Program Planning

The intervention level will focus on Community Mobilization and Public Health Awareness Programs to reduce youth tobacco smoking in United States. Combined and coordinated community levels of action have proved to be successful in reducing access to tobacco and stoppage to smoking. The community-based interventions mentioned by CDC (2007) involve initial awareness on prevention on initiation of tobacco among the young people through school based programs, increasing the price on narcotics, anti tobacco campaigns creating non-smoking zones to protect against secondary smoke and creating attitudes and behavior norms that will lead to change.

Mobilization of venders to restrict access to tobacco by the youth and under aged would reduce cases of tobacco among the youth considering denied access is as good stopping the desire over time. Public health institutions should also form a strong approach in public awareness in reducing the usage of tobacco by displaying and educating about the diseases caused by continuous use of tobacco and the adverse health effects like cancer, heart disease and respiratory complications that eventually lead to death due to poor diets.

In as much as the cessation program focusing on the individual is important, it is critical for the public to be involved in reducing the tobacco intake by social collective responsibility because a unified approach provides a greater effect. These efforts have proved successful as compared to group or individual therapy. Individual therapy is effective as well and would go side by side with the community mobilization. But government funding and public policy and laws should regulate the manufacturer and seller of tobacco. Government budgets should be allocated to public intervention programs that deal communities and the anti-tobacco campaigns. Massive education at grassroots is important if the war on youth tobacco usage will be stopped.

Community health promotion by preventing tobacco use.

To prevent the youth from starting to use tobacco, to encourage and help users of tobacco to stop using it, to eliminate and identify disparities arising from tobacco use  and to lower involuntary secondary smoke exposure.

What risk factors did the program address
The risk factors addressed by the program included poor nutrition, smoking, inadequate physical activity, noncompliance to policies and predisposing environmental factors.

How was the program implemented
For effective implementation, the program was divided into different functions each of which was headed by a committee. These committees worked in conjunction with the corresponding local agencies and this helped to minimize expenses, staff and efforts.

What do the health educators mean when they say the program is multilevel
It means that the design of the program incorporated different levels of people. Other than the target group, there were other three levels. The first level comprised of school children, university students, worksite employees and clients of local health department and minority groups
(Bajracharya,  Bowler, 2004). Second level comprised friends and relatives of the target groups and the third level comprised of counselors, school teachers and youth advocacy program coordinator.

What do these health educators recommend for successful implementation
They recommend that first the program organizers should try to win the confidence of communities in which they seek to implement the program in. This ensures the communitys good will and it goes a long way in making the program to be accepted by those communities it is intervening for. Any sort of program rejection or objection by those it targets can result into unforeseen hurdles hence causing project failure and a loss of resources. The programmer should also include everyone in the program and should involve community programs in the society that could be interested. This makes every one feel as if they own the program and it is an important factor in program success. Another important thing is to allocate tasks based on a members area of expertise or interest, this ensures that every one contributes constructively to the program. And above all, each members contribution should be recognized and their successes celebrated to maintain enthusiasm and active participation.

In terms of the 7 Areas of Responsibility for Health Educators, what was the health educators role in this program Please specify which areas apply, and comment briefly to say why you think so.
Responsibility to implement strategies, programs and interventions for health education. This is shown by hiring of a full time health educator to coordinate health education programs (National Commission for Health Education Credentialising, Inc. (2006). The other area is responsibility to plan programs, interventions and strategies for health education. This is illustrated by the development of an anti smoking television advert by Youth Advocacy Program coordinator who worked alongside health education coordinator. The above roles were designed to make this program a success. Often, programs and projects which fail to spell out duties and roles of various stakeholders end up failing.

The selected program, Smoking Cessation Program was implemented as planned by the strategists and planners. Several strategies and methods were deployed and implemented to ensure that the goals and objectives of the program would be achieved. Some of the strategies designed to ensure maximum achievement of the programs goals include the adoption of different types of sessions to be conducted in the course of the program implementation deploying volunteers trained in psychology and health offering the programs sessions to groups of prospective participants and providing incentives to those with progress and improvement in attendance (Moadel, A.  Lukoschek2009).

The program is comprehensive enough considering the nature and scope for a health program. By far, all tasks vital to the design, implementation and monitoring of the program are established. The parameters for monitoring the program are also in place (McKenzie et.al.,2004).

The program has already been implemented, the results having been reflected in the introductory part. The strategies designed and applied for the program are aforementioned. Basically, the stages of the program include the determination of the scope in terms of nature of the program, demographic factors, cultural factors and the basic facets of human nature such as cognitive, behavioral and physiological factors. The stages of the implementation are fairly appropriate to the programs goals and targeted participants.  (Moadel, A.  Lukoschek2009).

