The other day care dilemma

There are days when Doris Parker wants to throw up her hands in frustration and run screaming into the street.

Between a full-time job at the Social Security Administration and tending to her elderly parents who need round-the-clock care, Parker, 57, recognized long ago that she needed help during the day if she was going to keep both parents living in her Baltimore home.

“My father was diagnosed with Alzheimer’s six years ago, and my mother has slight dementia,” Parker says. “It’s kind of important that I have peace of mind about where they are and how they are doing while I’m working.”

Parker’s problem is one that challenges an increasing number of caregivers nationwide as the population ages. About 22.4 million households, nearly one in four, provide care to an elderly relative or friend 50 or older, according to the National Alliance for Caregiving and AARP.

Many caregivers must stop working to stay home with elderly loved ones. Others hire medical professionals to visit the home. Many end up sending their loved ones to assisted-living facilities or nursing homes. Parker’s solution was one that probably will become much more common in the future: adult day care.

For five days a week, her 93-year-old father, Robert Farmer, and her 94-year-old mother, Mary, join a couple dozen other elderly people at Levindale Adult Day Services near Sinai Hospital. They go shopping, make food, play bingo, picnic and work on arts and crafts. On a recent Friday, Robert Farmer was involved in making cupcakes while his wife dug deeply into some soil to plant purple and yellow pansies.

Adult day care has allowed Parker to continue working while keeping her parents at home. And it has provided her parents with a place to socialize, keep active and get proper assistance from medical professionals.

“I couldn’t find a better place to be,” Robert Farmer says. “It’s wonderful.”

The challenge for many caregivers is to help elderly loved ones cope with what can be a difficult transition from living an independent life to one in which they eventually will need 24-hour care. More than 3,500 adult day-care centers operating across the country are trying to fulfill that need.

“Adult day-care centers are new for a growing number of families who are finding themselves in this situation,” says Joy Loverde, author of “The Complete Eldercare Planner,” published in 2000. “People are living longer and their care is getting more complicated. When we as family members are forced to juggle our jobs, our families and our personal commitments, we need to begin to look for resources outside of our family unit.

“Adult day-care centers make a lot of sense,” Loverde says. “It avoids the guilt associated with putting a parent into a facility of some kind and it helps prevent social isolation and mental deterioration in elderly people. This is a wonderful compromise.”

But there is a shortage of such centers. About 8,520 more adult day-care centers are needed nationwide, according to the Washington, D.C.-based National Adult Day Services Assn.

And those numbers will rise as baby boomers age. It’s estimated that there will be 70 million people 50 or older by 2030, more than twice the number in 2000, according to the U.S. Department of Health and Human Services.

“It’s become widely recognized that elderly people need to get out of the home and interact with others because it increases their quality of life,” says Linda Velgouse, director for home and community-based services in the American Assn. of Homes and Services for the Aging in Washington, D.C. “Most adult day services work with not just the elderly family member, but the rest of the family, too. They develop a plan of care with the entire family in mind so that improves the participant’s life and the caregiver’s life. It allows caregivers to live their lives too.”

Adult day-care centers usually provide services such as transportation, activities, exercise, rehabilitation, meals and snacks, as well as assistance in the bathroom and other personal needs. Licensed centers usually have a nurse and social worker on site.

Many centers also provide counseling for the caregiver, or the family as a whole, to help them deal with the stress and frustration of caring for an elderly loved one.

Typically, average daily costs for adult day-care centers run $60 to $80. A few insurance companies, the Department of Veterans Affairs and Medicaid will cover some patients who qualify for nursing home care, and some adult day-care centers also offer financial grants for those who need assistance.

“If you’re paying for this out of pocket, it can be expensive,” Velgouse says. “Reimbursement from insurance companies or Medicaid is almost always under what it actually costs to provide the service. We’re working to get more funding for people because it’s recognized that these centers provide an immense value.

“They help keep people in the community longer,” Velgouse says. “Most people don’t want to be in an institution if they don’t have to. These centers help increase the quality of life for the elderly and decrease the steep, increasing cost of long-term quality care.”

Families should look for centers tailored to their needs, experts say. Some adult day care focuses solely on the psychiatric or physical needs of participants. Some will tend to both. For instance, some are devoted to patients with some level of dementia. Some focus on rehabilitating patients from a physical ailment, such as a stroke or injury.

Willie Mae Cherry credits Levindale with helping her get back on her feet quickly after her stroke in January 2004. She began attending adult day care in a wheelchair in March and was up and walking again by June. Recently, she was pulling clumps of moist soil up to plant pansies along with Mary Farmer.

“I love it,” says Cherry, 78, who lives with her daughter in Randallstown, Md. “When I stay home, I often don’t feel very good. Here, they are so focused on me. They just help me and encourage me. It kept my mind focused on getting better.”

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Finding and choosing a center

* To find centers in your area, ask your doctor, check phone directories, contact your local senior center or agency on aging.

* Call and ask for brochures or fliers, eligibility criteria, menus and application procedures.

* Check for license or certification, hours of operation, cost, staff credentials, patient-to-staff ratio, years of operation. Inquire about financial assistance.

* Visit two or more centers.

* Keep a checklist during the visit. Did you feel welcomed? Did someone spend time to explain the services and activities? Did they present information about staffing, procedures and costs? Was the facility clean and odor-free? Was the center wheelchair-accessible? Was there a quiet place and comfortable, sturdy furniture for relaxation? Was there a place to isolate sick patients? Are participants involved in planning activities?

* Determine if the center provides a safe, secure environment; social activities; therapy; assistance with walking, taking medicine, using the bathroom, monitoring health; nutritious meals and snacks; physical and mental exercise; support for the caregiver; transportation.

* Check references, and try the center for three to five days before making a final decision.

Source: National Adult Day Services Assn.