Daytime Respite for the Elderly : Adult Care Centers Help Meet Needs of Less-Active Seniors

Luz Co slowly pedaled on a stationary bicycle one morning recently at the South Orange County Adult Day Health Care Center in San Clemente. Her face showed a grim determination.

A year ago, the 73-year-old Laguna Hills woman lost the use of her arms and legs following a stroke. When Co began coming to this San Clemente facility for the frail elderly earlier this year, she recalls that she was confined most of the time to a wheelchair.

Today, after 1 1/2 hours of daily therapy at the center over the past five months, Co can walk with the aid of a four-prong cane and feels she is on the road to recovery from other effects of her stroke.

Co is among the growing number of Orange County residents, usually age 60 or older, who are participating in so-called “adult day-care centers.”

The county’s 14 facilities are designed for less active elderly people who cannot be left unsupervised during the day; they are functionally impaired because of strokes, heart disease, hearing loss, poor sight and Alzheimer’s disease, according to South Orange County Center program director Julie Doyle.

Adult day-care center participants are not ill enough to join the county’s estimated 5,500 elderly in nursing homes. Their spouses or children leave them at these centers during the day and then take them home at night.

“Contrary to myth, surveys show that over 80% of the elderly turn to their families for help when they become sick or disabled,” said Marilyn Ditty, executive director of San Clemente Seniors, the nonprofit organization which operates South Orange County Adult Day Health Care Center.

Unable to Live Alone

“Frail elderly people generally are unable to live alone,” continued Ditty, immediate past president of the California Assn. for Adult Day Services, which lobbies on behalf of 70 adult day-care centers in the state.

“Often these seniors are placed in nursing homes simply because their children work and aren’t available to supervise them during the day; or their spouses aren’t able to provide the 24-hour-a-day care they frequently require.

“Adult day-care centers prevent this premature, medically unnecessary placement of seniors in nursing homes because they’re places where the elderly can receive supervised social and health care.”

Attesting to the benefits of adult day care, Jessie Lebowitz, who attends the South Orange County Adult Day Care Center, said, “I come here every day, and I love it.”

“The people are nice, and we do things that make us happy,” said the 81-year-old Mission Viejo resident. “I live with my daughter, who works. If it wasn’t for this place, I’d be spending my time alone at home. It’d drive me up the wall. I’d be talking to myself and counting things--and it wouldn’t be money.”

Co and Lebowitz are among the 20,000, or 11%, of Orange County’s frail residents over age 65 needing help with daily activities such as personal or home care, according to a study by St. Joseph Hospital in Orange, the most recent and comprehensive study available on adult day-care centers in Orange County.

There are two types of facilities: “health” and “social” day-care centers.

Medical Assistance

The so-called health or medical model, like the South Orange County Adult Day Care Health Center in San Clemente, offers medical assistance to clients, in addition to the services provided by social centers. There are four health centers in the county.

In the so-called social day-care centers, participants typically are provided with meals, transportation, entertainment, education and counseling. The majority of adult day-care centers in Orange County--10--are based on this social model.

Participants in health day-care centers like South Orange County, program director Doyle said, tend to be in their late 70s and have various mental or physical impairments. To treat these problems, health centers provide physical, occupational and speech therapy, in addition to social and recreational services for seniors.

Although the participant’s personal physician remains responsible for his patient, Doyle said, he provides the center’s consulting doctor with information necessary to ensure proper medical care.

A registered nurse monitors such general health factors as the participant’s blood pressure. The nurse also dispenses medication, changes dressings and instructs participants in the principles of self-care, Doyle added.

Counseling Available

Psychiatric and psychological counseling is available not only for participants but also for their families. A resident social worker will alert the seniors and their families to services and community agencies available for resolving personal or social problems in such areas as finance, law, shopping and housing.

A mid-morning snack and hot lunch are provided, taking into account special diets. Recreational activities include crafts, singing, group outings and armchair exercises.

(The professional staff is supplemented by volunteers.)

The nonprofit Consolidated Transportation Service Agency of Orange County provides transportation to and from the center for both ambulatory and wheelchair-bound persons, Doyle said.

Day-care centers for the elderly were launched in the United States in the early 1940s, but they didn’t become widespread until 1973 when federal funding for demonstration projects stimulated interest in the concept, according to St. Joseph Hospital human development director Mark Headland.

Health Center Needed

Headland recently completed a comprehensive study of adult day-care centers to determine whether it was feasible for the hospital to establish an adult health-care center. The study determined such a center was needed, and it will open next month in Laguna Hills.

(St. Joseph Hospital, along with the Feedback Foundation of Orange County, operates the VIP Adult Day Health Care Center in Santa Ana.)

Today, there are 800 programs serving 25,000 people nationwide, according to Headland. More than 350 of these adult day-care centers are located in California, according to state Department of Aging spokesman Gerald Wenker.