I believe that there are no negative legal or ethical issues that may arise with this program. Legally-speaking, there are positive effects if the program would be implemented. As it is geared towards minimizing, or even to totally eliminating smoking habits among the target participants, this could reinforce anti-smoking regulations, policies, laws or ordinances as applicable to different types of communities. (Issel 2004)
Ethically, I see more benefits than adverse impacts because the traditional society actually abhors smoking in public, especially in work places. Some non-smokers could be offended or harmed by smokers (especially in public places or workplaces).  By cutting down on smoking, this ethical issue could also be eliminated.

MHM 522 Legal Aspects of Health Administration SLP

Healthcare provision is a critical service which ought to be carefully regulated by the relevant authorities in order to reduce or curb cases of malpractices that lead to losses of lives and revenue. Operating a healthcare facility is therefore subject to statutory regulation, and one has to comply with these laws in order to be allowed to operate. The laws vary from state to state though the basic ones are set on a federal level and as such are applicable to all states (AHCA, 2010). This case is focused on the state of Florida.

Applicable Statutes and the Licensing Process
The state of Florida has different procedural orders for licensing people or organizations to offer health care services. These depend on the particular service to be offered. Considering a hospital, the licensing procedure entails first applying to the Agency for Health Care Administration (AHCA) (Barnes, 2001). Usually, application for this license ought to be made first and its receipt confirmed before any organization can be allowed to advertise for the services being offered by the hospital. This rule is provided for under chapter 395, the first part of the Florida Statutes, as well as the second part of Chapter 408 of the Florida Statutes (Barnes, 2001). The hospital is usually required to maintain its current license although it is allowed to apply and be considered for Medicare Certification and then become an accredited hospital (AHCA, 2010).

In order to be compliant with licensure, an accredited hospital will have to meet the requirements of Chapter 59A-3.253(3) of the Florida Administrative Code (Barnes, 2001). Since such hospitals are compliant with certification and licensure requirements, they are usually exempt from the on-site surveys that are usually done routinely. However, every hospital has to be inspected for the Life-Safety Code. The procedure involves first applying for a Certificate of Need from the Financial AnalysisCertificate of Need Unit in order for a review of the project to be done. On receipt of the certificate, the Office of Plans and Construction must be notified to issue a plan review before any building is constructed (AHCA, 2010). With these applications must accompany a licensure application fee and the relevant documentation for support. Finally, upon approval of these, a licensure survey is conducted. A license is issued only if the survey is successful (Barnes, 2001). 

The State Survey Agency in Florida and the Conditions for Certification
The State of Floridas Survey Agency is called the Florida Agency for health CARE Administration (AHCA). Its criteria for certification include analysis of the organizations ability to comply with the applicable laws and regulations. One important area is the ability to adhere to state and federal laws that require that the requirements of the following chapters are met Chapter 395 Part 1 and Chapter 408 part II both of the Florida statutes, and Chapter 59A-3 of the Florida Administrative Code (AHCA, 2010). These statutes, among other provisions, outline the need for an operator of a facility to prove that all the safety requirements as well as the good practices codes are guaranteed (AHCA, 2010).

They require that an applicant for a license must be evaluated on the basis of proof of not only understanding these statutes but also ability to do as they require. The hospital also ought to be surveyed in accordance with the provisions of the Centers for Medicare and Medicaid Services. There has to be conducted two surveys, one before the beginning of the operations and the other after the hospital has begun operating on a full scale. A very important criterion entails having the organization have all the supporting documentation to prove that all the necessary legal and statutory requirements have been met (AHCA, 2010).

Adult Day Care.

Adult Day Care Services can be defined as organizations or centers that are designed to provide care for the senior members of the society who requires some assistance andor supervision during the day. This program is meant to relieve family members or rather care givers to these elderly people granting them the freedom to be able to attend to their personal duties. There are two main types of adult day care which include Adult social day care and the Adult day health care programs. The Adult social day care program is designed to provide social facilities, meals, recreation, and limited health-related services to the elderly. On the other hand, the Adult day health care program has been designed to offer services that are inclined towards health issues like the provision of therapeutic and social services to senior members of the society with severe medical concerns and those in need of nursing home care. Adult day care centers are usually opened during the working hours of the day (Bryce, 2000).
Where it begun
   
The majority of home care providers to the elderly members of the society are generally adults andor spouses. These groups of care givers are very crucial to the economic development of our country and therefore require some assistance in caring for their loved ones as they continue to drive our economic growth. Care giving has been identified as an enormous task both in financial and time wastage terms. Adult day care therefore offers a timely intervention to provide the much needed relief from care giving and this may also reduce the need for a nursing home care that could be quite expensive. According to the 2000 census, the number of adult day centers in the United States was estimated to be 3,407 which primarily served individuals with dementia and the frail elderly who were not suffering from dementia. Experts however argue that more than 5000 centers would be required in the coming years to cope up with the aging population (Eure, 2005). Thus with a witnessed growth in both demand and interest for alternatives in community care services, adult day care services are increasingly becoming the best alternative in the provision of health and general care. The adult care centers do not provide curative services but may engage in the provision of the required health care and social support to the elderly.

