Social Day Care in Bayonne, New Jersey

By Joan Marie Granato, President Future Focus Inc.
In loving memory of Archangel Benedetto

Advocacy has so many variables when it comes to the Adult Day Care Industry. For each facility or individual, Advocacy can invoke different meanings.

What is Advocacy really? The Definition…In the 15th Century was identified as: The Act of pleading or arguing for something, a cause, an idea, and a purpose. The Act or process of advocacy or supporting a proposal. The word Advocacy comes from the Latin terms ADVOCARE and literally means to call out for support. Today it is used to describe a particular democratic process, where different individuals or groups of people take different actions to try to influence those that make decisions that affect our lives. Advocacy is also about standing up for an issue or cause you believe in and trying to change people’s lives to build a better world.

Who are the Advocates in our Industry? Families, caregivers, physicians, the personal care assistant that takes care of our clients at home, the case manager, the Department of Health, the surveyors, the facility as an entity, the facility staff as individuals or as an interdisciplinary team, the neighborhood, the fire marshal, the politicians, governmental leaders, and so on…. They represent so many faces, positions and the core outline of our societal structure. There is no discrimination amongst advocates…There are no boundaries as to who can be our Advocates…Advocacy knows no language, culture, economic status or sexual orientation….
Advocacy is only seen through the eyes of the beholder.

If you believe in something worth fighting for, then Advocacy takes action…Advocacy can’t occur without action. Many of us may have a thought….an idea…even want to speak out We wish we could make a difference…but we don’t’ unless there is ACTION. I have found that Action is the key to everything, including Advocacy. If you want something changed, then you need to take action…. you need to do something about it…you need to take a position, make a proposal or argument about your beliefs and there starts the course of action.

I started out in this industry when I was 12 years old, visiting my Grandmother Archangel Benedetto in a Nursing Home in Jersey City, New Jersey…She had 10 children, 8 boys and 2 girls…and 45 grandchildren. They were told at that time that she needed to be in a Nursing Home because she had diabetes. This was nearly 32 years ago…There wasn’t Adult Day Care for her so the family had no other choice…I watched her—- as she lived and then—- as she slowly died…We went to visit her everyday after dinner…I didn’t mind, I loved her and wished she could be at home again being the Grandmother, the family pillar…Fond memories of her making Sunday Dinner still clouds my mind. Of course, we started with hot antipasto, then Spaghetti and Meatballs to feed an army and salad after we ate dinner…we couldn’t pass up the home made cannollies for dessert. The women of the family helped cook, serve and clean and the men played pinochle at the table while sipping Sambuca in their espresso. I also remember extremely large life like statues of St. Peter, The blessed Mother and Jesus in the out cove in the living room. Yes, growing up in a big Italian family was a beautiful experience…I was 12 and that’s when it all fell a part. My world as I knew it changed drastically. My Grandmother was put in a nursing home and the entire family separated. The Sunday gatherings were no more, the aroma’s of my grandmother’s cooking became a faint memory, the statues were donated to a church…the family as it was…had diminished…My grandmother was 78 when she died in that nursing home…she lost her legs, her home, her life and her dignity there…my father lost the most important women in the world to him and felt helpless the few years she spent there. We lost our family.

As I grew up in the Health Care world working in Nursing Homes, Assisted Living Facilities, Group Homes, I realized how important our Adult Day Care component is…. not just for the clients that we serve, but for the entire family structure and for those 12 year olds that could still benefit from their grandmother being home…

Sure I still got to see my grandmother, but it was not the same….what I saw more of was my father crying silent tears… he felt helpless, hopeless,each time we went there my mother and father were Advocating for my grandmother….why is she wet, why doesn’t she have water, why is her meals cold, why is she draped in a small white towel and wheeled to the showers without dignity, why is her curtain open while you are changing her….It seemed as though we had endless gripes and we weren’t being heard. My grandmother and many others weren’t being taken care of the right way. She was at the end of her life in pain, but never complained out of fear…she had unexplained bruises on her back, arms and legs,she cried and begged her boys not to say anything to the nurses aides that brutally took care of her…I am happy to say Nursing Homes and the entire healthcare system have come along way since then ADVOCACY took ACTION and the system was changed for the better.

