A Changing Service - Community facilities for the aged

An entire new category of health care facilities has come into being in recent years in response to the needs of the elderly. These community facilities are designed specifically for those elderly persons living at home who are not housebound.

Adult Day Care

A broad variety of community-based centers schedule adult day-care programs for the elderly. To some extent the programs provide an alternative to institutionalization. In each case the programs are tailored to meet specific needs. Each type has a basic therapeutic objective.

Medical Day Care

Where chronically ill or disabled persons do not require frequent or intensive medical intervention, the medical day care service may be the solution. Located usually in a long-term care institution or freestanding center, such a care service may include nursing and other supports. A physician's referral is required, and rehabilitation and maintenance are primary therapeutic goals. Reimbursement is by third-party (insurance company) payments on a sliding scale. Medicaid pays for medical day care in some states.

Mental Health Day Care

Offering a supervised environment along with mental health services to adults with organic or functional mental illness, the mental health day care service is usually located in a psychiatric institution or freestanding center. Referral by a psychiatrist is required. Three basic therapeutic goals are supervision, assistance with coping skills, and safety for the patient. Reimbursement is by third-party payment.

Social Adult Day Care

Title XX of the Social Security Act provides for funding of many social adult day care facilities, all of which are geared to the needs of adults who have difficulty functioning independently. Both families and health facilities can make referrals, but examination by a physician is normally required before admission. Third-party reimbursement is the norm. Program objectives and services vary widely, and are usually formulated by the funding source and the sponsoring organization. Program participants may attend part-days or full days five days a week; the facility may provide a midday meal and transportation within a specified area.

Nutrition Services

Nutrition ranks as a critical need for both homebound and more independent elderly persons. Meals-on-Wheels, a community service offered under voluntary auspices but funded partly by public funds, caters to the homebound. For a reasonable charge the service provides at least one hot meal daily for persons 60 and older. For the elderly attending senior centers, the Area Agency on Aging provides both adequate nutrition and a chance to socialize. Agency personnel can keep in touch with clients’ physical and social situations, giving the program an important outreach and prevention dimension.

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