Overburdened caregivers find respite with day care

By Rita Baum

Sixty-nine-year-old Kay Tachibana, a caregiver for her 98-year-old mother, Ko, knows the caregiver's dilemma well.

Ko was living alone in her home until age 96, when she suffered two falls requiring surgery and rehabilitation, which necessitated moving in with her daughter and son-in-law. The burden of care began to take its toll, and Kay soon experienced fatigue and burnout. Her mother agreed to try Sunnyvale-Cupertino Adult Day Care and found she enjoyed the mental stimulation and the Tai Chi exercise program.

For her part, Kay experienced a new lease on life. She had three days a week to do errands or spend time alone with her husband, knowing that her physically frail but mentally alert mother was happy and well cared for.

Maya Caudell of Campbell had a similar experience. She and her husband were looking forward to the freedom and travel afforded by their early retirement when Maya's 88-year-old mother, Elsie, began to decline in health and could no longer live alone. Maya says her whole life changed when Elsie came to live with them, and within a short time she felt trapped and depressed. Things turned around when Elsie tried Saratoga Adult Day Care and found she enjoyed the mental stimulation and activities there.

Adult day care--sometimes called adult day services--includes treatment and assistance on a part-time basis for frail adults whose ability to live independently is threatened or impaired. These community-based centers provide stimulation, protection, recreation, socialization and personal care services. Adult day care is a generic term for three types of service: adult day care, adult day health care and Alzheimer's day care. Extended respite care is available at Cedar Creek Alzheimer's Residential Care Facility (RCFE) in Los Gatos and other RCFEs and nursing homes. The Veterans Hospital in Menlo Park has beds reserved for U.S. veterans for three- to 28-day caregiver respite periods.

Adult day care programs are licensed by the Department of Social Services Community Care Licensing. Adult day care is available throughout Santa Clara County at 10 locations. Check Senior Information and Referral at 1.800.255.9333 to locate the nearest adult day care program.

The eligibility and admission process for adult day care is similar for all types of care centers. An assessment is conducted to determine appropriateness for service and level of need. A doctor's diagnosis, absence of contagious disease and a tuberculosis clearance are required. Individuals who do not qualify--such as those with severe dementia accompanied by combative behavior or the tendency to wander away, or with conditions that call for licensed medical staff--are referred to facilities better suited for their needs.

Adult day health care is licensed by the Department of Health Services, the same agency that licenses nursing homes. Required staff include a registered nurse, a social worker, a case manager, a licensed clinical psychologist, and physical, occupational and speech therapists. In addition, each center must offer physician-directed individual care plans, information and referral services, and caregiver support and counseling. Transportation in vans equipped for handicapped clients is provided. Adult day health care prevents premature or inappropriate nursing home placement of extremely frail elders and enables them to continue living with their families.

Only two adult day health care facilities are available in Santa Clara County: Avenidas, which serves residents of Palo Alto, Los Altos and parts of Mountain View; and Mexican American Community Services Association (MACSA), which serves residents of East San Jose.

Alzheimer's day care provides specialized service for all levels of dementia. The Alzheimer's Activity Center, located in San Jose, is well known throughout California. The maze-like design of the building allows wandering (a common symptom of Alzheimer's patients) without restricting freedom or compromising safety.

While staffing and services vary in each of the three types of day care, programming is similar. A typical day includes at least two nutritious hot meals, snacks and fluids, exercise, socialization, word games, reminiscing and listening to stories. Most centers are open five days per week with a variety of schedules. Three-day attendance is the most popular, and participants tend to rest from the stimulation on the off days. The typical age is 85.

The six most frequent medical conditions of Alzheimer's day care participants are stroke, heart condition, high blood pressure, diabetes, Alzheimer's dementia and arthritis. Fifty-eight percent use a cane, a walker or a wheelchair. Many are incontinent as a result of their conditions. Females outnumber males 2-to-1. Most facilities are nonprofit organizations with fees based on the participant's income.

What is the likelihood that our parents or we will someday need the assistance and support of adult day care? Right now, 5 percent of the over-65 population (approximately 6,500 people) in Santa Clara County lives in nursing homes. By comparison, approximately 350 people participate in the county's 13 day care centers. Leta Friedlander, executive director of the Live Oak Adult Day Care centers, believes that although the benefits of adult day care are well documented, the low percentage of participants is due to lack of public awareness of this valuable resource.

Japan and countries in Europe have used neighborhood care centers and home delivered services for some time. In the United States, 80 percent of elderly citizens receive care at home and a great deal of evidence reveals there are significant physical, financial, social and psychological costs of caring for an impaired spouse or parent.

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Rita Baum is a Los Gatos resident. She has a master's degree in gerontology.

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