After College I got my first job in a small Nursing Home….I was young but thought I could concur the world.I loved my work and have so many great memories, but there were some that still tug at my heart.

As a young girl ripe out of college I didn’t have a voice. I wasn’t being heard although I tried to advocate, no one would take me seriously. I was still wet behind the ears for these folks who ran the system…who knew best or did they. I share with you these memories because it is so important to understand that every action you take can make a difference, even if you are a little voice….eventually it will be heard.

Sadly, I was in the era when they used restraints on patients. I used to get in trouble because I would untie a patient so that they could drink some water. Especially those with Alzheimer’s or Dementia, they would tie their legs, arms and stomach down in the bed. The patients would scream and cry and ask to be released. They use to beg me to release them. As a young girl and a new professional…I didn’t have a voice…but I knew that something wasn’t right…it was wrong to tie these people up like that…it tugged at my heart…I remember going to the Director of Nursing and the Administrator and questioning this procedure they assured me that this is what was best for them and that all nursing homes do this. I understood that it was a common health care practice, but it still tugged at my heart.

It wasn’t right, but who I am, I would say to myself…I don’t know much, I am just learning…still the tug was there so I continued to Advocate. I got the facility to release these clients so that they can participate in Activities and also during meals, but at night as they lay in their beds, they were imprisoned.

I also got my tires slashed and my life threatened because one day as I was doing my rounds I saw the housekeeping staff tormenting this older Jewish patient who could not speak. He would just sit in his Geri chair and lay there. The family was very involved and tried to help take good care of him. He would follow you around the room with his eyes…His eyes said so much. Well as I passed his room, there they were 3 of them, throwing his yamaca back and forth around him and pushing him in the chair to catch it. It was an image I will never forget…his eyes told the story of his torment…he couldn’t speak, he couldn’t move, he couldn’t ask for help…After I stopped the action I immediately went to the Administrator to advocate for this patient who couldn’t advocate for himself. The workers were sent home for the day and nothing else occurred…except I had death threats and slashed tires. Looking back now, I was fearless….I didn’t care what they wanted to do to me, all I cared about was that they wouldn’t hurt these patients in any way. We use to have a monthly staff meeting…I had the opportunity to speak out to those workers that not only terrorized me, but also the patients. After that meeting I grew up quickly in the industry and learned that Advocacy does work….and we must speak out for what is right, for what we believe in and for those that can’t advocate for themselves. Those men wire fired for other incidents that were reported to Administration after my Advocacy Speech… That day I learned what respect was…that day changed my life…

Advocacy starts with you…Our industry is young and still growing….I believe it is a crucial component to the Continuum of Care and real “Aging in Place” I don’t ‘understand why they don’t see what I see, what you see…it all makes sense….Clients get to stay at home longer, with their families while receiving supportive services to maintain or enhance their medical, social and quality of life status. So simple…saves so much money at the State and Federal levels…why is this so difficult to understand…I will let you in on the secret…. it is not about what makes sense, what saves money, what may actually be the right choice for our seniors…it is all about ADVOCACY…that’s right…the bigger healthcare industries have strong Advocacy…they fight…they speak out…they make proposals come true…. they are powerful leaders in our arena and most definitely have their place in society…I am thankful for their position and services they offer…but it is not for everyone….and we need to be a more prevalent choice for our seniors while they still can utilize our services.

Advocate…taken action and things will change…Fight for what you believe in and you will be securing our future and the future choices of the clients we serve. Don’t be afraid to make changes, to propose new ideas, to speak for those who don’t have a voice. Don’t be afraid to take a chance or to reach out…

Be an Advocate for our wonderful mission…providing alternative solutions in health care.

