In some cases, older adults need more support than is possible with just home modification, but still do not need it on a full-time basis. For them, one pos­sible option may be adult day care. Adult day care is designed to provide support, companionship, and certain services during the day. This situation arises most often when the primary caregiver is employed or has other obligations and is unavailable during the day.

The primary goal of adult day care is to delay placement into a more formal care setting. It achieves this goal by providing alternative care that enhances
the client’s self-esteem and encourages socialization. Three general types of adult day care are available (National Adult Day Services Association, 2008). The first provides only social activities, meals, and recre­ation, with only minimal health services. The second type is adult day health care that provides more intensive health and therapy intervention and social services for people who have more serious medical problems or who require more intensive nursing care for a specific medical condition. The third provides specialized care to particular populations, such as people with dementia or developmental disabilities. Adult day care centers can be independent or spon­sored by a profit (22%) or nonprofit (78%) organ­ization. They may provide transportation to and from the center. Depending on the services received, Medicaid or other insurance may cover some of the expenses (Medicare does not). Because some states do not license adult day care centers, careful screen­ing of a particular center is advised.

About 35% of adult day care clients live with an adult child, and 20% with a spouse or partner. The average age of clients is 72, with about two-thirds being women (National Adult Day Services Association, 2008). Family members who choose adult day care (and can afford it) typically do so because they need
occasional assistance with caregiving, have safety concerns about the care recipient when the caregiver is not around, take increasing amounts of time off from work for caregiving, are experiencing problems in their relationship with the care recipient, or the care recipient could benefit from more contact with other older adults (MetLife, 2006).

For people with cognitive impairment, changes in routine can result in confusion or disruptive behavior. It is especially important for them, as it is for all older adults who may become adult day care clients, to inform them of this choice. A good strat­egy is to engage in a few trials to find out how well the person acclimates to the different surroundings and activities.

Research demonstrates that adult day care is a viable and important option for caregivers. They are interested in the kinds of programs that meet the needs of their loved ones, and are generally satisfied with the services provided (Madeo, Feld, & Spencer, 2008). Family members clearly seek what is best for their loved one in searching for and helping make the transition to adult day care centers (Bull & McShane, 2008). Evidence is clear that, compared with keeping relatives with cognitive impairment at home, good adult day care programs can reduce problematic

behaviors and lower the need for psychotropic medi­cation in clients, and result in lower reports of caregiving burden among caregivers (Mosello et al., 2008). However, a key factor in the success of day care programs is having culturally appropriate pro­grams in interventions, as demonstrated in a study of Korean clients who benefitted most when programs took their background into account (Park, 2008).