Helping Those Who Help : CAPS Spells Relief for Care-Givers and Respite for the Infirm Elderly

For three months, Conni Siminski and her brother struggled to give their ailing mother the 24-hour-a-day care she needed.

Siminski gave up virtually all her other activities to spend every day caring for her 79-year-old mother, Edith McMillian, who was diagnosed as having Alzheimer’s disease or a similar disorder.

Relief from the daily ordeal came only in the evening, when Siminski’s brother, Jerry McMillian, would take their mother to his home for the night.

Siminski, the mother of three, said she began suffering severe headaches, had the flu three times in two months and developed a chronic backache that her doctor attributed to stress.

“Being in that suspended animation was just horrendous,” said the La Crescenta resident. “I needed some semblance of a normal life while still helping her.”

Relief came only after a friend told Siminski about the Community Assistance Program for Seniors (CAPS), an adult day-care center in Pasadena that offers care for stroke victims as well as patients with Alzheimer’s disease and other memory disorders.

The center’s primary purpose is to ease the burden on relatives so that elderly patients can live at home as long as possible.

“Our main goal is to prevent inappropriate institutionalization,” said Georgia Hale, CAPS program administrator.

Despite what health officials say is a growing need for such facilities, the CAPS program is one of only a few adult day-care centers in the San Gabriel Valley.

Similar programs are offered at the Pasadena Community Hospital Adult Day Care Center, the San Dimas Senior Day Care Center and the Casa Colina Adult Day Health Care in Pomona.

CAPS is open five days a week from 10 a.m. to 3 p.m. It offers treatment to people over 55 who are continent and medically stable. The program costs $30 to $42 a day, depending on the level of treatment.

Housed in a large classroom facility behind Trinity Presbyterian Church on East Sierra Madre Boulevard, the program is run by Fuller Theological Seminary’s School of Psychology as a training facility for graduate students. The program is open to people of all faiths.

The CAPS program grew out of one established in 1981 by The Psychological Center, run by the school of psychology, that focused on working with seniors in their homes. The need for an adult day-care center soon became apparent, and the CAPS program was established in 1983, said Paul Clement, director of The Psychological Center.

According to Donna Benton, clinical director of CAPS, “Studies show what gets people hospitalized is the stress on the care-givers.”

For Siminski and her brother, enrolling their mother in CAPS last April provided relief just in time.

“I know that I would have opted to put her in a nursing home if I thought I had to take care of her all the time,” Siminski said.

Although she plans to place her mother in a nursing home in Oklahoma, where her father lives, Siminski was able to delay the move for nine months because of CAPS.

“I haven’t been sick since she started at CAPS,” she said. “The only way we can cope is to have her there. . . . She gets lots of love and attention at CAPS.”

In addition to the benefits for those who care for the elderly, the CAPS program helps clients function at their optimum.

Mary K. Powers’ husband, Walter, spent two years as a CAPS client before he died of Alzheimer’s in 1985. Powers said that if it hadn’t been for CAPS, her husband might have had to go to a nursing home.

“I feel CAPS kept him ambulatory for a long time. It kept his mind focused on something, so he did more than just look at me and follow me around the house,” she said.

The CAPS staff uses a structured but flexible program to reach the wide variety of clients it serves, from the physically impaired to the mentally deteriorating.

“We’re real sensitive to use all the senses throughout the day,” Benton said.

On a recent morning, team leader Dennis Wallstrom talked to a group of about 20 clients. He used a microphone to guide the clients, some of them hard of hearing, through the day’s activities, including music, a current-events discussion, exercise and some role-playing therapy.

“(I) need to be always alert to who’s involved and what they are able to do, (to) try to draw in everybody,” Wallstrom said.

One effective activity is singing, something most mentally impaired clients can do. “For most people, music means memories, and that’s a lot of what we’re about here,” he said.

It is also a way staffers can get Tom Roberts to communicate. Roberts, who suffered a stroke, cannot speak, but he can sing because that activity is controlled by a different part of the brain.

Staff members also find newspapers a good means of triggering memories and keeping people informed.