NADSA is a big voice ADVOCATING for the Adult Day Care Industry. Help us Help you to Help others…be a part of the ACTION….be an ADVOCATE…

For more ways to help Advocate go to


“The Focus On the Future in Activities…”
Editor and Chief:  Joan Marie Granato

The Health Care Industry is growing, which enhances our status as Activity Providers in all realms of care and services. Through history, Activity Providers were always the special part of every operation. Whether it was teaching ping pong to veterans in a hospital, painting rocks in a psych program or singing near the piano in the nursing homes…we were perceived as the “Fun People”…..later in years, we were even called the “Bingo Ladies”. Over the years, we have grown into more Therapeutic Activity Professionals, still providing fun and of course bingo…. Now we have a new delivery of service and care….an individualistic needs based programming concept that is sweeping the country. Our programs are becoming more dynamic and creative for our residents. Our Salaries have exploded over the past 30 years…I am speaking to Activity Providers who are making, 40, 50, 60k a year and more. Some of our business savvy Activity Providers are branching out into different worlds of consulting, resources, activity products, books, etc….let’s keep going….and going…

We have made it as a Career Choice, a Business, and really the most valuable of all…a need in every Health Care Facility Worldwide….Now that is an accomplishment!

When I started out in Activities, the seniors in the nursing homes were young, still crocheting, playing the piano and having their own coffee klatches. Now our nursing homes are models for end of life acute care, dedicated floors for sub acute and locked units for dementia residents. Each area of services needs an Activity Professional who knows how to provide services for these types of residents. Our Health Care industry has expanded to provide options of community care like Home Care, Adult Medical Day Care, Social Day Care, and Senior Centers. Our residential options have also expanded to residential care, Assisted Living Facilities and Programs, CCRC’s, Comprehensive Care Retirement Communities, Boarding Homes, Group Homes, Rehabilitation Units, Dementia Wings, Sub acute Care Units and of course Nursing Homes.

As a career choice, we have ample opportunities for employment….we need to continue to grow as a valuable industry of Activity Providers. Make sure your staff is educated, trained and even bet yet certified. Enhance your standards in your facility; create jobs with criteria for trained individuals. Send your staff to become trained and certified with a N.C.C.A.P. MEPAP Instructor in NJ. Instructor’s information is included in the newsletter.

Focus on your Future…


By Joan Marie Granato

There are so many definitions for Adult Day Care…my simple version is this…Adult Day Care’s philosophy is to provide an array of services that meets the individuals needs to promote physical, cognitive, social and emotional health and well being in a supportive environment while maintaining one’s independence.  Adult Day Care used to be the best kept secret, but today, Adult Day Care is the best community option…We provide a bundled service on a daily basis to individuals with needs, which in turn reduces the overall Federal cost of services, reduces hospital admissions, reduces care givers stress, reduces sad, withdrawn, socially isolated seniors that live at home alone.  Adult Day Care in my opinion is an exceptional service we are providing to our seniors and disabled communities.  It is crucial that in the future we are able to provide these services to individuals despite their funding sources.


“Adult Medical Day Care Overview”
By Joan Marie Granato

Adult Day Care is the best kept secret! Our aging society is growing and in need of service options. We have kept our seniors healthier and in their homes longer, preventing the early entrance of needing a long term care facility or institution. We want our mothers and fathers, grandparents and those that we care about home with us. We do not want to be faced with the day that we have to put them into a Nursing Home or Assisted Living facility, which sometimes becomes no choice. We also want them to be safe and not alone. Our society has become so busy trying to keep up with the economy and need to support our families; we may lose sight of the needs of our elders. Caregiving becomes another burden on many in the sandwich generation, those taking care of parent and children at the same time. Adult Day Care Programs offer a solution to those in these situations caring for senior parents. There are so many families that come to me and thank me for making a center for their mother or father. While they are at work, they are not worrying about their parents being home alone and sad.