General trends
Adult care centers also referred to as adult care services have been active for a period exceeding twenty years. It is approximated that 80 of the adult care centers are for non profit, 10 for profit, and the remaining 10 funded from the public funds. According to Whirrett, in 1978, there were an estimated 300 adult care centers in the United States and by 1980s the number had swollen to reach 2100 centers. The National Adult Services Association puts the number of the adult centers at 4000. The rapid growth in the number of the centers has been attributed to the ever increasing demands for home and community based services. This has also been attributed to the new funding openings such as the Medicaid waiver programs which have gone along way in support of alternatives to the institutional long term care and rehabs. The adult health care programs have moved away from the traditional adult care relief by providing therapeutic care to elderly with both cognitive and physical impairments in addition to the general provision of relief to family care providers (Whirrett, 2002).

Belmonte has defined an adult day care center as composed of a planned program of activities that are designated to enhance the well-being of the elderly via the established social and health services. She goes further to elaborate that these centers are functional at day time and during weekdays. They operate in what has been referred to as safe, supportive and cheerful environments. Meals with a high nutritive value are usually offered to accommodate special diets accompanied by a snack in the afternoon. These centers can be publicly owned or private. In general, the adult day care serves two main purposes which include the provision of an opportunity for the adults to experience a different environment from home and this serves them nice as they receive both mental and social stimulation.

The other function these centers have is in regards to primary caregivers who require a break in order to attend to personal obligations, or have time for resting andor relaxation. Adult care centers is befitting to senior members of the society who have the ability to benefit from the friendship and functional assistance that are offered at these centers. Those who are physically andor cognitively challenged but do not require a 24 hour surveillance are also eligible. The other seniors that could benefit from the services associated with the adult day care centers are those individuals in early stages of Alzheimers illness. Those who qualify for adult day care are expected to be able to move around with minimum assistance. In this regard, the elderly should be able to be self sufficient in mobility may be with some assistance from a cane, walker, or wheelchair. They also need to be continent (Belmonte, 2009).

Demography of the Adult Day Care Centers
As the United States population ages, adult day care centers are becoming an integral part of services offered to the elderly. They provide a variety of services including both social and medical to cognitively and physically challenged senior members of the society. Typically, the demography of the adult day care participants were regarded to be frail elderly members who are not in need of a 24-hour institutional care, but at the same time requires some health related services. The majority of participants in the adult day care centers are those who have attained the age of 65 and above. Studies have shown that participants especially in the adult day health care (ADHC) centers are those with cognitive impairment, those suffering from different forms of dementia and therefore are in need of significant supervision. Other conditions that are commonly associated with ADHC participants include chronic mental problems, physical conditions relating to heart diseases, diabetes, e t c. These are ailments that are mostly associated with old age (Moore, Geboy  Weisman, 2006).

Services provided by the Adult Day Care Centers
Adult day care centers provide a variety of services that are focused on benefiting of the participants life in general. Such programs are centered on skills, knowledge, strength, and unique abilities of the seniors that are the main point of focus. These care centers provide customized plans in order to meet the needs of their participants. Such services include recreational activities such as arts and crafts for the elderly, musical entertainment, games for mental stimulation, local outings, simple exercises, and holiday and birthday celebrations, among other activities. Apart from the recreation activities, these centers give emotional support, mental simulation, personal care such as bathing and shaving to the participants. Some adult day care centers provides for the transport cost to and from the center. They also offer social services including counseling services and support groups for care givers. They also at times offer some health services including monitoring of the blood pressure and vision screening (U.S. Health and Human Services, 2010).

General Advantages
When our parents become frail due to the effects of aging, we would really want to provide them with any assistance that will enable them to stay for long and as happy as possible. But keeping our parents in homes has come with great challenges. Most elderly have come to live in these homes as disgruntled members of the society in which case they are more often isolated, lonely, and resorts to sleeping all day long. They spent most of their lives waiting for appointments from the doctor. The idea of a day care center comes in handy to address the issue of loneliness of the elderly in the homes as they are stimulated back to life through social and physical stimulation. It has been established that even elderly individuals with moderate form of dementia who seems to suffer memory lapse responds in a better way when they are socially and physically stimulated.

Such patients can be said to be living from moment to moment and therefore the quality of the individual moments collectively impacts on their overall health and happiness (Dabelko  Decoster, 2007). It should also be noted that the adult day care centers are designed to meet the daily socialization needs of the elderly as well as providing respite to the weary caregivers in the home. The elderly with dementia are known to sleep very little and this may leave the care givers exhausted since their sleep is usually interrupted by the suffering senior members of the family. In such a case, the adult day care center will provide the caregivers with an opportunity to run errands and have rest. In the event that the care giver is a spouse, then the care giver needs time to attend to social functions, attend to physician appointments and be able to maintain their own health and contentment (Kobrin, 2010).

