Centering On Care
Fundamentally different from the typical neighborhood senior center, adult day centers must comply with myriad regulations. In Maryland, they must provide medical care and employ an RN, LPN and social worker. Program assistants, who help with daily living needs, and nursing assistants fill out the regular staff, which also includes a program director and activities coordinator. Seniors who do not require medical supervision or who can drive themselves cannot qualify for services.
Centers provide a wide spectrum of medical services in both the type and level of care needed. There are some limitations, which are assessed on a case-by-case basis.
“We manage their diabetes and their hypertension,” said Mills. “I have people on tube feedings, colostomy care, catheter care, wound care; we pretty much do everything the doctor orders.”
Mills explained that because of routine health assessments that all centers are required to perform on clients, health changes are noticed quickly. This can help prevent a client from developing a more complicated health problem or experiencing a catastrophic illness. With most clients attending daily, or at least multiple times a week, this translates to regular, consistent oversight and care.
Most centers are open Monday through Friday from 7 a.m. to 5 p.m. Transportation is provided for many locations and included in their fee. The cost per day is between $80 and $90 on average, said Mills. Clients and their families not qualifying for state or federal coverage have the option to pay out of pocket or can apply for scholarships when available.
“Adult day is a well-kept secret and such a gem of a service. And it serves the client as well as their family,” said Mary Faith Ferretto, geriatric social worker, LCSW-C, C-ASWCM and owner of Ferretto Eldercare Consulting, Inc. “I can’t say enough about it, because it’s such good medicine for people, truly. It helps them stay well as long as possible. It gives them meaning and purpose.”
Although in existence for decades, the option of adult day centers still tends to be a lesser-known choice of care compared with nursing homes and in-home care, said Ferretto. “For those hours and those dollars, you’re getting skilled nursing, you’re having an RN oversee medications and communication with a doctor if that’s needed; they do weights and blood pressure on a regular basis, [clients] get a snack in the morning, a main meal and snack in the afternoon, activities nonstop all day, outings, exercise, music, dance — you name it.”
Ferretto speculated that even with their growth, adult day centers may find public awareness a challenge because of their size. A large nursing home facility that includes room for living quarters is more visible in a neighborhood, whereas an adult day center can be housed within a synagogue, in the basement of a building or even in a storefront space.
“It is also a change in the relationship for a retired couple to be separated,” even for hours each day, said Ferretto. “It’s not always comfortable. They feel they are doing this to their loved one instead of doing it for their loved one.”
In the beginning, she added, people may be reluctant to go to an adult day center because of the unfamiliar surroundings and unknown clients. But once they get into a routine, it’s like a day out on the town.
“And soon they’re setting their clothes out the night before,” said Ferretto, “and they have their friends, and it’s my ‘lunch bunch,’ it’s my senior center — it gets called a lot of things. Some people even call it their job because working is such an important role for them.”
Time to Adjust
Pikesville Adult Day Services, one of the two centers run by Levindale, is where Mary Lois Fisher’s 86-year-old husband, Harold, attends two days a week. His care is covered by the Veteran’s Administration, and he’s been at the center for about one year. With the couple’s children living out of town, his wife is the only caregiver.
The Pikesville center has a very large and bright open main room, a medical area and treatment room, a physical therapy area holding three recliner chairs, a crafts area, a whirlpool tub, a stand-up scale, a Hoyer lift assist, one hospital bed, multiple accessible restrooms and a conference room. There is a large-screen television and a tropical fish tank in the main area.
Fisher heard about adult day centers from her physician’s secretary after explaining that she needed rest and time to catch up on household duties and other personal necessities. But above all, it was important for her not to worry about Harold’s welfare.
“I really truly can’t [physically] handle him,” she said. “He can’t walk very well, and it’s hard for me to get him in and out of the house. It’s tough on me.”
Harold is not particularly enamored with attending the center twice a week, but said “I realize it gives her a break.” And, he added, the people and staff are nice.
Said his wife: “I think that for any woman or wife who is a caregiver, it’s an excellent place [to take your spouse] in order for you to get a couple days of rest.”
Marvin and Annette Wolfson have been married 57 years. Marvin, 80, is a retired jeweler. In retirement he taught poetry through the Osher Lifelong Learning Institute and to inner city teens through the AmeriCorps seniors program. He authored two books of poetry. He is now blind and walks gingerly but with confidence using a cane, and his sense of humor is evident in interactions with the staff. He’s been attending the Pikesville center twice a week for two years.
Marvin said he likes the nurses and other clients. From time to time he leads an organized event at the center where he tells stories and reads poems that have a moral or message.
“It incites discussion and gets other people to open up a little and talk about their problems,” he said.
“It gives me some free time, and that’s important,” Annette, 78, said of Marvin’s days in the center. “I can go to classes at Myerberg Senior Center. And I was just glad that he had some variety to his life and other people in his life.”
Lauri Malin, RN, BSN, is the nurse manager at Pikesville. She recommends that new clients allow themselves time to adjust to new surroundings and experiences. The center offers a free trial day to clients and their family members to help ensure it’s the right fit.
“We have a very eclectic group,” said Malin. “I think when someone walks into an adult day care they look around and say, ‘Oh, I don’t know if my family member will fit in,’ but you have a mix of 40 people who have different needs, and there is somebody who you’re going to blend with. You just have to find that little place.”
Malin said that many of the clients have been attending for years.
“That was the fascinating thing to me,” she said. “I came with no knowledge of how long clients stay, and as I became more familiar with the charts, I found that they were here for many years — 10, 15, 20 — and I was really amazed by that. … They love it here.”