Aging & Health A to Z
Community-Based Care
Basic Facts & Information
A variety of healthcare options allow older adults to stay at home, while still providing important healthcare or personal care support.
Adult Day Care
Adult day care is a community-based option that has become more common. It provides a wide range of social and support services in a group setting. Most adult day care centers are either in churches or community centers. Adult day care is commonly used to care for people who need supervision and help with activities of daily living (for example, patients with dementia) while primary caregivers are at work. It may also serve as a form of respite for caregivers.
Providers of adult day care may offer a variety of services, ranging from simple non-skilled custodial care to more advanced skilled services. For example, a registered nurse may be available for on-site health services, clinical assessment and monitoring, and help with medication management. In general, custodial adult day care is not covered by Medicare, although some costs may be covered by Medicaid or other insurers.
Day hospitals
Day hospitals provide a broad range of skilled-nursing services, including injections, chemotherapy, and intensive rehabilitation. Most day hospital programs are housed in chronic-care hospitals or rehabilitation centers. This allows the healthcare provider to take advantage of in-house professional expertise and resources, while allowing the patient to return home for the evening. Services are covered under Medicare, with requirements similar to those of home healthcare.
Day hospitals are most often used for two groups of patients: those needing rehabilitation in multiple areas and those with psychiatric illnesses. A systematic review of day-hospital care found that day hospitals compared favorably with other sources of care for many traditional health outcomes (eg, death, disability, etc.). In fact, those receiving care in day hospitals tend to have less functional decline and less hospital and institutional care.
Program of All-inclusive Care for the Elderly (PACE)
The Program of All-inclusive Care for the Elderly (PACE) is a relatively new program that pools funds from Medicare and Medicaid (in participating states) to provide acute and long-term care to frail older people. This coordinated financing allows PACE to provide traditional coverage of acute, rehabilitative, home, and institutional care. However, participants in the PACE program must meet state-defined requirements regarding their need for a nursing-home level of care. As of 2010, there are 75 PACE programs in 29 states.
The goal of PACE is to keep participants in the community for as long as it is medically, socially, and financially feasible. The system uses a team of healthcare providers who know the patient and caregivers well and who can provide complete care whether the patient is at home or in the hospital, an alternative living situation, or an institution. It also allows for adult day care, respite care, transportation, medication coverage, rehabilitation (including maintenance physical and occupational therapy), hearing aids, eyeglasses, and a variety of other benefits. The program also has the flexibility to pay for non-medical costs in unusual circumstances (eg, paying a person’s electric or gas bill). Care by the healthcare team provides for the complex social needs as well as the medical needs of older adults.
The PACE system has been described as one of the few truly integrated systems of care in the United States. Although the effectiveness of PACE has not been directly tested by a scientific trial, PACE appears to provide high-quality care, albeit with significant site-to-site variation.
Updated: March 2012
Posted: March 2012