Although dementia has probably been around since humans first appeared on earth, it is only as we live longer that we have begun to see its widespread occurrence in older adults. The most common type of dementia is Alzheimer’s disease, but there are other types and causes of dementia. In fact, new research is suggesting that “pure” pathologies may be rare and most people likely have a mix of more than one type of dementia.
Worldwide, more than 50 million people live with dementia—and this number is expected to triple by 2050 (ADI, 2019). In Florida, there are over 500,000 residents currently living with Alzheimer’s disease and by 2025, this number is expected to increase by more than 200,000.
For those of you working in adult daycare, it is very likely you will have contact with clients with dementia. Many of your clients will also have chronic conditions and recent hospitalizations. A major goal of adult daycare is to reduce the risk of hospitalizations and readmissions and help families and caregivers learn about dementia, and successfully manage their loved one’s chronic conditions (Caffrey and Lendon, 2019).
Pre-Test: Try these True/False questions before continuing.
Answers are listed below the box.
- Specialized Adult Day Care services are for people who do not have dementia.
- Geriatrics specialists refer to behavioral changes in people with dementia as behavioral and psychological symptoms of dementia (BPSD) or neuropsychiatric symptoms of dementia (NSP).
- Challenging behaviors arising in people with dementia are best managed when interventions are tailored to each person.
- In a specialized adult daycare facility, a physical restraint should always be used when a person is acting out.
- The humanity with which assistance is offered, especially help with eating and intimate care, is crucial in helping the person retain their self-esteem and dignity.
- Carefully designed activities can have a positive effect on depression, confusion, and challenging behaviors for people with dementia.
- Providing care for a person with dementia places practical, psychological, and emotional stress on caregivers, which can lead to denial, anger, and depression.
- In many developed countries, the vital caring role of families and their need for support is often overlooked. In developing countries, the reliability and universality of the family care system is often overestimated.
- A therapeutic environment recognizes that people with dementia are influenced by their surroundings and do better with environments that are individualized, flexible, and designed to support differing functional levels and approaches to care.
- For people working in facilities catering to people with dementia, staffing is often negatively affected by unclear roles and functions, heavy workloads, demanding work schedules, difficult ethical issues, job strain, and burnout.
- A key ethical principle in dementia care is to understand and remember that people with dementia remain the same equally valued people throughout the course of their illness, regardless of the extent of the changes in their mental abilities.
Questions 1 and 4 are false, the remainder are true.
1.1 Adult Day Care in Florida
In Florida, as of 2021, there are approximately 349 non-specialized adult daycare centers providing therapeutic programs, social services, health services, and activities for adults in a non-institutional setting. Nearly half of non-specialized adult daycare clients have Alzheimer’s disease or a related disorder (FADSA, 2021).
Adult day service centers provide non-residential coordinated services in a community setting for less than a day. There are three types:
- Social,
- Medical/health, and
- Specialized (providing programs for people with dementia) (FADSA, 2021)
1.2 Specialized Adult Day Care
Specialized adult daycare centers are specifically designated to treat clients with Alzheimer’s disease and other types of dementia. Specialized centers enroll a higher percentage of clients with dementia than do regular adult day centers and require specialized dementia training for their staff. A specialty license is required to provide services as a Specialized Alzheimer's Services Adult Daycare Center. (O’Keeffe, 2014, latest available).
Most adult daycare participants attend at least 3 days each week and most clients use transport services provided by the centers. In 2022, the median cost of adult daycare services in the U.S. was $81 per day (Alzheimer’s Association, 2023).
In Florida, specialized Alzheimer's adult day centers must have, at a minimum, 1 staff member providing direct services for every 5 participants with Alzheimer's disease or other dementia. All adult day centers must have, at a minimum, 2 staff members present in the center at all times (1 of whom has a certification in first aid and CPR) (O’Keeffe, 2014).
The owner or operator may be counted as one of the required staff members if that person provides direct services and is included in the center's work schedule. However, the owner or operator must not be counted more than once in the staff-to-participant ratio, calculated on the basis of daily census (O’Keeffe, 2014).