Adult Daycare Proposal Golden Years

Adult Daycare

Proposal "Golden Years Adult Daycare"

The proposed program will demonstrate a significant goal of reducing the number of adults, needing daily medical and social supervision who must receive such care from non-formal caregivers. The problems of aging and some disease processes that occur in aging are a significant social need that needs to be effectively answered by structured programs that reduce the care giving burden on family and allow them the ability to have normal lives, that include working and perusing social and other essential activities without the concern of their aging loved one to ensure their ability to continue to be primary caregivers.

As the population of the United States ages demographic changes are evident and potentially troublesome, if changes are not implemented. The changing population has changing needs that are dependant on the funding of programs that offer such programs at prices comparable to other social services.

Life expectancy in the U.S. has increased from 48 years in 1900 to 83 years in 2000..."

Couper & Lapham, 2002, p. M16) Though we must identify this as a social problem only in that it significantly increases the number of people requiring care in formal settings for age related problems that require supervision. In a sense we can think of increased life expectancy as a positive outcome of strong social policy of the past. "Reduced death rates for children and young adults (largely because of better public health systems like clean water: better nutrition, and better medicines like antibiotics) are the main factors behind increasing life expectancy over the last century."

Couper & Lapham, 2002, p. M16) Recognizing this change as a positive social outcome, does not however resolve the fact that this demographic is in need of social services at a higher rate than a smaller aging population did in the past. Additionally, many diseases are specific to the elderly, just as a result of the fact that the older one grows the higher the chances for living with debilitating diseases become. Though the main function of adult daycare is to provide services for elderly people experiencing diseases that cause dementia, of which there are several, this does not exclude those who need medical supervision for other reasons or as a result of longstanding disabilities that leave them minimally functioning as adults. Though today only 4 out of 100 adults who are aged 65 years old or older live in nursing homes,

Couper & Lapham, 2002, p. M16) there are many who could avoid such care if there were capable individuals and institutions to meet their needs during daytime hours so traditional family care can be offered for a longer period of total years. An adult daycare, such as the one proposed here could significantly increase the ability of family to care for aging adults for longer periods as such care offers respite to pursue activities that enrich their own lives, and make it possible to continue to be able participating adults in the community.

Although Mr. G. resisted at first, he was finally convinced to try adult daycare. This is a means of increasing his socialization, mobility, and providing medical supervision. Mrs. G. worries about the cost of daycare, but recognizes its importance in relieving her of constant caregiving responsibilities. Counseling by the nurse convinced Mrs. G. that preserving her health through rest and recreation is essential to preserving her caregiving abilities. She uses her "new private time" to that end. (Kim & Keshian, 1994, p. 66)

For some caregivers the respite of eight to ten hours per day for care giving responsibilities can make the difference between whether they can remain as primary caregivers for financial as well as health reasons. The reality is that as people age, and require more care, caregivers also age and may require more support and if this support cannot be gleaned elsewhere, such as within the family it must be attained outside the home and for many the last resort is institutionalization, and already taxed resource. (Kim & Keshian, 1994, p. 63) According to an expose on aging done by MSNBC

The proportion of older people in the United States is also growing. Today, a baby boomer turns 50 every 7.6 seconds, and by mid-century old people will outnumber young people for the first time in history. As a result, our families and social institutions are in the throes of a social revolution. The number of people over 65 has grown tenfold since the turn of the last century. But we're only at the beginning of the curve - the baby boomers are moving across the demographic chart in a huge wave. (Winokur, 2003, MSNBC Online)

When Winokur discusses the issues associated with aging the full range of them is both positive and negative, older Americans are contributing to the economy for longer periods of time and they are technically more successful than their aging counterparts in the past. The view of the aged individual, by society is slowly changing to better reflect the diversity and contribution of these people in the past and now.

