Introduction: Adult Day Care programs provide cognitively or functionally impaired adults with medical, social, and therapeutic services as well as offer valuable respite and education to family caregivers. The Visiting Nurse Association’s Adult Day program manages three centers that offer these services and are located in Colchester, Williston, and South Burlington. We have explored the underutilization of these centers by comparing variables such as demographics, services provided, referrals, transportation constraints, and satisfaction surveys between centers and to national success guidelines for adult day services.https://scholarworks.uvm.edu/comphp_gallery/1043/thumbnail.jp

Ares, William

Hart, Michael

Huang, Derek

Jemison, Jill

Karian, Laurel

LaFromboise-Perretta, Donna

Michael, Maria

Otts, Auna

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University of VermontScholarWorks @ UVMPublic Health Projects, 2008-present Public Health Projects, University of VermontCollege of Medicine2-24-2010Assessing Barriers to Utilization of Adult Day CareCenters in a Rural CountyWilliam AresMichael HartDerek HuangLaurel KarianMaria MichaelSee next page for additional authorsFollow this and additional works at: http://scholarworks.uvm.edu/comphp_galleryPart of the Community Health and Preventive Medicine Commons, and the Health ServicesResearch CommonsThis Article is brought to you for free and open access by the Public Health Projects, University of Vermont College of Medicine at ScholarWorks @UVM. It has been accepted for inclusion in Public Health Projects, 2008-present by an authorized administrator of ScholarWorks @ UVM. For moreinformation, please contact donna.omalley@uvm.edu.Recommended CitationAres, William; Hart, Michael; Huang, Derek; Karian, Laurel; Michael, Maria; Otts, Auna; LaFromboise-Perretta, Donna; and Jemison,Jill, "Assessing Barriers to Utilization of Adult Day Care Centers in a Rural County" (2010). Public Health Projects, 2008-present. Book44.http://scholarworks.uvm.edu/comphp_gallery/44AuthorsWilliam Ares, Michael Hart, Derek Huang, Laurel Karian, Maria Michael, Auna Otts, Donna LaFromboise-Perretta, and Jill JemisonThis article is available at ScholarWorks @ UVM: http://scholarworks.uvm.edu/comphp_gallery/44Assessing Barriers to Utilization of Adult Day Care Centers in a Rural CountyWilliam Ares 1, Michael Hart 1, Derek Huang 1, Laurel Karian 1,  Maria Michael 1, Auna Otts 1, Donna LaFromboise-Perretta 2, Jill Jemison 11 University of Vermont College of Medicine, 2 Visiting Nurses Association, Colchester, VTIntroduction Discussion80%90%Site UtilizationAdult Day Care programs provide cognitively or functionally impaired adults with medical, social, and th ti i ll ff l bl it d 20%30%40%50%60%70%Utilization RateFalcon ManorA national study of adult day services conducted by the Robert Wood Johnson foundation, Partners in Caregiving, determined that adult day programs in Chittenden Countyerapeu c serv ces as we  as o er va ua e resp e an  education to family caregivers. The Visiting Nurse Association’s Adult Day program manages three centers that offer these services and are located in Colchester0%10%7/14/087/21/087/28/088/4/088/11/088/18/088/25/089/1/089/8/089/15/089/22/089/29/0810/6/0810/13/0810/20/0810/27/0811/3/0811/10/0811/17/0811/24/0812/1/0812/8/0812/15/0812/22/0812/29/081/5/091/12/091/19/091/26/092/2/092/9/092/16/092/23/093/2/093/9/093/16/093/23/093/30/094/6/094/13/094/20/20094/27/095/4/095/11/095/18/095/25/096/1/096/8096/15/096/22/099-6/30/097/6/20097/13/20097/20/20097/27/20098/3/20098/10/20098/17/20098/24/20098/31/20099/7/20099/14/20099/21/20099/28/200910/5/2009USouth BurlingtonPrim Road        appear to be in excess capacity of the population in need of them.These circumstances reflect the overall underutilization        , Williston, and South Burlington. We have explored the underutilization of these centers by comparing variables such as demographics services provided referrals Results46/29/20097 7 7 8 8 8 8 9 9 9 1Figure 2.  Utilization rates of each of the VNA Adult day sites by week.      of the Visiting Nurses’ Association three adult day programs(Figure 2). According to client surveys, satisfaction is high among   ,  , , transportation constraints, and satisfaction surveys between centers and to national success guidelines for adult day services. Surveys Distributed to VNA Clients (Figure 3) Interview with Referrers (Figure 5)those who attend. Clients across all three programs are happy with the quality of activities, improvement in Methods      The results of the survey (n=29) indicate client satisfaction especially in the areas of socialization, caregiver respite, quality of activities, and managementOn average, each of twelve referral services we interviewed has referred 10 to 20 clients to the VNA for Adult Day Care in the past year. Location is the most mood, and respite for caregivers. However, a portion of the clients, especially those at Prim Road, have Three different analytical methods have been used tocollect the data for this project:• A survey assessing satisfaction was distributed to       of medical needs. Transportation questions indicate a substantial difference between the sites. 50% of South Burlington common factor considered by referrers when deciding between the various VNA sites.  