Adult day programs and respite: the two kinds of day program in New York, and how to get a real break

Two kinds of day program

• Social adult day services: a supervised group setting with activities, meals, supervision, and hands-on help with walking, eating, and toileting. Run under the state Office for the Aging's rules, often by nonprofits, senior centers, or assisted living communities. For someone who is frail or has dementia and needs supervision or hands-on help during the day. Cost varies; the county Office for the Aging may help pay, and Medicaid managed long-term care plans can cover it for members.
• Adult day health care (medical model): a program run by a nursing home, on site or nearby, with nursing, therapy, medical social work, medicines, meals, and transportation. The person must be eligible for nursing home level care and have a doctor's order. Paid mostly by Medicaid, sometimes privately or by insurance. Usually one to five days a week, at least five hours a day.

Who tends to fit

Social day programs suit someone who is lonely at home, who is unsafe alone while you work, or who has early to middle stage dementia and does well with structure. Medical day programs suit someone with real nursing needs, like wound care, diabetes management, or therapy, who would otherwise be heading to a nursing home. Many people try a social program two days a week and add days as it works.

Questions to ask a day program

• Which kind of program are you, and who licenses or oversees you?
• What does a day look like? May we visit and stay for a meal?
• How many staff for how many participants, and is a nurse on site?
• Can you handle wandering, incontinence, or someone who gets upset in the afternoon?
• Is transportation provided, and how long is the ride each way?
• What are the hours, the daily rate, and what happens on a day we cancel?
• How do you tell me about a fall or a change?
• Do you take Medicaid managed long-term care, long-term care insurance, or county funding?

Respite, in every form

Respite is any arranged break from caregiving. The person keeps being cared for; you get hours or days back.

• In the home: an aide or a trained volunteer for a few hours, so you can go to your own appointments or sleep.
• At a day program: the most common kind of respite, several hours a day.
• Overnight: a short stay in an assisted living community or nursing home, from a few days to a few weeks. Many communities offer it and it often becomes the trial run for a longer move.
• Through hospice: for someone on hospice, Medicare covers short inpatient respite stays so the family can rest, with a small share of the cost.

Help paying for it

New York's Office for the Aging funds respite and caregiver support through every county office, with priority for care receivers 60 and older who are frail or have disabilities. The county can also connect you to the Expanded In-home Services for the Elderly Program, which pays for non-medical help at home for people who do not qualify for Medicaid, with a cost share based on income. Medicaid managed long-term care plans cover day programs for members. Long-term care insurance policies often cover respite and day care; read the policy. Start with NY Connects, 1-800-342-9871.

Try it before you need it

The Alzheimer's Association's advice is to use respite before a crisis so the person is used to the place and you are used to leaving. The first few days are often hard, and regular stays get easier. Guilt is normal. Handing care to trained people for a while is how you keep doing this.