I have had the honor and privilege to work in the health care industry for over 25 years servicing seniors and their loved ones through a variety of programs, services and institutions. All the Long Term Care facilities serve its purpose for those in need. Since I have begun my career in the 1980’s, the choices and options for seniors and their caregivers have expanded to include less institutional options. Nursing Homes always had a bad reputation over the years, but through strict regulations and surveys, the industry has been improved to service our most fragile seniors. There is a need for Nursing Homes as well as Assisted Living Facilities. What do we do with those seniors that can still function mainly on their own with the need for some assistance and socialization. Adult Day Care Programs are here to join forces with the overall health care industry to provide that option. We want to keep them at home and provide them the services that they need to maintain their proper functioning in life. We want them to live out the remainder of their life with happiness and hope. We want to provide them with quality of life so that they can enjoy their moments and we can have some peace of mind that they are taken care of when we cannot be there.


By Joan Marie Granato

It is the most crucial option for senior adults and caregivers who are in need of services. We are a bundled service…we provide all that an individual needs.  It provides a safe and secure environment in a caring setting for adults who are eligible for services. There are a variety of programs and services to meet each individuals needs, which include, Medical Services, Nursing Services and treatments, Social Services, Dietary and Food Services, Therapeutic and Recreational Services, Transportation Services, and other affiliated services; Physical, Occupational and Speech Therapy, Podiatry Services, Doctors escorts and visits, etc.  Programs are designed and structured through the development of a individualized care plan.   Many facilities are following a Person Centered Approach to care through their approach and services. Through a daily program, the services cover the individual needs of each participant, including a variety of social and supportive services. There are many reasons a person may need an Adult Day Care Program including a participant who may be physically, mentally or functionally impaired, or they may simply need companionship or supervision during part of the day.


By Joan Marie Granato

Adult Day Care provides individuals with a comprehensive Medical and Social program to maintain or enhance their quality of life. There are some facilities that offer more Social and others that offer both Social and Medical.

We offer nutritious meals based on culture and special diets related to diagnosis. We also provide full transportation with professional drivers to and from your home. The most exciting part of the day is a variety of activities that offered with the purpose of providing stimulation and socialization for participants. Through a well balanced calendar of activities, participants will enjoy exercise, yoga, tai chi, musical programs, arts and crafts, painting, physical group activities, games, independent activities, trips and outings, current events, and cognitive word games. We also have special events for holidays, birthday parties and cultural and religious events. Our activity programs are based on the client’s needs, interests and requests.

In summary, Adult Day Care is the most valuable option to adults, seniors and caregivers in need of services. Adult Day Care, yes, still the best kept secret for many. Please help us spread the good news!

Help support Adult Day Services and join NADSA today! NADSA is a great organization focused on advocacy and support for Adult Day Services Internationally. 

Here is a great definition and overview from NADSA,

The National Adult Day Services Association


The History of Adult Day Care Centers in the United States
Category : Adult Day Care and You
Written By : Adult Day Care Centers

Some may wonder: how old is the concept of senior day care facilities in the U.S.? The answer is this particular brand of elderly care has only existed for less than a hundred years. Adult day care facilities as we know them today developed over time from the 1930s and continue to evolve.The roots of adult day care programs began with the Older Americans Act of 1965 (OAA) and the subsequent establishment of the Medicare and Medicaid programs. These laws commissioned the funding of senior health care initiatives and the creation of the Administration on Aging. The OAA rose out of advocacy championed by the National Committee on Aging – soon after renamed the National Council on Aging (NCOA) – from the 1950s until the late 1960s. The NCOA conducted a series of research studies, which led to a better understanding of the growing needs of an increasing elderly population in the U.S.It is true that adult day care programs rose out of this context in the field of senior health care, but the mode of care was focused on what we now know as “nursing homes” or assisted-living. After a series of provocative studies conducted in the 1950s and 1960s bought to light abuses in nursing homes, there was a shift in the way the health care industry began to view senior care. Eventually, senior day care centers developed as an alternative to institutionalized “nursing home” care.The “day hospital” originally developed overseas in Britain in the 1960s and was imported to the U.S. by Dr. Lionel Cosin. Dr. Cosin introduced non-residential senior health care methods, promoting senior living skills necessary to prevent institutionalization and maintain independence: the dominant school of thought in senior day care today.Studies in the 1980s began to show statistically that not only was the elderly population in the United States growing as more workers retire, but the overall cost of senior health care was increasing too. While the average cost of a nursing home was covered by Medicaid, the need for lower cost alternatives to institutionalized care became apparent, along with the fact that many seniors began to raise there voices and demand an alternative. Mirroring the history of the U.S., the desire for independence was the driving force behind the development of senior day care centers, as we know them.Recently, the national spotlight on Health Care Reform has put senior health care back in the forefront with the passing of the Affordable Health Care Act of 2009. Through this legislation, seniors will benefit from expanded Medicare prescription benefits that close the infamous “part D loophole”. The act also greatly expands Medicaid funding to the states, which will allow them to provide affordable alternatives to institutional long-term care.All of these events have culminated to produce adult day care programs as we know them today. The issue of our growing aging population will ensure that day care programs continue to evolve and improve.