Two referrers feel that the Prim Road site is inconveniently located. Cli t di l d i th d t f tdifficulty arranging transportation.  Prim Road currently allocates resources providing transportation f li t h b bl t tt d       clients at each of the three sites of the VNA. The survey included questions regarding transportation, health care services and socialization services Surveys wereclients, 36% of Falcon Manor clients, and 50% of Prim Rd. clients agreed that transportation complications influence their attendance to the program. en  me ca  nee s s e secon  mos  common ac or considered by referrers. Referrers commented that the Prim Road site “is more for medical needs than social needs” and “tends to have an older frailer population ”or c en s w o may e a e o a en  other sites at less cost. Transportation is one factor among many that influences attendance. Our survey also shows that clients choose to attend the program based upon,   .   completed by the VNA client or  their caregiver.• A standardized telephone interview was conducted with community referral services to assess referral rates toClients at all sites have difficulty arranging transportation and would appreciate a low cost option. They account for 40% of all question respondents. H l 30% f i d d h      ,  .   Three out of twelve referrers are less likely to refer clients to the Prim Road site, citing inconvenient location and lack of socialization         recommendations by family, friends, and healthcare providers. Reputation and community perceptions, especially of referrers, strongly influence the site that clients        each VNA site and factors that influence which site a patient is referred to.• A structured interview was completed with each siteowever, on y  o  quest on respon ents agree  t at a low cost option would help them attend more regularly. When asked why clients chose to attend VNA adult day program 60% cited that the particular site they .F l         choose to attend. Healthcare providers who were interviewed consider location and medical needs foremost in recommending a program. However, referrers perceive the         director inquiring about their perspectives regarding client medical needs, transportation needs, and socialization needs Interviews also determined each center’s ,        attended was close to home. Significantly, 75% cited referral from friends, family, and/or their healthcare provider•Medical needs of clients mostly are associated with the sequelae of Alzheimer’s. Only two clients at this site require wheelchair assistance. a con Manorthree VNA sites differently in the activities and opportunities for socialization provided. Despite the overall quality of the program, all three adult .      utilization statistics and rates.. •The average medical need of each client ranges from receiving medications such as insulin to being helped using the bathroom and/ or being changed.  Conditions include stroke, developmental delay, Alzheimer’s and multiple sclerosis.South BurlingtonStrongly Agreeday centers are not operating at capacity. This appears to be due to several factors including transportation complications and referrer perceptions.•The medical needs of this facility are directed towards medical management with glucometers, fall prevention and education, transfer education, flu management, mental health and weekly nursing lessons for patient education.Prim RoadAgree RecommendationsI h f ti f 7 t 6 (RWJ)    Figure 4.  Responses by site directors in regards to medical needs of the average client.Neutral• ncrease ours o  opera on rom  am o  pm • Pursue more aggressive marketing to caregivers, formal referral sources, and community organizations to make enrollment twice that of capacity (RWJ)3456of ReferrersDisagree     • Prim Road clients with transportation problems due to financial constraints could attend a center currently accessible via public transportationWorks CitedInternational, Research Triangle. (2006). Adult Day Services: A Key Community Service for Older Adults U S Department of Health and Human Services of the Assistant Secretary forFigure 1. Geographical distribution by town of total client visits to VNAAdult Day Programs between (1/1/2003 and 12/31/2008) Black arrows012Location of site Medical needs Social needs Atmosphere Do not refer to ifi VNANumber oTransportation Low Cost TransportationCaregiver RespiteQuality of ActivitiesSocialization Mood ImprovementMedical NeedsFalcon Manor South Burlington Prim RoadStrongly Disagree    . . .            Planning and Evaluation.Visiting Nurse Association of Chittenden and Grand Isle Counties. (2007). Adult Day Program. Retrieved November 11, 2009, from http://www.vnacares.org/services/adult-day-program.represent location of specific program. Additional towns utilizing theAdult Day services not shown include Barre and South Hero, VT, as wellas Dedham, Northampton, Leominster and Merrimack, MA.Figure 3.  Graphic representation of  selected client survey items. Figure 5.  Graphic representation of interview with referrers.spec c  sites

Assessing Barriers to Utilization of Adult Day Care Centers in a Rural County

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Assessing Barriers to Utilization of Adult Day Care Centers in a Rural County

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