the right center for your family member, refer to the following websites and the text of a brochure which was developed by the Adult Day Care Working Group of Montgomery County.
http://www.helpguide.org/elder/adult_day_care_centers.htm
http://www.nadsa.org/

1)   INTRODUCTION
2)   PHYSICAL ENVIRONMENT
3)   NURSING AND SOCIAL WORK SERVICES
4)   ACTIVITIES
5)   NUTRITION
6)   PERSONNEL
7)   TRANSPORTATION
8)   ADMINISTRATION/FINANCES
The Montgomery County Adult Day Care Working Group consisted of the following groups who worked together to prepare this publication:
  • Alzheimers Association of Greater Washington
  • Bethesda Fellowship House
  • Holy Cross Hospital Adult Day Care
  • Misler Adult Day Center (Closed Effective March 20, 2020)
  • Montgomery County Government
  • Office of Consumer Protection
  • Department of Health and Human Services
  • Aging and Disability Services
  • Public Health Services
  • The Support Center, Inc.
  • Winter Growth, Inc.
INTRODUCTION  
What is Adult Day Care?
Adult Day Care is a comprehensive program specially tailored for adults who need supervision and assistance during the day. It was developed so that families could have their relatives stay at home instead of entering an institution such as a nursing home. Based in the community, centers which provide Adult Day Care bring together health, social and other supportive services in a protective, friendly and non-institutional setting.
Adult Day Care is a personalized service. Each participant attends on a scheduled basis and receives the services detailed in an individual plan of care. Nursing, rehabilitation, activities counseling, exercise, socialization, nutritious meals and snacks, and arrangements for transportation to and from the Center are all coordinated to help the adult maintain maximum independence.
The growing number of Adult Day Care Centers enable families to choose among several convenient programs. You will be seeking the highest quality care with a program best suited for your family member. This guide will assist you in determining the quality of care in a particular Center, and will help you to make a wise selection.
How To Start
Adult Day Care Centers must be licensed by the Maryland Department of Health and Mental Hygiene. The licensed Centers in Montgomery County, Maryland are listed at the back of this guide. However, in your search for the right program, you will want to look beyond the licensing requirements.
It is important to visit several Centers at least once to get a feel for their day-to-day activities. Make an appointment to talk with the social worker, director, nurse, or other professional staff. This guide is intended as a convenient reference to use when visiting centers. It will help you develop a sense of the facility and whether it offers quality care for your family member.
Remember, the most important consideration is your family member's specific situation. You cannot change the participant to fit the Center so select the Center that meets the needs of your family member.