Studies have continued to show that the main beneficiaries of the day care services are the care givers and the professionals. The former often appreciate day centers since they provide respite care under a different name. Adult day care centers can be considered as a blessing to many elderly people. Several communities are engaged in the provision of adult socialization and activity through the adult day care centers. Adult day care centers actually provide a variety of services that are of great benefit to the senior members of the society. Some parents also value the perceived security and reliability that accompanies the services that are usually offered in these centers. From the agencys point of view, day care centers are predictable and easier to run than any other organization. For instance, in case of staff shortage, two activity groups can be merged and coordinated by a single member of staff (Clark, 2001).

The adult day care centers thus produce a winwin situation in the sense that everyone becomes a beneficiary. To the caregiver, the centers provide the relief from the burden of taking care of the elderly while to the elderly, the benefits include safe and secure environment in which to spend the day, enjoyable and educative activities, enhanced independence, socialization and peer support and an improvement in both the mental and physical health. The elderly are also put on nutritious diets which is good to their health (Belmonte, 2009). In summary, adult day care centers usually provides a relief to family members from committing all their time to caring for the elderly. They also provide social interaction, health services, customized exercises, crafts, and meals to the elderly (Blanchard, 2010).

When and how to call for Adult Day Care Services
The decision to enroll a senior member of the family is not easy to come by. To the elderly, it becomes a challenge especially if the individual has a high degree of independence and was involved in the caring for others. To the care givers, the idea of giving out your beloved member of the family to strangers is not comfortable (Belmonte, 2009). You would rather have the senior member of the family under your care than throw all the caution to the wind and hand him or her to the strangers.

However, there comes a time to let go when it is destined to work in both the interest of the care giver and the senior member. Experts advise that one should consider using the adult day care services when the elderly member of the family exhibits certain characteristics. Such indicators includes when one cannot structure his or her own daily activities, feels isolated and is in need of company, cannot safely be left behind at home, and when the caregivers work station is away from home. With such challenges, then one might consider tapping on the services that are provided by the adult day care centers (Cohen-Mansfield, Taylor  Werner, 1998).

Before one identifies the right adult care center for the senior member of the family, there are certain considerations that one has to keep in mind. The first thing to consider will be the specific services that are needed by the care giver and the elderly. You also need to know whether social activities are the primary needs that the elderly needs. Explore the other needs that the participant may be requiring which may include assistance in walking, eating, medications, exercises, or mental stimulation among others. Caregivers may be requiring some free time and some facilitation with transport being offered to the participants. With the above in mind, one will be able to comfortably choose the type of the adult day care center that will be appropriate. In addition to the above, one can acquire some resource and reference from the family doctor, the local social services or health department, local senior centers, and even the yellow pages that are under the adult day care (Belmonte, 2009).

Choosing the Adult Day Care Center
One is required to conduct some research in order to be able to determine which center is the right choice for a loved one. There are certain basic features that one should look for when choosing an appropriate adult day care center for the senior members of the family. One needs to carry out an assessment of individual needs before admission in order to determine the persons range in terms of abilities and needs. You also need to develop customized treatment plan for the participating individuals and monitor it regularly offering the necessary adjustments.

The best day care centers for adults should be able to provide referrals to other needed community services. You also need to determine whether the care center has the ability to meet the social, recreational, and rehabilitative needs of the participant. Good day care centers also need to have clear criteria for service and guiding principles regarding termination that are based on the participant. They also should provide a full package of in-house services which may include but not limited to personal care, meals, rehabilitative services, educational programs among other services. The environment should also guarantee some safety to the participants. The personnel in these day care centers need to be well trained professionals and qualified staff. Above all, the day care centers should be registered by the authorities for legality (Whirrett, 2002).

Types of Adult Day Care Services
 There are three different types of adult day care models which include the social model, the medical model, and the specialized model. The social model is engaged in the provision of social services which includes activities of daily living and therapeutic services that are designed to aid the participants with mental and physical well being. The medical models on the other hand are designed to advance on the social model through the provision of skilled nursing and rehab services. Such services include the occupational and physical therapy, speech and language therapy, among other services that are related to health issues. Services offered by the medical model are partially funded by the Medicaid since most of these services are health related. Lastly, the specialized model specializes in the provision of services that targets a specific group with unique demands. These groups may include the individuals with HIVAIDS, those with brain injuries, those suffering from mental problems, and those with multiple sclerosis. The California state is known to run special programs for those suffering from dementia and Alzheimers disease. Those with development disabilities have also been provided with specialized care (Health Management Associates, 2007).

The term Adult Day Health Care (ADHC) is most commonly used to refer to the medical and the specialized models. The difference of the two models when compared to the first one lies in the provision of the health services. The provision of the medical services have enabled the adult day care to benefit from the Medicaid system thereby receiving payments for the services offered under Medicaid waiver programs designed for home care. Medicaid has recognized the major contribution that is brought in by these day care facilities which include offering of rehabilitation and curative services that form the best alternative to nursing homes. Medicaid has the objective of promoting the keeping activeness in individuals and teaching them the skills that will prevent them from institutionalization. At the same time, Medicaid has offered an avenue through which care givers are provided with relief in the home by enhancing the provision of these services outside the home. ADHC have continued to benefit from Medicaid and this has impacted on the general trend in the Adult day care as most have converted to include the provision of the health care services in their programs in order to be able to tap from Medicaid and other government funding (Day, 2010). The table below shows the percentage of adult day care centers in relation to the services being provided.

