Adult day programs that provide meals, social connections and activities for older adults – and a reprieve for stressed caregivers – are sparking greater interest as one answer to the question of how countries like Canada will deal with an aging population.
These programs have existed for three decades, but they remain in many ways an underused and unknown resource. Yet those in the eldercare field say they could be crucial in preventing Canada’s health and long-term care systems – and family caregivers themselves – from collapsing under the strain of the years to come.
The first of the baby boomers will turn 65 next year, and Statistics Canada estimates that by 2016, the 65-plus population will outnumber children under 15.
"People see it as babysitting for seniors, and we really have to get through that perception," says Sarah Price, president of the fledgling Canadian Coalition of Adult Day Services and director of dementia care programs with the Alzheimer’s Society of Calgary. "The concept is similar, certainly, in the sense that you have a family member and you’re taking them somewhere to spend the day, but the social programming, the peer support that they’re getting . . . that’s all very different."
Many adult day programs have a social or recreational focus, bringing members together to share fun activities and build friendships, she says, while others take on a "medical model" geared toward specific conditions, such as dementia or stroke recovery.
Price helped establish the coalition one year ago after realizing there was only a "patchwork" of grassroots organizations in Canada. Their U.S. counterpart, the National Adult Day Services Association, has a 30-year history.
Without resources such as adult day programs, experts say there are few options available to adult child caregivers who work full time or spouses who need a break, and these programs are critical to helping people "age in place."
"People who are attending the programs want to continue staying at home as long as possible, in order to delay moving into residential long-term care," says Teresa Johnson, president of the U.S. association. "As long as they can get that care in the community, it’s much more cost-effective to serve them in those group settings than for them to go into long-term care."
The holidays often spur changes in eldercare because family members who may not have seen each other all year are together and changes in older loved ones suddenly become obvious, she says.
A recent MetLife national study of adult day programs in the U.S. found more than 4,600 centres providing adult day programs, a 35 per cent increase since a previous study in 2002. More than 260,000 participants and family caregivers took advantage of the programs, a 63 per cent jump over eight years earlier. No comparable statistics were available for Canada.
The Canadian coalition has so far gathered 43 members within Alberta, Price says, with others from British Columbia, Saskatchewan and the Maritimes.
The difference in health-care systems has led to more private day programs in the U.S., she says, but as Canadian families juggle their needs with the limits of what government home-care programs will provide – in Calgary, individuals are allotted two days a week in day programs – she predicts more private options will appear in Canada.
"Not only is there the opportunity for these services to grow, but they could make a huge difference in the lives of caregivers," says Colin Milner, CEO of the Vancouver-based International Council on Active Aging. "It’s like the Ghostbusters: when you need time on your own, who you gonna call?"
He plans to devote part of his address at the ICAA’s annual conference next month to adult day programs. Milner says governments are wrong to look at adult day programs as something they offer "philanthropically," because these sorts of programs could save money and lives by providing more cost-effective care and alleviating stress on caregivers who typically see their own health decline in tandem with the person for whom they are caring.
Vancouver’s Ruth Hughes was initially unimpressed by her adult day program experience. The 98-year-old has vision and hearing loss, but she was "bored out of my tree" by activities such as a Jeopardy game that asked for the name of three fall vegetables.
"We hear it over and over again that if you don’t use it, you lose it, and yet if you give them pap, that’s what you’re going to get back," Hughes says.
She stuck with the program and now attends two days a week, and she’s one of three people out of the group of 30 who can stand for exercise, something the instructors use as motivation for everyone else.
"You get to be 97 or in that range, you’re darned happy when someone wants you around," Hughes says, chuckling. "You come to see the people."
Clarissa Green, a therapist in Vancouver who works with families dealing with aging issues, wants to see more seniors involved in planning these programs so it’s not just assumed that a room full of octogenarians will enjoy each other’s company because they were born in the same decade.
"The first thing I often hear is that it’s filled with a bunch of old people, and this is said by people who are 78 and 88 and 98," she says, of objections to day programs. "There’s nothing to suggest that seniors have fewer interests than you or I do. But I think we’re still breaking loose from a lot of stereotyping about what old people are all about."
In Ottawa, The Good Companions day program provides meals, non-denominational worship services, exercise and entertainment for 25 seniors three days a week. On a recent afternoon, a piano player bantered with an audience of "recycled teenagers" while Edward Susser, 93, the centre’s resident flirt, wove his way between the chairs, seeking a dance partner.
After he was rebuffed by a couple of women in the group, a volunteer seven decades his junior joined him on the dance floor and they performed a waltz-Hokey Pokey hybrid through several songs.
"I love them all," Susser said of the ladies. "Especially when they’re under 90."
Sharon Oatway, the day centre director, says they might be the only source of social interaction for members who are isolated. Staff and volunteers watch for illness, unwashed clothing or troubles completing daily activities, which might signal a member needs a re-assessment by the Community Care Access Centres that co-ordinate care for seniors in Ontario.
But Oatway echoes others in the field in pointing out that programs like theirs really serve two groups of clients.
"All day programs also are respite care for the caregivers. It gives the caregiver a bit of time for themselves, to collect themselves. Maybe they have to do errands or they have a recreational program they want to take themselves," she says. "If not, a lot of those people who didn’t get the respite would end up being clients themselves."
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