But the aging of our society also has created new demands and problems. Currently a quarter of all households are caring for an older relative....long-term care facilities can expect a 100% turnover in nursing staffs every year and veterans with Alzheimer's disease have been kicked out of Veterans Administration facilities because there aren't enough beds. (Winokur, 2003, MSNBC Online)

Many people and groups have identified the need for adult daycare o0fferings as a demonstrative social and societal need, as the extension of the retirement age makes it difficult for some people to work and care for an aging spouse or even parent. (Torres-Gil, 1992, p. 3) the result is that many elderly people, except where highly motivated live out their days in almost complete social isolation and unless their condition is so extensive, as to require medical supervision, this may not change for many, many years. There is simply no excuse for continuing to isolate and ignore this population, as they can and should be out in the world enriching it with their diverse and powerful life experiences and personalities. Though dementia is only one of several reasons for the admission of individuals into a care center or need for supportive care, it is estimated that nearly four million people in the U.S. have some form of dementia and the need for care continues to rise, as does the need for alternative services for families caring for such individuals.

Arno and colleagues (1999) estimated that the national economic value of informal caring for people with dementia is $196 billion. Because care needs increase substantially as dementia progresses, professional health and human services are needed to supplement the care provided by family members and to support their efforts. Although studies have found a great need for services among people with AD and their primary informal caregivers, low levels of service utilization have been reported (for example, Adler, Kuskowski, & Mortimer, 1995; Cotrell, 1996; Kosloski & Montgomery, 1992). Therefore, interventions that encourage and support greater use of formal services appear warranted. (Mccallion, Toseland, Gerber & Banks, 2004, p. 441)

The aging population must be better served, and by proxy their families must be supported through this extensive demographic change in society. The consequences of this demographic change will be significant if services are not developed to aide families caring for older adults and if older adults are offered to few services, accidental deaths will continue to rise among the population and worse.

The veterans Administration, is one example of a powerful agency that is seeking to find alternatives to costly institutionalization for those who require only minimal care, but who cannot live alone without significant monitoring and assistance. (Cox, 1993, p. 73) the Department of Health and Human Services, has done significant research to determine the growing costs associated with caring for the frail elderly.

Estimates of the annual cost of health care for frail older persons range from $54 billion to $80 billion, and by 2030 this cost could be $132 billion (Department of Health and Human Services, 1991). Moreover, this sum is an underestimate of costs in that it does not include all of the other services and assistance, formal and informal, that these frail individuals require. (Cox, 1993, p. 2)

The traditional cost of care, as the DHS points out is not inclusive of the volunteer care provided the individual, such as in the home and usually does not include Adult Daycare in figures, either. Yet, as a prevention method, an adult daycare could be of significant assistance. Adult daycare has the ability to monitor healthcare daily, and to help families avoid costly hospitalization, as a result of accidents and the injuries they cause, by simply being present for daytime hours, when families may feel the need to inadvertently neglect their aged loved one as a necessity to keeping a roof over their head.

The stress of caring for a frail relative is often compounded when the caregiver is employed. In the last few decades the percentage of women in the labor force has dramatically increased from 11% in 1940 to 56% in 1980 with 62% of the women between the ages of 45 and 65 employed (U.S. Department of Labor, 1986).The extent to which such employment affects caregivers is apparent in the results of a survey conducted by the AARP. Findings reveal that 55% of the women caring for frail relatives were simultaneously employed outside of the home (American Association of Retired Persons and the Travelers Foundation, 1989).

(Cox, 1993, p. 112)

Individuals, be they spouses of children of the frail elderly are under increased risk of duress, as a result of the intensity of pressure associated with work and care giving. These individuals need alternatives that will significantly reduce their stress and help their family member better interact in the community and therefore stay healthier longer. Another group that is beginning to show interest in the development of services for the frail elderly are the baby boomers, as they constitute a significant portion of the individuals caring for frail elderly individuals and are seeking support in doing so, just as their children and grandchildren are seeking support in caring for their children. Additionally, the largest generation in human history, will also be seeking such care in the very near future, for themselves and their demographic is so large that the ensuing generations will not be capable of maintaining traditional care giving roles, as a matter of logic.

The Golden Ages Adult Daycare will be a combination facility, that offers respite care to families caring for medically fragile individuals, who are at least partly ambulatory, or who have alternative mobility and who are in need of assistance with daily living tasks, such as cooking, an issue that often determines one's ability to continue to remain independent, grooming and other necessary daily activities. Additionally, the center will offer medical and social transportation to individuals utilizing the service, so they may continue to independently pursue needed services, whenever possible. The center will also offer opportunities for social interaction and age appropriate activities that will be offered daily if not hourly, in both a structured and informal manner.