Table 1 Percentage of Adult Day Centers That Provide Specific Service

Type of service of CentersTherapeutic Activities97Personal Assistance96Meals84Social Services82Health-related Services74Medication Management70Transportation68Personal care60Rehabilitation Therapy28
Source Thomas Day About Adult Day Care, 2010

Adult Day Care Services A blessing to government, community, and the individual
The elderly population in the United States is rapidly growing. It is estimated that by the third decade in the new millennium, the number of those aged 65 years and above will have increased with two folds totaling to about seventy million. Between 50 and 80 of these individuals are believed to be in need of some sort of long term care due to disability, functional limitation, cognitive impairments plus other chronic health care problems. This definitely is going to be a burden to the government in its quest to provide for the basic services especially those related to health matters. Health care costs are on an upward trend whereas the number of the skilled and legitimate workers is on the downward trend. Most Americans are familiar with the nursing and private home health workers. However, little has been explored regarding the adult day care services which have been expanded to include what is referred to as the adult day health care services (ADHC). This sub-section of the adult day care engages in the provision of health and long-term care services to the seniors including those with medical conditions (Health Management Associates, 2007).

ADHC comprises of a full package of comprehensive medical services targeting low income seniors including those with chronic health problems. Common services being offered under the ADHC includes several therapeutic measures, skilled nursing care, and customized dietary and nutrition services. ADHC thus deals with patients who require considerable assistance with the daily activities and also faces health care challenges which do not require an admission in 24-hour health care facility. ADHC can therefore be said to be model to serve the chronically ill elderly population when one considers the multi-disciplinary approach it takes in handling the needs of the geriatric individuals. It has been established that ADHC allows the participants to remain in the homes or society settings thereby delaying admission to nursing and any other health institutions. The model also provides high quality and cost effective health care services (Burke  Laramie, 2004).

Many states in the United States have opted to cover ADHC via the Medicaid state plan. It is therefore imperative that policy makers, health care providers, and all stakeholders to have a clear understanding of the important role played by the ADHC for it to become a respected and valuable resource in the society. The table below shows the implementation of the ADHC program in six states including California, Maryland, New Jersey, New York, Texas, and Washington.

Source   Health Management Associates, July 23, 2007
Notes
a). Assessment is done by a multidisciplinary team (MDT), which includes at minimum a nurse, a therapist, the participant, and the ADHC program director. Additional members may also be involved depending on the providing facility.
b). Census Bureau, March 2005 and 2006 Current Population Survey, Annual Social and Economic Supplement
c). ADHC utilization is the population 65divided by the number of individuals participating in an ADHC Program.
 
Health services provided in these adult day care centers includes several therapeutic measures involving physical, occupational, speech, and language therapies. They may also offer psychological and psychiatric services, podiatric and vision care to the participants. The nursing services that are availed to the participants involve the evaluation, treatment, and the provision of health education. The ADHC are also engaged in the coordination and monitoring of the health situation extending the emergency and personal caring services to the participants. Some ADHC centers may offer more advanced health care services to the participants which include supplementary services such as laboratory services, EKGs and X-rays, and specialized clinics.

The services are designed in the sense that they meet the varied needs of the participants. ADHC employs flexibility approach to invoke elasticity in the provision of health care services and in the long run providing excellent services that are rarely available in other long-term care centers. It can be argued that the regularity of attendance in the ADHC centers and the multi-disciplinary nature of the provided services guarantee some safety net for the participating seniors. This enables the team involved in the provision of the services to hastily gather around patients when their conditions alter or deteriorates. ADHC has been a neglected area when it comes to long term care giving but as we can see, it has a rich history and therefore should be recognized as one of the pillars in the provision of health care services that are designed to cater for the fragile elderly members of the society (Health Management Associates, 2007).
   
ADHC participants are associated with chronic health problems that may include cognitive and mental health conditions. Others are physical conditions that are linked to stroke, heart ailments, diabetes, etc. Such diseases are categorized as top causes of disability in the seniors and therefore the ADHC becomes a very essential component of the society in addressing health issues of the elderly. This is due to the functions that the ADHC plays in the prevention of these complications and co-morbidities among the participants with such conditions. In most cases, the ADHC participants may require assistance with between one and three activities of daily living (ADLs). It has been observed that the number of ADLs in which a participant would require some assistance could be used as a yardstick for nursing home admission.

