Dawn's mother loves to go to her local senior center. At least three times a week she attends to participate in her art class and to play bridge. Because they serve lunch, she sometimes spends most of the day there, socializing with her friends and just "hanging out." On other days, she runs in for an activity or class and then leaves to do other things.

Dawn's friend Maurice heard about the senior center and thought it would be ideal for his wife, Eleanor, who was spending most of her day isolated at home. After he left  Eleanor at the center several times he was dismayed and angry when the director took him aside. She sadly told him that Eleanor was unfortunately no longer welcome to attend without Maurice. Eleanor had been bothering other attendees with incessant questions, she was unable to find the bathroom, and she had been found wandering confused in the parking lot. She suggested that an adult day center would be more appropriate for Eleanor.

Why Was the Senior Center the Wrong Choice For Eleanor?

Senior Centers, usually sponsored by local municipalities and often with support from the Area Agency on Aging, are designed to be recreational facilities for independent citizens over the age of 50.  While they have a few staff members who organize activities and make sure everything runs smoothly, they do not have the staff to monitor and direct participants. The seniors who attend come and go freely throughout the day, depending on what activities are scheduled and what they choose to do. Many also volunteer at the senior center, which helps to keep the need for paid staff and costs down.

Activities are designed to be appealing to those who are cognitively fairly sharp. They often lean toward arts, crafts and competitive games such as bridge, mah jongg, Scrabble, canasta and poker. Seminars and exercise classes and, where a pool is available, water workouts, are very popular. Ballroom, swing and square dancing keep everyone moving. Often senior centers also sponsor day and even overnight bus excursions.

Most senior centers charge residents of the town or city a small fee for membership, and of course additional fees for craft materials or excursions almost always apply. Because most senior centers are subsidized and they operate with a very small paid staff, the cost for local residents of using the facility is usually low.

Eleanor was not successful at the local senior center because she needs guidance and carefully structured activities throughout the time she attends a day program. She is no longer able to direct herself or to pick and choose between activities she might enjoy. She is unable to engage with the other seniors, who are uncomfortable with her forgetfulness and annoyed by her repetitive questions and "odd" behavior. She is at risk while she is there alone because there is no staff to keep an eye on her, and she has already demonstrated that she will not stay safely indoors until Maurice returns. To be successful and to have an enjoyable day Eleanor needs an entirely different kind of program.

Adult Day Care: A Better Choice For Eleanor

Adult Day Activity Centers (most seniors do not want to go to "Day Care," which sounds childish) are designed to provide structured activities and supervision throughout the day. They are intended to provide the opportunity to socialize and to participate in activities at which people with memory or physical impairments can have fun and be successful. They also serve the critically important function of providing daytime respite to people caring for someone with dementia so they can work or have personal time.

Adult day centers have enough trained staff to supervise and work closely with those who attend. While most specialize in dementia care, some even have a nurse and other medical professionals to supervise and work with individuals with other medical needs. This is day care model is generally called "Adult Day Health Care" or ADHC, as opposed to the purely "social" adult day activities model. Adult day health care centers usually require a physician's health assessment and documentation before enrollment.

Most adult day programs require that attendees pay their daily or weekly charges privately, although many long-term care insurance policies cover the cost of these programs. For low income seniors Medicaid sometimes covers the cost of attending an adult day health care program. Some programs do offer a sliding fee scale. Medicare does not cover adult day programs.

Because the costs of running an adult day program are significantly higher than for a senior center, the average cost of an adult day program averages from $30 to $80 or more per day, depending on location and the services provided.

While adult day activity centers are designed for those with dementia and other needs, many non-medical centers require that participants be independently mobile. Some will permit the use of a walker or wheelchair, and some do not. Most require that attendees be continent or able to manage incontinent briefs on their own.

Most day activity centers open fairly early in the morning and close after normal working hours, so that participants can attend while caregivers are at work. Attendees are supervised from the time they arrive to the time they are either picked up or delivered back to their homes if the center provides transportation (most do not).

Adult day programs are the best choice for individuals who:

• Are in the beginning to early-mid stages of a dementing illness (the non-medical model);
• Are no longer able to plan and carry out daily activities independently;
• Are no longer safe at home alone;
• Are isolated and in need of stimulating activities;
• Live with a caregiver who works or needs a break from caregiving.

Good adult day activity centers can sometimes be more difficult to locate than city-sponsored senior centers. However, because they are asked so often, senior center employees will usually have a list of most of the adult day centers in the area, as will the local Area Agency on Aging.