Holly Dabelko-Schoeny

The Effectiveness of Adult Day Services for Older Adults A Review of the Literature From 2000 to 2011

Adult Day Service (ADS) centers offer a variety of services to meet the needs of older adults and their caregivers. During the last decade, ADS has received increased attention due to shifts in policy toward home and community-based services for an aging population. This article reviews the effectiveness of ADS from 2000 to the present, with particular attention given to caregiver and participant outcomes, health care utilization, and future directions in ADS research. Multiple databases were searched to identify relevant research and 61 articles were selected for review based on inclusion criteria. The results of this review emphasize the need to implement and test more specific interventions targeting the needs of the ADS population.

Civic engagement for nursing home residents: a call for social work action.

Civic engagement has been found to be associated with a number of emotional and physical benefits for older adults. For those residing in nursing homes, however, opportunities for civic engagement are limited. Societal barriers such as ageism and practical issues such as transportation can limit their access to activities that promote civic engagement. In this article, we review past research on civic engagement for older adults and explore the challenges and barriers faced by nursing home residents. We conclude with a call for social work professionals to develop, implement, and evaluate interventions that increase civic engagement opportunities for this undervalued group.

The state of adult day services: findings and implications from the MetLife National Study of Adult Day Services.

With approximately 4,600 centers serving over 260,000 persons each day, adult day services (ADS) continues to be a growing sector within the long-term care industry. However, due to the absence of national data, a full and detailed understanding of the ADS industry has been limited. In the first national study since 2002, researchers collected descriptive and programmatic data on a randomly selected sample (N = 557) of ADS facilities across the United States. Results indicated substantial changes in facility characteristics (e.g., size, staffing), participant characteristics (e.g., age, care needs), service provision (e.g., psychosocial, nursing, and medical services), and financing and funding (e.g., rates, reimbursement). Data suggested that the ADS industry has an increased capacity to serve as a provider of comprehensive health care for families and as a platform for chronic disease management. Implications for public policy makers, providers, and researchers are discussed in light of the current health care environment.

Civic Engagement for Older Adults With Functional Limitations: Piloting an Intervention for Adult Day Health Participants

PURPOSE Past research has demonstrated the importance of civic engagement for older adults, yet previous studies have not focused specifically on the potential benefits of civic engagement for older adults with functional limitations. This pilot study explored the feasibility and effectiveness of an intervention designed to promote civic engagement in this growing and often overlooked population. DESIGN AND METHODS A convenience sample was recruited from 2 adult day health centers (N = 43). A multicomponent intervention was implemented comprising education, service, and recognition phases. Using a nonequivalent switching replications design, researchers compared participants receiving the civic engagement intervention with participants receiving treatment as usual. RESULTS In terms of feasibility, the intervention was unproblematic and amenable to this population; however, challenges existed in data collection. Participants receiving the intervention reported higher, yet nonsignificant, levels of purpose in life, self-esteem, and perceived physical health when compared with those in the control group. However, 5 weeks following the withdrawal of the intervention, participants reported a significant decrease in self-esteem and perceived physical health. IMPLICATIONS Civic engagement interventions appear to be quite feasible and possibly beneficial for older adults with physical and cognitive limitations, such as those enrolled in adult day health programs. Future studies should examine the nature and amount of engagement needed to maximize the benefits of such interventions.

“Quite Frankly, I Have Doubts About Remaining”: Aging-In-Place and Health Care Access for Rural Midlife and Older Lesbian, Gay, and Bisexual Individuals

ABSTRACT Midlife and older adults prefer to stay in their communities as they age. The ability to age-in-place is affected by physical health status, along with access to services and social support. Few previous studies have included the experiences of lesbian, gay, and bisexual (LGB) midlife and older adults living in rural communities and their concerns about aging-in-place. This study used a qualitative approach to explore health care service utilization and support networks of 20 midlife and older LGB participants over the age of 40 who live in rural communities. Themes emerging from this study included transportation difficulties, lack of choices for care, affordability of care, and the lack of connection and sense of belonging to a community. Unique issues faced by LGB adults, such as isolation and the lack of informal support, make obstacles to aging-in-place for LGB adults living in rural communities particularly more difficult to overcome. Future studies are needed to gain a better understanding...