According to a study done in 2007, having three or more dependences meant that the individual is highly in need of a nursing home admission. Further research on the behavioral and psychological indicators of nursing home entry has shown that participants who receive community based care aimed at the improvement and maintenance of their physical and cognitive functioning have recorded a considerable delay in nursing home admission. Most ADHC participants are known to live with either a spouse or some other relatives. Others however may be living on their own andor rely on caregivers who are either formal or informal. Therefore, ADHC definitely comes in handy to provide some relief to these caregivers who are considered to be the backbone of the countrys long term care system. It has been established that in the United States, over seven million Americans are involved in the provision of 120 million hours of care to an approximated 4.2 million elderly people, with an unprecedented economic value of between 45 and 96 billion dollars per annum (Health Management Associates, 2007).
   
The ADHC related programs are designed to provide for health care to a very high-needs section of the population which has varied medical conditions at reasonable costs. The cost of the ADHC services is generally lower compared to those charged by the nursing homes. There is profound evidence that ADHC plays a crucial role in the prevention and delay of admission to more costly health institutions through the provision of a wide range of integrated services enabling the individuals to remain in the community setting. A survey that was carried out in the six states clearly demonstrates that ADHC bundled services are less costly compared to the nursing home care. This has been well elaborated in the table below

Table 3 Daily Rates and Monthly Reimbursement for ADHC versus Nursing
Facilities in 6 States
StateADHC Bundled ReimbursementNursing Home ReimbursementDailyMonthlyDailyMonthlyCalifornia76 914 152 4,562 Maryland65 808 208 6,240 New Jersey79 992 255 7,650 New York142 1,703 192 5,760 Texas26 520 83 2,476 Washington52 475 119 3,575
Source   Health Management Associates, July 23, 2007
Notes
a). Monthly rate based on average monthly use of 12.5 days. Data provided by each states Adult Day Health Service Organization.
b). The daily nursing home reimbursement rate is the monthly rate divided by 30 days
c). ADHC organizations 2006
d). ADHC participants in Texas attend an average of 5 days per week, which accounts for a monthly rate that appears higher than the other states.
  
With the ADHC area in the provision of long term care having been sidelined from research activities, much of the information on the subject has been dependent on surveys. However, in recent times, researchers have been interested in finding out the impacts that the ADHC have on the health outcomes. This has greatly leaned towards the effectiveness of ADHC in delaying the admission of participants in costly nursing institutions. Recent studies have suggested that generally, adult day care centers enable informal care providers to continue with the provision of care in the homes hence causing a delay and to some extent prevention of institutionalization. Several other researches have been launched to establish the cost-saving aspect of the ADHC. For instance a study has been conducted by the National Multiple Sclerosis Society to establish cost savings that result from the ADHC services even though the sample sizes were too small. Previous research had shown that ADHC participants had improved health outcomes in comparison to those in nursing homes. They showed higher rates in client satisfaction and also recorded lower mortality rates (Health Management Associates, 2007).

Though nursing facilities may be a compulsory option to some individuals, a simple delay to admission into these facilities may go along way in cutting down the overall cost that could have been spent on the patient. Apart from the preventive and even the avoidance impacts ADHC has on the admission of participants to the nursing homes, timely engagement of ADHC services has also been identified as having beneficial health consequences to the care givers. Research done to establish the effects of community based programs to care providers showed that timely engagement of the ADHC services was imperative to the reduction of the care givers burdens and despair. These services also encourage some independence on the part of the participants and this will enable them to live happily as they are not subjected to control by another person. They are able to socialize and interact with their peers and this works well for their social and psychological well-being (Beisgen  Kraitchman, 2003).

Possible reasons as to why Adult Day Care Centers are avoided
The Adult day care services have been hailed as a valuable component of care provision but still remain the most underutilized. There are very limited data and information if any in regard to the issue and this has led to the perpetual theorizing of the possible causes of this phenomenon. An argument has been advanced saying that care recipients may not be pleasant with the concept. In many surveys carried out, it has been established that a majority of the care recipients happen to be afraid to leave their homes. They seem to fear change of environment that comes with the day care centers. They may also not be pleased with the type of activities that are associated with the day care centers and would rather spend the day at home than at the center. On the part of the primary caregiver, they might be reluctant to surrender their loved ones to the day care centers for lack of trust in the day care centers.

They might also lack the fee that is charged by these day care centers and thus opting to have the senior members of the family in the home and not at the centers. There is a misconception that a loved one might suffer in the day care centers which is to the contrary. Many care givers would be heard threatening the elderly that they would be taken to the day care centers incase they misbehave. Another speculation would be that most care givers are not familiar with the services being offered at the centers. May be if the people are educated about the benefits and the general services that are stationed at the day care centers, then we would see a surge in the number of those who would prefer  the use of these services. Lastly, we can say that perhaps the adult day care programs might be regarded as their very worst enemy. Since most of them are non-profit in their orientation, they could be too lenient and this can easily compromise their sustenance. When they do not survive the test of time, public confidence is greatly hampered and this negatively impacts on recruitment. When arguing out this point, one has to be careful since if these care centers were to overcharge, the practice can easily drive away possible clients at the same time (Day, 2010).