Adult day-care concentrates on serving the functionally impaired by offering a comprehensive program of health, social, and special support services in a protective setting (the National Institute on Adult Daycare, 1984). Day-care can therefore play a significant role in the lives of the frail elderly as it offers support and social interaction while providing caregivers with respite assistance. In a survey of 60 day-care programs, three models of day-care were identified (Weissert et al., 1989). These models are those associated with a nursing home or rehabilitation hospital that serve the most dependent elderly; centers affiliated with a general hospital that serve a less physically frail but often more mentally impaired population; and centers which serve only one population, such as Alzheimer's patients or patients belonging to the Veterans Administration. Each model offers in varying amounts case management, health assessment, nutrition education, transportation, and counseling. (Cox, 1993, p. 72)

The value of such care is paramount to the ability of families to continue to monitor the health of the frail elderly as well as maintain lives outside of their care responsibilities. The growing demographic of older adults will also likely lead to more and more cases of neglect and abuse, as families becomes overburdened or incapable of caring for the frail elderly. As these abuses mount, laws will likely be created and strengthened that could potentially devastate a family, and without preventative institutions such situations will likely increase tenfold in the coming years.

A the lack of satisfying treatment alternatives on behalf of abused older people is a disincentive to reporting of risk status. A frequent solution offered to victims of elder abuse is safe haven in a care facility, but this comes with a loss of personal liberty (Sadler, 1994). (Litwin & Zoabi, 2004, p. 133)

Though there is little research that can definitively say that elder abuse is caused by lack of services for the elderly, and therefore increased burden and stress on family, the logical connection can be made easily. Anyone who has cared for a loved one, for any length of time 24 hours a day 7 days a week is aware of the stress that such care causes on ones person and life. Abuse of children is also linked to such stress, as are many other seemingly personally incongruent crimes against others. Abuse of the elderly can range in severity from neglect to outright violence, and stress is clearly a significant factor in most if not all of these cases. If these same people were given respite care alternatives, even a few hours a day this trend could be halted and the occurrences could be reduced. Equitable, non-cost prohibitive care for the frail elderly, such as that offered by an adult daycare institution could be a social response that would actually reduce this growing trend and protect individuals and families from facing such extreme situations.

The natures of opportunities for social interactions, on the part of the current community for the frail elderly are limited to say the least. For the most part when individuals become to frail to drive, cook, clean and groom themselves, they are either rejected by the community and must depend on family to meet their social and physical needs or they are neglected, as a result of fear of loss of independence and secrecy, sometimes on the part of the individual. Those who seek help, are afraid that they will lose everything that makes them an independent adult for the whole of their lives, so they remain silent about problems, living conditions and/or medical needs. It therefore can become a very extreme situation, over a relatively short period of time. If prior to the recognized need for daily assistance the individual can expect a phone call or visit from family once or twice a month the situation can become almost deadly before interventions can be taken. (Holstein & McCurdy, 1999, p. 168) Additionally, those already being cared for in the home of a family member can be neglected, inadvertently by care givers as a result of the need to meet other obligations, or worse intentionally as a result of increased stress and demands. The services of a safe, clean healthy environmental alternative for the frail elderly in the form offered by an adult daycare will be successful, because they will meet the needs of a growing population for alternatives to institutionalization and increased care inclusive of independence and dignity. (Suggs, 1999, p. 87) Most, importantly, if a frail elderly individual is offered alternatives to extreme dependency on loved ones he or she will be more capable for longer of coping with their own needs and responsibilities as adults, as they will be lacking in the guilt and depression that is often felt by such people when they "become a burden to loved ones." People who feel as if they have become a burden are at higher risk of depression, declining health related to stress and suicide. (Brown & Vinokur, 2003, p. 131) Adult daycare can offer an individual the opportunity to continue pursue their own independent adult life, with the nominal aide of others, without straining their family or putting them in a position of constant fear, associated to living without a safety net.

The primary goal of the Golden Years Adult Daycare center is to offer alternatives to families, for the care of frail elderly, during daytime hours while providing these adults with the opportunity to continue to pursue independent interests and holistic health in a clean, comfortable and supportive environment.