In Their Own Words: Participants' Perceptions of the Impact of Adult Day Services

Despite the growth in the number of adult day services programs providing long-term care in the United States, researchers have struggled to consistently identify the benefits of the services to older adult participants. Instead of identifying participant outcomes driven by administrative databases, funding requirements or accreditation expectations, this study attempted to identify outcomes through the lived experiences of the older adult participants through one-on-one interviews after 3 months of attendance. The purpose of this qualitative study was to gain an understanding of the experiences of older adult participants and to build theoretical understandings that connect experiences with outcomes. Twenty-eight semistructured interviews were conducted with older adults attending 4 day health programs administered by 1 organization in a large mid-west City. Three main program experiences were identified: social connections with participants, empowering relationships with staff, and participation and enjoyment of activities and services. These experiences seemed to be associated with perceived improvements in psychosocial well-being and a perceived decrease in burden or dependence on the caregiver. The findings provide theoretical connections that are helpful for exploring the impact of adult day services based on participant perspectives. Results suggest a need for further examination of the role social workers play in supporting psychosocial services within adult day programs.

Ready or Not: Transitioning from Institutional Care to Community Care

Federal legislation has moved toward the support and expansion of home- and community-based alternatives to nursing home placement. Despite the seemingly positive nature of these efforts, the question remains as to whether individuals, families, and communities are prepared for this shift in long-term care. Furthermore, there has been a lack of attention to the impact of nursing home transition programs on family caregivers, community resources, and the availability of appropriate housing alternatives. Although nursing home transition programs offer a promising alternative to institutional care, the authors suggest a closer examination of the policies and practicality of these transitions is needed.

A Constellation of Concerns Exploring the Present and the Future Challenges for Adult Day Services

While adult day services (ADS) continues to grow within the home and community-based services sector, questions remain as to the challenges that the industry faces and anticipates facing in the future. In this study, a national sample of ADS centers (N = 557) responded to open-ended questions regarding current and future challenges. Qualitative and quantitative analyses revealed that funding was a central concern around which a complex and interconnected constellation of challenges revolved, such as adequate staffing, marketing their services, physical space, and complicated care needs.Given the challenging economic times, these findings suggest that the continued evolution of the ADS industry depends largely on the implementation of changes in policy and funding mechanisms.

Equine-Assisted Intervention for People with Dementia

ABSTRACT The purpose of this exploratory study was to determine the feasibility and effectiveness of using guided interactions with horses as a nonpharmaceutical intervention to improve the physiological and behavioral states of persons with dementia. A convenience sample of persons with dementia was recruited from an adult day health center (n = 16). A multi-component intervention was implemented comprised of opportunities for grooming, painting, and leading horses. Using a randomized pretest-posttest crossover design, researchers compared participants receiving the equine-assisted intervention with participants receiving treatment as usual. Older persons with Alzheimers disease and related dementias engaged positively in animal-assisted therapy with horses. A reduction in behavioral problems was found post intervention in contrast to the comparison group. Pre-intervention measures showed that participants exhibited lower levels of disruptive behaviors compared with the control group on the days they were scheduled to work with the horses. Interestingly, cortisol levels, used as a physiological measure of coping with stress, were elevated after the intervention in participants with higher Mini Mental State Examination scores. Equine-assisted interventions are feasible and possibly beneficial for adults with Alzheimers disease or a related dementia disorder, such as those enrolled in adult day health programs. Future studies should utilize multiple methods of assessing impact and include process measures to delineate which specific activities seem to provide the most benefit.

Adult day services: A service platform for delivering mental health care

Objectives: The purpose of this study was to understand the degree to which mental health services targeting anxiety and depression disorders are offered by adult day services (ADS) centers in the US. In addition, researchers wanted to determine whether staffing and organizational characteristics are associated with the provision of medication management, individual counseling, and group counseling for participants with anxiety or depression. Method: Data were drawn from the MetLife National Study of ADS. Hierarchical logistic regression analyses were conducted to determine which staffing and organizational factors were associated with the provision of services to treat anxiety and depression. Results: Approximately, three in four adult day programs provided medication management for the treatment of anxiety and depression while 38% provided individual counseling and almost 30% group counseling. Programs offering medication management were more likely to have more registered nurse (RN) service hours available per shift and higher costs. Programs that provided individual and group counseling for participants with anxiety or depression were more likely to have more hours of RN and social work services available and a lower percentage of participants who pay privately for services. Conclusion: The results suggest that ADS are well positioned to act as a platform for delivering mental health care to older persons with anxiety or depression.