Funding for Adult Day Care
    According to a survey done in the year 2001regarding the average daily cost of adult day services, the average figure was estimated to be around 56 dollars. The prices have considerably gone higher since then and it should be expected that the prices are determined by the living index of the area. This means that areas with high living standards will charge highly for adult care services compared to those areas with moderate and low cost of living (Day, 2010). Medicare does not address the costs of the day care services. However, as seen earlier Medicaid can chip in and provide all the payments in a licensed adult day care centers that are run on a medical model. Medicaid has recognized these services as providing good alternatives to the nursing home care. Some day care facilities may charge using the slide fee scale whereby one pays for the services depending on his or her income. Private medical insurance policies may at times partially cover the adult day care costs if the personnel involved in the care are registered and licensed. Depending on the policy, long-term care insurance policies may at times pay for the adult services. Also designed to cater for the adult care payments is the dependent tax credits which may be availed to the care givers (Whirrett, 2002).  The pie chart below gives some insight on who shoulders the responsibilities of paying for the adult care services

Source Thomas Day About Adult Day Care, 2010  
Adult day care services should be a welcome move for those individuals who have other obligations or rather would want to have a rest from the tiresome responsibilities that are associated with care giving. This offers them with some freedom away from a loved one to be able to accomplish their duties, socialize, and refresh. Adult day care centers have also been identified as beneficial to the participants given that they willingly appreciate being part of the day care centers. This is essential since when they accept to be part of the experience, they are psychologically and emotionally sound and this would work well for their adaptation capabilities. Adult day care has also been identified as a possible alternative to the costly nursing home facilities through its cost effective services to those participants with chronic illnesses. As we have seen, day care centers comes with a range of benefits that can be of value to virtually everyone including the caregivers, the participants, the government, and the community at large.

Health

The health of an individual is very vital especially when it comes to dieting, lifestyle and wellbeing. An individual is expected to eat and live healthy in order to be active in daily chores. However, some aspects of life contribute towards health living by an individual. Lifestyle is one of the most common aspects of life that is connected to health. As an introductory part the author of this essay paper is impressed to define lifestyle as an issue in relation to health.
   
 Life style is the way an individual lives in the society and this basically constitutes the behaviour of a person that impresses him or herself and other members of the society. Dress code, social gatherings or relations, entertainment such as drinking or smoking and consumption are some of the common aspects of live that constitute to lifestyle. These are some of behaviors and practices that affect the health of an individual and will be discussed in the main section of this paper.
   
Wellbeing is used to refer to quality of life as is concerned with healthcare. The quality of life does not necessarily include such concepts like wealth or education but it means that an individual is mentally and physically fit. The lifestyle of an individual can influence his or her wellbeing in some aspect thus there is a link between lifestyle and wellbeing (Wiseman, 2008).
   
Health is very much linked to lifestyle and the wellbeing of an individual. To humans, health can be defined as the functioning of body organs in a good way. In other words it is the mental, social and physical wellbeing of human body. Individual lifestyle such as consumption, dieting, hygiene, management of stress and exercise are some of the aspects that contribute to good health. These definitions clearly bring out the context of the entire discussion in relation to the impact of individual lifestyles on health and well being.
   
Individual lifestyles like the use of drugs and other behavioral practices of individuals are considered to be one of the major causes of health problems. Material factors such as the quality of living standards or environment and psychological factors such as risk taking or stress are considered to be the major impacts on the health of a person. According to LaLonde report that was released in 1974, the presence of pharmaceutical, hospital and physician services does not guarantee a health living (Whiteman, White, 1999). The report identified four main key health issues that are responsible for the health of a person. The four fields are human biology, environment, health care organizations and lifestyle. The major concern of this report is lifestyle.
   
Health centers are very essential when it comes to treatment of an individual but lifestyle is the common area that must be checked to enhance proper health. In real life an individual has the right to do what he or she feels like doing and this is very risky because many individuals opt to engage in unhealthy lifestyles which cause illness and to large extend death. It is known that smoking has negative impacts on the body health of an individual but people choose to do it in the name of lifestyle. For instance smoking is associated with cancer and infertility both in men and women. Women who have a lifestyle of smoking have high chances of being infertile and have a risk of not getting a child. This means that life expectancy is reduced by a certain percentage (Wiseman, 2008). Smoking as a health problem causes asthma, lung cancer and cardiovascular diseases. These are some of the issues that must be handled by health organizations as a way of promoting health living.
   
Lifestyle such as drug taking has a very big impact on the health of individuals. When drugs are taken in large quantities it becomes a problem of addiction and this has a very devastating impact on the health of individual, family and the entire community. Individuals engage in a lifestyle of alcohol taking which leads to addiction and it becomes a health problem. Taking drugs excessively leads to poor dieting because the drunker abuser has no appetite hence he or she is at the risk of contaminating serious diseases. Alcohol is the most abused drug substance which leads to infection of the liver. Liver is the most sensitive body organ and once it has been affected the body becomes very weak and is subjected to health problems. The health of individual is very important but once it has been affected due to engagement in various lifestyles it becomes a major problem and can lead to premature death (Whiteman, White, 1999).

