Day care provides medical, rehabilitative, and cognitive support services several hours a day for several days a week. All day care facilities provide certain core services: transportation, nutrition, and recreational and social activity programs. In the US, there are only about 2,900 day care programs compared with > 16,000 nursing homes. Most day care programs are small, averaging 20 clients.

There are several models.

• Day hospital: This model emphasizes rehabilitation or intensive skilled care. It is designed for patients recovering from an acute condition (eg, stroke, amputation, fracture). Programs are usually limited in duration (6 wk to 6 mo) and are costly because the ratio of staff members to patients is high.
• Maintenance: This model combines limited skilled care (screening for and monitoring of chronic disorders) with physical exercise. Goals are to prevent deterioration, to maintain or improve the patient's functional level for as long as possible, to improve self-image, to eliminate the monotony of daily life, to prevent exacerbation of chronic disorders, and to prevent loneliness, isolation, and withdrawal. Maintenance programs provide long-term care and are less costly than day hospital programs.
• Social: This model provides counseling, group therapy, and cognitive retraining. It may resemble a typical senior citizens' center, which provides care to elderly people with various psychosocial needs, or a mental health center, which provides care to elderly people 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.

In addition to providing needed medical care, these facilities also provide respite care. By doing so, they may help delay or avoid placement in a nursing home.

Reimbursement

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.

Last full review/revision June 2009 by Mary Ann Anderson, PhD, RN