"Some of our people, if they didn't come here, would be in nursing homes, or they'd be home alone-lonely and depressed-and they's deteriorate mentally and physically," said Beverly Besley, director of the Mount Vernon Place geriatric day care center, 900 Massachussetts Ave. NW.

"An alternative to nursing homes is what this program is all about," added E. Josephine Manley, project director for the Downtown Cluster of geriatric day care centers, of which Mount Vernon is a part.

"By offering stimulating and interesting activities, by emphasizing rehabilitation, we can shorten or prevent institutionalization for the frail or physically or mentally disabled elderly people who come here. For their families, it means the family members can work or have free time to do things-caring for a frail, elderly person who may be confused or disabled can be a burden and the family needs support," Manley said.

During a day that typically runs from 10 a.m. to 3 p.m., the Mount Vernon center starts with a light snack. Then staff members take participants' blood pressures, hold a cuurent events discussion and conduct an occupational therapy activity, which is followed by a hot lunch. After lunch, participants play games, hold a checkers tournament, have an art class, go for a walk or do exercise or play shuffleboard.

On a recent Tuesday morning, 14 of the 46 elderly men and women enrolled in the Downtown Cluster's programs gathered in a brightly lit room that looked onto K Street. Billed as occupational therapy, the session had participants make tissue paper flowers to decorate a special lunch the following day.

A woman in a wheelchair who had a stroke and did not have full use of both arms was patiently working on a yellow flower. A staff aide held the folded tissue while the woman, with one hand, laboriously peeled the layers of tissue apart to create a flower effect. As the flower took form, a smile spread over her face.

"This is a very exciting and rewarding program because we see, right away, what we can do to help these people." Manley said.

Geriatric day care facilities in the District are operated by the city and by nonprofit groups. The care is free in some centers, and in others fees are based on the participant's ability to pay. Day care is one of the alternative services that can mean, for some elderly and frail people, the difference between life at home, or life in an institution.

Day care centers are the Area B Geriatric Day Care, 1125 Spring Rd. NW, 576-6509; Area C Geriatric Day Care, 461 H St. NW, 727-0438; Convalescent Day Care Center, 2800 Otis St. NE, 526-4100, extension 71; D.C. Village Multidisciplinary Geriatric Extension Program, 2 D.C. Village La. SW, 889-1700, extension 38; Downtown Clusters' Geriatric Day Care, 900 Massachusetts Ave. NW, 347-7527; Psychiatric Day Care, Barney Neighborhood House, 3118-16th St. NW, 232-1354. In addition, the Jewish Senior Day Program, 6121 Montrose Rd., Rockville, 468-1740, accepts persons living within a 45-minute drive of the home and provides transportation.

As is the case with nursing homes, alternative care is not plentiful, well developed or well financed. Choices are often limited.

Karyn Barquin, nursing ombudsman in the Office on Aging, said that "what we need, and what the Office on Aging is trying to establish, is a long term care service system for the vulnerable elderly which would provide services that are inadequate in the community or services that don't exist."

The core of the program, Barquin said, would be an assessment facility in which the overall needs of an elderly person would be reviewed by a social worker, physician and other health sepcialists who would then advise the most appropriate care.

"There isn't any proper assessment available now for District residents. A doctor fills out a medical form (to place an elderly person in a nursing home), but doctors aren't aware of the alternatives and they don't discuss them with the families or the elderly person," Barquin said.

The long term care service, which may be developed by the city on the site of the Lutheran Nursing Home would have some nursing home beds, community residence facilities where personal care would be provided, independent living facilities with some supervisory services, day care and respite care.

"Through day care and respite care, we would hope to encourage families to make a committment to care for an elderly person in their homes. Should the family want to go away on a vacation or on a business trip or whatever, they would know that we would be there for short term back-up care," Barquin said.

Some of the alternative services now available for the elderly in the District are:

Home health care: Agencies, such as Visiting Nurse Association or Consumer Health Services, provide skilled nursing care, physical, occupational and speech therapy and social work services. Fees vary but one agency charges $12 per hour for a visit by a registered nurse. Several agencies are certified to accept Medicare reimbursements or third-party insurance payments.Some, like Visiting Nurses, have a sliding scale of fees based on ability to pay. Agencies are listed in the telephone directory under Home Health Services.

Companion/homemaker/chore services: Several agencies provide trained companions, homemakers or aides to help elderly residents with activities such as light housekeeping, shopping, cooking or personal grooming. Fees vary but one agency charges between $5 and $6 per hour for homemaker visits. For those who are income-eligible, the social services division of the Department of Human Resources may be able to provide some in-home service. Private homemaker agencies are listed in the telephone directory under Home Health Services.

Home Delivered Meals: A wide variety of volunteer and community groups provide Meals-on-Wheels-a hot lunch and cold supper delivered to the home every weekday. Some programs include weekends. Most charge a sliding scale from zero to about $15 a week, based on ability to pay. For more information, call 434-1922 between 9 a.m. and 1 p.m. weekdays.

Adult day care: Like children's day care, adult day care provides supervision and planned activities intended to stimulate participants. Fees are between $15 and $20 a week.

For more information on alternative services, District residents should call the Office on Aging's Information and Referral section, 724-5626.

The National Council of Senior Citizens publishes a long term care directory, which lists nursing homes and alternative services in the District, suburban Maryland and Northern virginia. The booklet is $2.50 and available through the Council's Nursing Home Information Service, 1511 K St. NW Washington, D.C. 20005, or call 347-8800. CAPTION: Picture, Mary Lewis, right, of Homemaker Services, makes up a grocery list for Mrs. H.A. Ellerbe. By Craig Herndon-The Washington Post