We used this format from Wikipedia to provide an array of definitions related to the Adult Day Care operations.

Adult daycare center

From Wikipedia, the free encyclopedia

An adult day care center, also commonly known as adult day services, is a non-residential facility that supports the health, nutritional, social support, and daily living needs of adults in professionally staffed, group settings.[1] Adult day services centers serve as an emerging provider of transitional care and short-term rehabilitation following hospital discharge. Most centers operate 10 – 12 hours per day and provide meals, meaningful activities, and general supervision. Operations in adult daycare centers are often referred to as social models (focusing on socialization and prevention services) and/or a medical model (including skilled assessment, treatment and rehabilitation goals).

Day care centers may focus on providing care only for persons with a specific chronic condition such as Alzheimer’s disease and related dementias, or their services may be available for any adult with disabilities. Many centers maintain a nurse on-site and devote a room for participants to have vital signs checked, and receive other health services from a medical assistant/nurse when needed. They may also provide transportation and personal care as well as support groups for caregivers.

According to the 2010 MetLife National Study of Adult Day Services, there is one direct care worker for every six participants, facilitating individualized, person-centered care and enabling staff to care for increasingly complex needs.[2] Nearly 80% of adult day centers have a nurse on staff, nearly 50% have a social worker on staff, and approximately 60% offer case management services.[2]

Participation in adult day centers may prevent re-hospitalizations and may delay admission to residential long-term care. For participants who would otherwise stay at home alone, the social stimulation and recreational activities may improve or maintain physical and cognitive function. For caregivers, adult day centers provide respite care, enabling caregivers to work or to have a break from their care giving responsibilities.[3]

More than 5,000 adult day centers are operating in the United States providing care for more than 260,000 older Americans each day.[4] Almost three-quarters of all adult day centers (71%) are operated as nonprofit organizations, and 16% are affiliated with the public sector.[5] Daily fees for services are almost always less than a home health visit and about half the cost of a skilled nursing facility. Daily fees for adult day services vary depending upon the services provided. Average daily fees across the country are approximately $62.[5] Funding for adult day services comes from participant fees, third party insurance, and public and philanthropic sources.

The largest provider of adult day services in the country is Senior Care Centers of America / Active Day which operates 80 centers in 11 states, primarily in the Northeastern US and parts of the Midwest.

A prime example of the above described senior centers is the Adult Day Care Center in Atlanta, which is part of King David Community Center of Atlanta, Inc. The Center has been serving seniors and elderly immigrants in the metropolitan Atlanta area for over ten years – with services like Home Delivered Meals, In-Home Personal Care Services, and, of course, the Adult Day Home. Uniquely, the King David Adult Day Care Center in Atlanta is also a multi-cultural organization, servicing Russian, Nepali, Vietnamese, Korean, Chinese, and clients of several other nationalities in their native language, as well as aiding them in learning English.