Mission Statement:

The mission of the Golden Years Adult Daycare center is to recognize the inherent value in the elderly by allowing them to live safely and express independence through the pursuit of activities and the reception of needed care, in a safe and inclusive environment with their peers. This mission will allow individuals the ability to continue to live healthy and independent lives, despite their medical frailty.

The Golden Years Adult Daycare will be located in a rural area, as the demographic need for such care is greater outside of urban areas. (Cox, 1993, p. 73) the need for alternative care is greatest in areas of traditionally underserved populations, as the demographic shortfalls in rural areas grow, with regard to medical services alternatives must be offered. The center will attempt to obtain a lease or purchase on one of several old town buildings currently underutilized by the community, as a part of downtown redevelopment organizations and to centralize services. Two particular building of interest is the former lodge, and the former grange buildings as these buildings offer the infrastructure (i.e. A full commercial kitchen) as well as the space, on a single floor that would allow for all needed spaces and services. Individual elderly people living in rural areas are also much more likely to have families separated by geographic difference, yet may feel very reluctant to leave their community as it is a longstanding place of comfort and support in their lives. Furthermore, people in rural communities by nature live farther away from their nearest neighbor and are therefore further from help or assistance if and when it is needed. Whenever possible, public transportation support services will be utilized to bring individuals to and from the adult daycare, but the center will also offer private transportation, where none is available to the individual. There are very few such institutions in rural areas and funding is crucial, as the demographic rural population frequently has a lower average income and therefore ability to pay for services out of pocket. Additionally, as adult daycare is currently a rarely covered medical expense, not recognized by insurance companies and/or funding agencies as a covered service, as they currently prefer to believe that such care can and should be provided by the family. For this reason supplemental funding is foundational to the ability of frail individuals to access this service. The cost-prohibitive nature of such care must not be the greatest obstacle to receiving it. In some larger communities such care is offered through support from umbrella organizations such as the United Way. (Julian, 2001, p. 851) Rural communities frequently do not have such funding, though these avenues, in the form of grants will be pursued to reduce investor burden and decrease cost of services.

Many steps will be taken on a marketing as well as personal level to obtain and maintain acceptance by the neighborhood and the greater community as a part of the downtown redevelopment initiatives, currently in place in this community. Residents of the community have a significant emotional and social connection to the downtown area, and this is especially true of the communities elderly population, as they remember the significance this area played in the past. A commitment to redevelop such a central aspect of the community will likely be met with serious community support, as many buildings downtown have fallen to neglect and miss-maintenance as a result of suburban like growth in the community. The community is therefore actively seeking solutions to this problem, by finding sustainable businesses and services that can relocate to the old-town area and revitalize it. If the community recognizes the organization and its served clients as committed to this goal they will be more likely to support and seek its services and recognize it as a valuable addition to the community. Furthermore, there are several churches and a small community supported senior center who serve the elderly population, as a matter of civic responsibility. Though the Golden Ages Adult Daycare center will be an ecumenical institution it will be greatly served in seeking allies in these two areas, as they can most effectively offer referrals to people who might be interested or in need of the services, provided. Additionally, a blanket personal marketing campaing will be mounted to make other community services aware of the center, pharmacists, local doctors, church clergy, dentists, and local federal and state agency providers will all be personally handed materials that explain the services offered and provide contact information. The social, economic and political climate of the area are such that such a service is sorely needed, the population is aging with little or no local family support, the economics of the community are fragile and the political desire to maintain the communities, population is essential tot the support of such services. The effects of implementing such a service could be that those who are at risk can be afforded the opportunity to remain in their home community for much longer and therefore continue to be active and valuable parts of their beloved community.

Agency stakeholders include, owners, managers, employees, those provided care, the families of those provided care, local and national funding sources as well as the lending institution that will hopefully provide a small business loan for the purchase or lease and improvement of the building to be used by the center.

Services will be coordinated and controlled through first the owner/manager of the center and through the specialized staff who will be hired to fill supportive roles, such as a kitchen and service staff, a recreational coordinator, 2 licensed nursing professionals (who will provide medical evaluative care and medication administration where needed) and split 5 12-hour shifts between them and 2 unskilled nursing professionals per day who will serve as direct assistants to those served. Outside services, such as a hair care professional will be offered a salon chair and area for services that will then be paid for by the individual or their family, directly to the stylist as he or she sees fit.