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PHYSICAL ENVIRONMENT  
What You Should Expect
Licensing regulations require Centers to have adequate usable space, be barrier free, and have an appropriate number of restrooms. Centers must also comply with applicable state and local building regulations and fire and health codes.
Beyond basic safety issues, look at the environment with an eye toward the emotional impact it may have on your family member. The fanciest facility in the world can feel foreign and forbidding if adequate accommodations to meet the physical and emotional needs of its users have not been made.
What You Should Ask and Observe
  • Are there hand rails?
  • Are spaces well lit? At least some natural light is important.
  • Are there cues for finding rest rooms and activity rooms?
  • Are staff using the environment to promote independence?
  • Are there provisions for privacy when needed or desired?
  • Are there spaces where small groups can engage in simultaneous activities? Is there space for large group activities?
  • Are displays and decorations age appropriate, suggesting respect for the adulthood of participants?
  • Adult Day Care Centers were developed as an alternative to an institutional environment. Do you believe, in your family member's eyes, the Center has achieved a non-institutional feel? If not "home-like", does the Center feel like a lodge or clubhouse that they may have experienced in the past?
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NURSING AND SOCIAL WORK SERVICES 
What You Should Expect
Adult Day Care participants may have a variety of medical, rehabilitative, and social service needs. Adult Day Care Centers that are licensed by the Department of Health and Mental Hygiene are required to have a registered nurse and a social worker on staff. Both should be knowledgeable and experienced in meeting the broad medical, psychological and social needs of the elderly and disabled adult day care population.
What You Should Ask and Observe
  • Does the Center have a registered nurse on staff? If so, what are his/her hours?
  • What type of nursing services are available?
  • Medication administration and management?
  • Blood pressure/weight screening?
  • Physician and family liaison?
  • Bladder training and/or continence management?
  • Nutrition instruction and special diet management?
  • Specific nursing procedures required by your family member?
  • What personal care services are available?
  • Bathing? Hair care? Nail care?
  • Assistance with meals? Incontinence care?
  • Does the Center provide or arrange for speech, physical, and occupational therapies?
  • Is there a social worker on staff? If so, what are his/her hours?
  • What type of social services are available?
  • Information and referral?
  • Caregiver support groups?
  • Individual, group, and/or family counseling?
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ACTIVITIES 
What You Should Expect
One of the greatest benefits of Adult Day Care is that it gives socially isolated adults the opportunity to establish new roles and relationships in a safe and trusting environment. The Center's daily activities are the tools which create this important sense of community. A successful activity program will be diverse, focusing on mental and physical stimulation, and the strengths and interests of the participants.
Ask to speak with the activity coordinator and find out what types of individual and group activities are conducted.
What You Should Ask And Observe
  • Does the Center's activity calendar reflect a diversity of activities?
  • Are the activities appropriate for an adult population?
  • Are the activities stimulating, interactive, and enjoyable?
  • Are participants encouraged to take part in activities?
  • Is the Center culturally diverse?
  • Are there opportunities for individual or small groups activities in addition to large group activities?
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NUTRITION 
What You Should Expect
Proper nutrition plays an important role in preserving the health of participants. Centers are required to provide a minimum of one meal and two snacks a day. The dining area should be conducive to a relaxing meal, with tables placed to encourage socialization. The area should be clean, attractive, well-lit, and inviting.
Special diets are often necessary for participants. Those meals, as well as the standard meals, should be appetizing.
What You Should Ask And Observe
  • Is the food tasty and attractively served?
  • Does the Center provide meals that are low in fat and sodium?
  • Does the Center provide meals that are calorie controlled, kosher, vegetarian or meet the special requirements of diabetics?
  • Are supplemental feedings or pureed foods provided when necessary?
  • Is there adequate time to eat meals?
  • Is there sufficient staff to serve and assist in providing meals and snacks?
  • Is there a warm, congenial atmosphere during the meals and snacks, or is it stilted and uncomfortable?
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PERSONNEL 
What You Should Expect
Adult Day Care Centers should provide the services of a variety of full-time staff specialists. Each staff member's background, experience and personality contributes to the character of the Center. Centers should be staffed by a multidisciplinary team including a registered nurse, a licensed social worker and a qualified activity coordinator.
Program assistants (they may have other titles) provide the hands-on care and assistance with activities. The qualifications of program assistants are set by each Center rather than specified by regulations.
Remember, Adult Day Care was developed as an alternative to an institutional environment. Staff should dress consistent with this goal.
What You Should Ask And Observe
  • Are the Center's priorities consistent with what you want for your family member? Is there a sense of commitment, caring, concern, and professionalism?
  • What are the education and work experiences of the staff?
  • What is the staff/participant ratio? Regulations require at least one staff member for every six participants. Volunteers cannot be counted as part of this ratio.
  • Do you see one-on-one conversations between staff and participants? Do staff show interest in and affection for the participants?
  • Are the participants treated as adults?
  • Are staff courteous and respectful?
  • Do staff respond quickly to participant calls for assistance?
  • Do you get a sense of community within the center? Do staff know participants by name?
  • Are staff members dressed in a neat and appropriate manner?
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TRANSPORTATION  
What You Should Expect
If a Center is located on your route to work and the Center's hours match your schedule, you may want to provide transportation yourself. However, if that is not possible, you will need to evaluate the Center's transportation. Keep in mind that the trips to and from the Center are typically the most stressful time of the day for your family member. It is a time of transition and your family member will rely on the Center for their safety and security. Therefore, it is critical that they receive any reassurance and support they need.
What You Should Ask And Observe
  • How are the drivers trained? Is there follow-up training? Who supervises the drivers? What reference checks are conducted?
  • Is there an aide on the van?
  • How much assistance at the home will be provided by the driver or an aide? Can your family member's physical or mental limitations be accommodated?
  • About what time would your family member be picked up in the morning and returned in the afternoon?
  • How long is the route and how much time will your family member have to spend on the van?
  • What safety equipment is carried on the van? Are seat belts routinely fastened? Who is responsible and how often are vehicles checked for safety? Is a radio or cellular phone available for emergencies? 
  • If your family member is wheelchair bound or has impaired mobility, how would the Center accommodate them for transportation?
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ADMINISTRATION/FINANCES 
What You Should Expect
Along with your evaluation of a Center's environment, activities, personnel and transportation, you should very carefully consider the financial aspect of contracting with a Center.
Read the admission agreement carefully. Make certain you understand all the terms and conditions. Do not hesitate to ask for written clarification of anything you do not understand or that is not specifically included in the agreement. Make sure you receive and retain a copy of everything you sign.
Be sure to check the Center's references. Talk to several current and past participant's families to get their opinions of the Center. Check out how long the Center has been in operation. Ask if the Center allows unexpected visitations by family. Such visitation can enable you to determine whether your family member is receiving the expected services and is happy at the center.
What You Should Ask and Observe
  • What is the application/admission process?
  • Are deposits required and are they refundable?
  • What is the base daily fee? What are the days/hours covered by this fee? What is the cost for extended hours? Does the fee cover transportation?
  • Does the base fee cover all activities? If not,what are the additional charges? Is there an extra fee for physical therapy or other related health services?
  • Is there a minimum attendance requirement, i.e., two days a week?
  • When and how is payment expected? Does the center bill you or are you expected to pay each day?
  • What is the policy regarding vacations?
  • Do you pay as long as the center is open or can you give notice and not pay when the participant is away?
  • What is the Center's policy regarding attendance and payment when the participant is sick or not feeling well?
  • What is the Center's policy regarding payment during holidays and snow days?
  • What notice is required to cancel the contract/agreement?
  • Is the Center certified for Medicaid or VA benefits? Does the Center receive any other subsidies and how can you qualify?
  • Does the Center have a Participant's Bill of Rights and formal grievance procedures?
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For a current listing of Adult Day Care Centers, contact:

Maryland Health and Mental Hygiene Department
300 W. Preston St.
Baltimore, MD 21201
410-767-6860
Montgomery County Department of Health and Human Services
Senior Information
240-777-3000


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