While there are just four health-care centers in the county, a county government study estimates that as many as another 280 such facilities may be needed in coming years to serve an estimated 8,700 elderly in the county.

The greatest need for both health and social centers exists in areas of the county with high concentrations of seniors, St. Joseph’s Headland said. Concentrations of the elderly are generally measured in two ways:

Those communities, according to the 1980 U.S. Census, with the largest portion of seniors as compared to the total city population are: Laguna Hills, 58%; Seal Beach, 40%; South Laguna, 26%; San Clemente, 20%; Laguna Beach, 18%, and Newport Beach, 17%.

Those communities, according to the 1980 U.S. Census, with the largest portion of seniors overall as compared to the entire county are: Anaheim, 11%, or 25,000; Santa Ana, 9%, or 21,000; Laguna Hills, 9%, or 20,000; Huntington Beach, 7%, or 15,000, and Garden Grove, 6%, or 14,000.

Emphasize Interaction

In contrast to the rehabilitation stressed by the county’s four health centers, the county’s 10 social facilities emphasize programs that allow seniors to interact with one another.

Social centers like Garden Grove Adult Day Care Center, according to assistant director Julie Duarte, provide hot breakfasts, lunches and snacks, as well as modified exercises; classes in ceramics, cooking, music and fine arts; travelogues, games and special events; entertainment, and local field trips and outings.

Limited health services such as blood pressure screenings and health education are provided by the staff of the Medical Center of Garden Grove, Duarte said.

A family support group shows ways to cope with the psychological and physical demands of caring for elderly relatives.

(Only four staffers are full time. The part-time staff of five is supplemented by 15 regular volunteers, Duarte said.)

On a recent morning visit to the Garden Grove facility, 13 participants sat playing bingo around three tables at the far end of a large activity room. In a smaller, adjacent room, about an equal number sat on sofas and chairs sharing pointers on home repairs.

Daily Exercise

After the bingo game and home repair discussion, the 29 participants assembled in the large activity room for their daily exercise session.

The more active seniors danced gleefully to the sounds of lively Mexican music emanating from the record player; their more physically or mentally impaired friends sat on couches clapping in unison to the tunes. Then they did stretching exercises, either on their feet on from their seats.

After this 20-minute workout, the seniors listened to a reading of that day’s “Dear Abby” column in the newspaper. A lively discussion followed.

An 80-year-old woman was asking Dear Abby for advice because her grandson’s wedding date conflicted with the funeral of her 76-year-old brother.

“I think she should attend her grandson’s wedding,” said one senior in echoing the others’ opinions. “A wedding is a celebration of the beginning of life. Her brother’s dead; he won’t know if she’s at his funeral or not. She can always pay her respects to him later at the graveyard.”

They then broke for lunch. In the afternoon there was a ceramics class, snack, a current events discussion, games in small groups and individual reading.

At Center Five Days a Week

John Malgeri, 62, a former real estate salesman from Garden Grove, began coming to the center two years ago following a stroke which left him largely confined to a wheelchair. He attends the center five days a week.

Malgeri, who is divorced, lives during the week with his 34-year-old son, who is a carpenter. He spends weekends in El Toro with his former wife “so my son can have a life of his own.”

“My son, who works, was concerned about leaving me alone during the day,” Malgeri said. “At home I can get around with a cane, but if I were to fall while I was there by myself, I’d be up the creek. Here, I can practice walking with my cane without worrying about falling because there’s someone here to watch me and catch me if I trip.

“There’s always something happening to keep our minds going--ceramics, arts, field trips. I guess my only regret is that I wish I was well enough to be a volunteer here; there’s just so many people who need the kind of help a place like this provides.”

While Malgeri comes to the Garden Grove center during the five days a week it is open, other participants come only a few days a week. Myrtle Schneider, 95, of Garden Grove comes three days a week.

Schneider has lived in Garden Grove since 1907 and has watched it “grow from a horse and buggy town, with dusty roads, to a city, with nice paved streets.” Her late husband Edmond Schneider operated “a general merchandise store on Main Street where Lloyds Bank (California) is now.”

Schneider, who lives with her daughter Winifred Gatarst, 72, and son-in-law Orval Gatarst, 74, began coming to the center three years ago. “They started going to this place for water therapy for their aches and pains from arthritis, and they were afraid to leave me alone,” explained Schneider, who herself is confined to a wheelchair because of advanced arthritis.

Schneider, a homemaker for most of her life, said, “I enjoy coming here very much. I feel comfortable here because it’s located in (the Garden Grove Methodist Church) where I’ve belonged for 75 years.

“I enjoy all the programs and getting acquainted with different people. Talking with them takes me back to my former days. All my old friends are gone; I’m making new friends here.”