The teenagers are the common victims of alcohol abuse and they have been subjected to health related diseases and body injuries caused by violence. Drinking has posed mental, physical and social health problems that must be checked to reduce the rate of premature deaths. Nutrition is another major area that has an impact on the health and wellbeing of an individual. The eating habits of individuals have been a challenge especially during this time of economic challenges. Many families have no full potential of providing a balanced diet and this has led to health problems. Many developing nations who depend on donations can only afford cheap foods such as ugali which when consumed for a long period of time can lead to kwashiorkor. Consumption itself is an element of lifestyle and it is only the rich who can afford a whole meal.
   
Lifestylism is based on the choices an individual makes about lifestyle or to an extend it is related to medical doctrine that is related to health living. It is true that lifestylists are only concerned about their way of living and they dont concentrate much on their nutrition and health. Their common way of live is basically based in politics and material things which adversely affect their health (Wiseman, 2008). This focus by many individuals who adore lifestyle leads to environmental and structural factors such as pollution and excess exploitation of resources. The health and wellbeing of an individual is mostly influenced by structural factors such as exercise, good rest and management of stress. Every individual is encouraged to live health by putting into practice these factors. In addition, environmental factors such as dieting, reduction of pollution and conservation of environment must be focused on lifestylism.
   
The focus of individual lifestyle can be connected to victim blaming whereby an individual is held responsible for any unfortunate incident that has happened to another persons life. Victim blaming has occurred in several cases relating to lifestyle and health or wellbeing. For instance people in developing countries hold their government responsible for lack of sufficient food or drugs that lead to poor health. In another case, lifestyle is taken as an influence by people of the same peer pressure groups. When an individual engages in behavioral practices so as to fit in a particular social group, and he or she is affected health wise, then it becomes a blame game. It is advisable therefore to make sure that an individual is very careful when indulging in groups that may lead to engaging in activities that will cause health problems. A good example about victim blaming and lifestyle in relation to health and wellbeing is a case where youths are influenced by their friends to indulge in sexual activities that leads to contraction of AIDS (Wiseman, 2008).

Once they notice they have been infected, the victim starts to blame their friends and this has been a major challenge to health living. Nutrition is another key area that is related to lifestyle and its impact on health and wellbeing. Every individual must have a lifestyle of accessing balanced diet that will keep him or her both mentally and physically fit. Individual lifestyle has led to health complications to many people because those who are obsessed to a particular lifestyle have time to attend to their own issues thus they forget about health living. The concerned parties must put measures such as organization of health seminars to enlighten people about the benefits of health living.
   
Lifestyle is one major area that has brought a lot of problems to the health and wellbeing of individuals in the modern society. The world is changing at a very fast speed and the introduction of information technology has also influenced the way of life. This has posed a lot of challenge in administration of individual health. The health of any particular individual is very important and the way an individual lives determines a lot about his or her health and wellbeing.

 It is therefore, very important to make the right choice when it comes to lifestyle. There should be no blame game because an individual must be concerned with individual health living. Smoking is one lifestyle practice that has led to health complications among women and men and should be reduced whenever it is possible. Health organizations must give guidelines and rules that relates to smoking so as to reduce cancer diseases and other health complications. Rules governing drug abuse and addiction must be provided. Individuals who have been addicted by drugs must be taken to rehabilitation centers for reformation.

Reading Response

The primary strengths of the quasi-experimental design is its attempt to reflect geographic dispersion and its narrow audiencespecifically, public health practitioners. The primary weakness, in my view, is that of the narrow audience, there is too much of an emphasis on tech-savvy workersmany graying eminences in this field are less likely to react to CD-Rom inquiries, ask for technical advice, or even attend the (increasingly techno-centric) world of conferences.         

As mentioned above, the primary strength of the quasi-experimental design is its admirable attempt to get a diversity of respondents from a diversity of locations. Though my criticism remainsthat, specifically, the nature of the dissemination narrows down the field theyve attempted to broadenthe attempt at diversity is often overlooked in modern studies.         

With this in mind, I feel the research projects validity was heightened by the use of the experimental design. Experimental research remains highly effective, and the attempt to randomize respondents in order to get a greater breadth of answers is something thats not always easy (or even feasible) within the realm of public health.  And though some critics such as Sandra Soo-Jun Lee (2005, p .2133) think the notion of personalized medicine is more rhetoric than fact, the attempt at personalization is, currently, the way to patient satisfaction on both the treatment and marketing aspects of medicine.          

I feel that the best strategy for dissemination would be a tiered approach targeting newer hires, midrange employees, and upper management. As mentioned above, I feel this dissemination is more likely to get younger, tech-friendly employees. To this experimental design, I would add informal paper surveys distributed to a variety of agencies. I feel this would address one of the weaknesses of the original studynamely, that state respondents were more likelyto have a shorter tenure in their agency. (Brownson et al., 2007, p. 1903) With my addition to the quasi-experimental design structure, I feel a greater breadth of longer-term employees would be reflected in the results.