When, in 2003, it became clear that Rebecca Lewis's 76-year-old mother could no longer live on her own, Lewis decided to take on the role of her full-time caregiver. But mom Minnie Covington's transition from North Carolina to Lewis's Northern Virginia home wasn't a smooth one.
Suffering from Alzheimer's disease, Covington would "pack all of her clothes in a suitcase as many as six times a day, and say, 'I want to go home,' " reports Lewis. She was agitated and had trouble sleeping at night. Within months, Lewis, then 52, was frustrated and emotionally drained.
"I was totally exhausted," she says. "I told my husband, 'I have to do something.' "
Still, with her mother relatively young and physically healthy, a nursing home didn't seem the right option.
"She just needed guidance and stimulation," says Lewis.
Through a local Alzheimer's association, Lewis and her husband, Kevin, found their way to Mount Vernon Adult Day Health Care Center, one of five facilities run by the Fairfax County Health Department to provide day care for elderly and disabled adults.
"When I first heard of it, I'm thinking 'day care.' I'm thinking, 'They'll treat them like children,' " admits Lewis. "And I wanted so much for her to do something that would stimulate her."
But Lewis says her mother enjoyed the facility from the start. She, too, saw an immediate benefit.
"It allows me to do things for myself and not always concentrate on how I'm going to keep her busy," says Lewis, a stay-at-home mom. "Really, it's my lifeline and I feel like it's my mom's, too."
For Lewis and a growing number of others faced with caring for the elderly, the 3,500 to 4,000 adult day service facilities nationwide increasingly are an attractive option, allowing caregivers to keep a loved one living at home longer than they might otherwise, says Linda Velgouse, director of home and community-based services for the American Association of Homes and Services for the Aging.
Facilities range from social models similar to a senior citizens' center to medical models that offer social interaction along with medical monitoring. Most operate during regular business hours, although many now offer expanded hours and some even offer nighttime care.
Fueling the demand for such services is an aging population, a high number of caregivers who are also employed outside the home (about 60 percent) and an increase in individuals' access to funding to pay for such services, says Velgouse.
The concept has been around for at least 25 years, but providers today are putting a greater emphasis than ever on offering both supervision and stimulation. "Everyone is looking at the baby boomers and they're saying, 'We don't want an institution; we don't want to go to a senior center to play bingo; we don't want to sit in a chair,' " says Velgouse. "It's not maintenance anymore, it's active, long-term living."
To adapt, most centers have revamped their programming to provide more creative options, and designed an environment that is "more attractive, more consumer-centered and much more homelike," says Velgouse.
At the Harry and Jeanette Weinberg Adult Day Health Center in Northwest Washington, for example, participants are taking part in a Montessori pilot program that adapts the early-learning curriculum for the elderly, says Jochebed Jordan, director of day health services. Included are puzzles, games and other activities that help keep dementia at bay.
"What it does is benefit them from the standpoint of doing something that they enjoy and can succeed in doing," says Jordan, who expects to continue the program after the pilot ends this fall. "When they finish putting the jigsaw puzzle together, they feel successful."
The move of Fairfax's not-for-profit Alzheimer's Family Day Center to a new facility in 2004 allowed for an environment designed "to meet the needs of people with various kinds of memory loss," says Executive Director Blair Blunda. The new space includes subtle color in the late-stage area to minimize overstimulation of those participants but bright colors elsewhere to stimulate participants with better cognitive thought. A wandering path with handrails gets participants walking and allows them to negotiate the center without having to remember the way.
And, after completing a federally funded project to document the positive effects of tai chi on Alzheimer's patients, "we have people here doing tai chi every day," says Blunda. The center also offers such services as a mobile hair salon and a visiting podiatrist. "We try to make life a little easier for the caregivers," she says. "That's one less appointment that they have to make."
At Fairfax's county-run facilities, the first of which opened in 1980, "We've really paid a lot of attention to the decor," says Shauna Severo, long-term care coordinator for the Fairfax County Health Department. "There are chandeliers, fireplaces, flowers. The staff do not wear uniforms because we don't want to give it that institutionalized feeling."
Locally, for such services, participants typically pay $55 to $90 per day, although with the help of Medicaid, private long-term-care insurance, veterans benefits, grants and sliding scale fees, many participants pay far less. In Fairfax County, daily rates range from $8 to $65, with the average participant paying $55 per day, says Severo. Fees are based on the elderly person's assets, rather than the caregiver's.
Of course, even with help, daily care "can be very expensive," says Rebecca Lewis's husband, Kevin, who now serves on the board of Fairfax Adult Day Health Care Associates, a not-for-profit that helps fund adult day services. In addition to the cost, "people have to make the adjustment to being a caregiver and working day health care service into their lives."
That challenge applies to the elderly as well as the caregiver, as District resident Lizann McLaughlin found when she first broached the idea of her mother, Dorothy, going to a day health center.
"The doctors had told me that people [with Alzheimer's] become apprehensive when there is a change in their surroundings. So it was new, and she hated it," recalls McLaughlin, who worked full time and lived in the same building, but not the same apartment, as her mother.
Over time, though, she adapted. Dorothy McLaughlin died in May at age 83, but her daughter credits adult day services with making her last years of life fulfilling. "We had a wonderful luxury of being able to be creative and she was really able to live independently," McLaughlin says.
Lewis says her mother has benefited in a similar way. "She's not getting any better, but she's happy and that's all that matters right now. She's living her life in dignity, and the health care center has a lot to do with that."