“We use current events to reminisce . . . to show there is a continuity of life,” Benton said.

Clients are also invited to participate in a role-playing exercise called Sticky Situations, during which they imagine themselves in different settings and decide how to respond.

Daily Exercise

They may be asked what they would do if they received a gift they didn’t like or how would they deal with someone who talks non-stop to them at a party.

Clients also take part in daily exercises, which give them a sense of accomplishment and the feeling they can succeed.

“Exercise is something you do visually,” Benton said. “Even if they can’t hear you or understand you, they can see what you’re doing.”

Although 78% of its clients have chronic, mentally degenerative illnesses, the CAPS program also cares for mentally alert seniors suffering from strokes or other debilitating illnesses.

To provide those clients with a more stimulating environment, Wednesdays are devoted to more mentally challenging programs, including guest speakers, artistic self-expression and games such as Trivial Pursuit.

For Emanuel Lee, 70, partially paralyzed by a stroke, the Wednesday programs are a bright spot in his week, he said.

Exchange of Ideas

“It . . . helps me keep abreast of the times and allows me to exchange my ideas and feelings with a group of interesting and loving peers whose feelings and ideas stimulate me,” he said.

Occasionally staff members care for senior citizens who at first appear mentally impaired but are actually depressed.

According to administrator Hale, depression in the elderly often mimics Alzheimer’s disease, but the key difference is that depression is treatable.

“It is so exciting when I find someone treatable,” Hale said, explaining that after social interaction with others and individual therapy, a depressed person can completely recover.

One such success story involves 78-year-old Beatrice Margolis, who came to CAPS two years ago after she had lost her memory and become confused in her thinking.

Her problems began after she had two minor one-car accidents. “I blacked out,” she said. After the second accident, she woke up in a hospital.

Memory Problems

While there, although she had not suffered any serious head injury, Margolis began having problems with her memory and thinking processes.

As her confusion increased, she began to fear that she had Alzheimer’s disease. She sought help from a neurologist who diagnosed a memory block and told her about CAPS.

Hale said the depression was brought on partly because Margolis, a sociable person, relinquished her driver’s license after the second accident and could no longer get around easily or drive herself to visit her 58-year-old son, who is mentally retarded and in an institution.

Hale said Margolis’ concern about Alzheimer’s disease was an indication that she did not have it, since Alzheimer’s patients are usually unaware of their memory problems and unconcerned about their mental status.

Margolis responded quickly to individual therapy, and within a month her memory returned and her thinking cleared dramatically.

“I hold (CAPS) responsible for getting my thinking back,” said Margolis. “I was going to prove to the world, and myself mostly, that I was going to work through that.”

‘Love and Kindness’

She was taught to slow down when she became confused. “I (learned) to stop talking when I was floundering around, to listen and to not worry,” Margolis said. “A little love and kindness is the greatest way to get better.”

Following her speedy and successful recovery, Margolis made the unusual switch from client to weekly volunteer at CAPS.

“She is really good with people who are mentally impaired,” said Hale. “She’s particularly sensitive with people’s self-esteem.”

CAPS differs from other adult day-care centers because it is staffed primarily by interns who are graduate students at Fuller. Several are trained psychologists, working on their doctoral degrees, who complete part of their training through internships at the center.

The arrangement enables the center to get qualified professional staff without having to pay high salaries, Hale said.

“The economics of day care for seniors is very difficult,” Clement said. There is little state or federal assistance for adult day-care centers; insurance companies don’t cover such expenses, and neither does Medicare or Medi-Cal, he said.

To further cut costs, CAPS operates in rent-free rooms at the church. In addition, many members of the part-time medical staff work at reduced salaries or as on-call volunteers.

Counseling is also available from the students and the staff.

Helene Kaker, whose sister, Euginea Kaker, is a CAPS client, found that nine weeks of counseling helped her and her four sisters get a better perspective on the problems of caring for Euginea.

“I have become much more objective than emotional,” she said. “It all goes together (at CAPS). They are touching all bases, so it all comes together in a loving, supportive environment.”