Day Care

Day care provides medical, physical, and cognitive services several hours a day, several days a week. Reimbursement for services is limited. In the USA, there are only about 2,900 day care programs compared with more than 16,700 nursing homes. Most day care programs are small, averaging 20 clients.

Medicare does not reimburse for day care services. Funds generally come from the Older Americans Act, Medicaid waiver programs, long-term care insurance, and private funds. Some centers use donated funds to subsidize transportation and a sliding-fee scale to match aid with the patient's financial need.

The day hospital model emphasizes rehabilitation or intensive skilled care along with core services (transportation, nutrition, recreational and social activity programs). It is designed for persons recovering from acute events such as a stroke, amputation, or fracture. Day hospital programs are usually limited in duration (6 weeks to 6 months) and are costly, because the ratio of professional staff members to patients is high.

The maintenance model combines limited skilled care (screening and monitoring chronic disorders) with core services and physical exercise. Goals are to prevent deterioration and to maintain or improve the patient's functional level for as long as possible; to improve self image; to prevent loneliness, isolation, and withdrawal; to eliminate the monotony of daily life; and to prevent exacerbation of chronic disorders. Maintenance programs provide long-term care and are less costly than day hospital programs.

The social model combines counseling, group therapy, and cognitive retraining with core services. It may resemble a typical senior citizens' center, which provides care to elderly persons with varied psychosocial needs, or a mental health center, which provides care to elderly persons with dementia or psychiatric disorders. Programs are increasingly accepting patients who are in wheelchairs and those who are incontinent; however, patients cannot be socially disruptive. Care may be long-term or limited in duration.