“I wish I had known sooner,” is what most caregivers say after their first visit to Main Line Adult Day Center (MLADC) says director, Pam Barton. Typically, they are caring for a 78-year-old woman with multiple medical issues including cognitive deficits. The caregiver had not realized that the center existed, the range of services it offered, or how little it cost.
Adult day centers provide meals, activities and other resources in a safe environment to adult participants, including increasingly younger ones, who can't be left alone during the day. For many families, they are the win-win solution for caregivers and adults needing day-time socialization, medical and therapeutic services. From the legal planning point of view, Elder Law Attorney, Linda M. Anderson, has utilized this important level of care for families who are determined to maintain a family member in his or her home. In some cases, Medicaid or Veterans benefits may be able to assist with the cost of this invaluable service.
Often a caregiver and participant arrive at the center after the caregiver acknowledges that he or she is no longer able to provide the at-home safety that the participant requires, and the caregiver’s own resources are stretched to the limit. The center can provide what Barton describes as “a partner in care and problem-solving.” An example is 76-year-old “Phyllis” who became a participant at a center after her daughter-in-law, Jill, noticed changes in memory and behavior and pointed them out to Phyllis’ husband, John. Phyllis was getting lost going to familiar places and was often uncharacteristically anxious. Jill worried about Phyllis’ safety when she was alone in the house. As Phyllis’ self-care skills declined, Jill also worried about the toll of caring for her was taking on John. Jill initiated contact between the center and John, who was conflicted about visiting. On one hand, it was an unwelcome confirmation that his once vigorous and independent wife now needed help to get through the day. On the other hand, he craved relief from worrying about her safety and from the increasing physical and emotional burdens of caregiving. Looking back, he saw that his conversation with the director was a turning point in his and Phyllis’ lives. His decision to bring her to ADC brought a support system into their lives as well as individual benefits for each. The benefits went beyond what he had expected or hoped for. For example, he was predictably relieved to give over the responsibility of the medication routine to someone else. Additionally, he found that their relationship improved when the pill-taking struggles were removed. While each center has its own personality, all share several characteristics. According to the Pennsylvania Adult Day Services Association (PADSA), those in Pennsylvania are affordable at less than half the cost of at-home or nursing home care, provide therapeutic activity, a safe environment and administration of medication. Additionally, participants can live at home while enjoying the benefits of socialization that is widely thought to reduce memory decline. Many caregivers want their loved ones to agree to come to adult care before they come. Barton says that 99% of the time, the person will refuse. Instead, she suggests using some of the 15 strategies described in the handout, ”15 Ways to Tell Mom or Dad he/she is Coming to the Center.” They include highlighting the social and downplaying the care aspects and explaining that the doctor has suggested it to monitor blood sugar. MLADC in Bryn Mawr began life as a mission of Bryn Mawr Presbyterian Church which partnered with Main Line Health System. Barton describes the center as mission-driven with several other unique characteristics. The building is a house, which keeps its participant numbers small and has a home-like setting. The longevity of the staff, most of whom are certified nursing assistants, is noteworthy. Barton has been there for 10 years, the shortest tenure is five years, and one person has been there for 18 years. All have had at least five years’ experience working with people who have dementia. “It’s their calling,” Barton says. A typical 7 a.m. to 6 p.m. day at MLADC includes breakfast, hot lunch, snacks, daily orientation, chair exercise, cognitive exercises, current events, relaxation/personal care/one-on-one interactions, physical activity, creative arts and entertainment. “We tweak our activities and how we present them so everyone can be successful. The activities keep participants awake during the day so they can sleep better at night,” Baron explains. Participants may come for half days and less than five days a week. Here are things to consider when looking at adult day centers for a loved one:
Do the location, hours and schedule meet your needs?
Is there flexibility in how many hours and days a participant may come?
Is the facility welcoming, clean, and appropriately accessible?
What is the background of the staff and are you comfortable with them?
How individualized are the activities?
Do they provide services such as administration of medication, help with bathing, incontinence care, occupational and physical therapy?
Is there a nurse on staff?
Who are the current participants/members?
Is it licensed by the Pennsylvania Department of Aging?
When a caregiver is operating on empty and the care-recipient’s facilities are declining, an adult day center can be the gem hidden in plain sight that fills the tank for both. It can fall into the sweet spot that provides respite to a caregiver and protected, appropriate socialization to the participant. Centers can also serve as a less costly and disruption bridge alternative to, or even companion, to residential care. For additional information, contact Pennsylvania Adult Day Services Association, www.PADSA.org
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