Caregiver: Day Programs Help Seniors, Adult Children Cope

After Peggy Brown’s mother, Margaret Tourtelot, had a stroke five years ago, Brown had to give up her job as an electronics inspector to provide 24-hour-a-day care. Brown, who is divorced and whose children are grown, also gave up her apartment and moved into her mother’s home in Van Nuys. To get a few hours to herself, she hired her son’s girlfriend to care for her mother. Occasionally, she would leave Tourtelot alone for an hour or so to go grocery shopping.

“But that was it,” Brown said. “Otherwise I stayed with her.”

Her role as caregiver was draining, but Brown, 50, was determined to keep her mother at home. “My mother worked in convalescent homes when she was younger, and she didn’t want to have to go in one.”

Eventually, Tourtelot’s doctor recommended that Brown enroll her mother in the adult day health-care program at Jewish Valley Storefront, a social services agency in North Hollywood. “My mother wasn’t too sure at first, but she said she’d give it a try,” Brown said. “At home, all she did was stare at the four walls.”

Today, the 76-year-old Tourtelot attends the program five days a week, giving her a much-needed chance to get out in the world again and give her daughter an equally important respite from her role as caregiver.

“The program has given my mother something to talk about every day. She loves it,” said Brown, who now works as a baker in a North Hollywood school cafeteria. “She’s made friends, and every day when she comes home she tells me everything that happened that day.”

Adult day-care programs, which cater primarily to senior citizens, usually for five to six hours several times a week, are designed to keep participants as active as long as possible, delay the need for placement in a nursing home and give the caregivers some time to themselves. There are a half-dozen public programs in the San Fernando Valley area, some of which are open only to local residents. Most of the programs have vacancies.

According to program administrators, adult day care is a relatively new solution and many families do not even know that it is an option. “I think the reason we are not at full capacity is that not enough people know about us,” said Ruth Nebron, a social worker with the Jewish Valley Storefront’s adult day health-care program. “We are trying to make more families aware of us, mainly by contacting doctors.”

Physicians and administrators involved in Valley programs emphasize benefits both for parents and children. “Many of the adult children are two steps away from saying, ‘I can’t handle it anymore,’ ” said Kathi David, program director for the adult day health-care program at St. Joseph Medical Center in Burbank. “This program helps to delay, defer or eliminate the need to go into a convalescent home.”

And there are other benefits to adult day care: Tourtelot, like many other participants in the program, has her costs fully covered by Medi-Cal and her transportation is provided free by Valley Storefront. By way of comparison, convalescent homes run from $60 to $151 a day and private nurses cost $17 to $25 an hour. Non-professional care runs about $6 an hour, and that doesn’t include any therapy--such as occupational or speech therapy--that an elderly or ailing person might require. (Medi-Cal also covers Tourtelot’s therapy costs.)

“We think people should stay in a home setting as long as possible,” said Dr. Aviva Hoyer, a consultant with the Valley Storefront program. “We find that a lot of people come to the program really depressed, really down. One of the things we see, without any specific therapy for the depression, is that it lifts quite quickly.”

Participants in the adult day health-care are taught various coping skills. “Sometimes their mobility improves,” Hoyer said. “For instance, they learn how to transfer out of the wheelchair better when using the bathroom.”

Dr. Alfonzo Olsen, who has several patients participating in the program at St. Joseph Medical Center, said: “It allows older and debilitated people to stay at home without depleting the family’s resources and energies.”

There are two kinds of adult day care: adult day health care (participants must have a primary medical problem that requires therapy or monitoring) and social adult day care, which emphasizes socializing. To qualify for adult day health care, “it could be as simple as a diabetic who needs supervision with injections to the extreme of someone with multiple sclerosis or a stroke victim,” Nebron said.

There are 61 adult day health-care programs in the state, most of which are in Northern California. Of the 11 sites in Southern California, only two--Valley Storefront and St. Joseph--serve the Valley. Adult day health-care programs are regulated by the California Department of Aging, and staffing requirements include full-time therapists and nurses.

At social adult day-care programs, there are no health care professionals on staff. “Most participants are suffering from beginning dementia,” Morgan said. “Most typically, this is due to Alzheimer’s disease in its early stages and Parkinson’s disease.”

What follows is a rundown of the Valley’s adult day-care offerings. The first two listings are adult day health care; the remainder are social adult day-care programs.

Valley Storefront Multipurpose Center for Seniors (12821 Victory Blvd., North Hollywood, 818-984-1380). This program was started three years ago and is licensed to take 49 participants. The average daily attendance is 40. Half the participants attend five days a week; the rest, three or four days a week. The service area is all of the Valley except Burbank. About 80% of the participants are on Medi-Cal. The rest pay on a sliding-scale basis; the highest fee is $55 per day. Anyone over age 18 is eligible, but the majority in the program are over 65.

Most participants use the center’s buses or VALTRANS (a service that provides free or low-cost transportation). The program begins at 9:30 a.m. with snacks, followed by group exercises, bingo, music or crafts project. The staff organizes activities such as crossword puzzles and word games before lunch. In the afternoon, there is time for games before the 2:30 p.m. closing. During the day, participants may be taken to physical, speech and occupational therapy sessions.

St. Joseph Medical Center Adult Day Health Care Program (3413 Pacific Ave., Burbank, 818-953-4455). Licensed to accommodate 50, the program averages 25 participants a day. Hours are 9 a.m. to 3 p.m. weekdays. The program serves residents of Burbank, Glendale and the East Valley, and transportation is available through VALTRANS and Burbank Senior Services. Half the participants are on Medi-Cal. The cost to others is $43 a day.

Participants typically watch TV until 9:30 a.m., when there is a snack followed by a discussion of current events. This is followed by chair exercises and arts and crafts. After a hot lunch, there are sing-alongs and sometimes more crafts and a snack. Separate women’s and men’s support groups are held once a week, and the staff shows a movie once a month. Participants receive physical, speech and occupational therapy according to individual assessments. There is a weekly support group for caregivers.

Alternative Care Experience (ACE) at Valley Senior Service and Resource Center (18255 Victory Blvd., Reseda, 818-705-2345). This social adult day-care program has been open eight years, accepting seniors, 60 and older, with Alzheimer’s, Parkinson’s, or other forms of dementia “up until there are behavioral or incontinence problems,” Morgan said. Participants meet two days a week, either Tuesday and Thursday, or Wednesday and Friday, from 9:30 a.m. to 3 p.m., in a group of 10 (there is a waiting list). The service area is all of the Valley, but the free program, funded by the L.A. City Community Development Department, is open to low and moderate-income families only.

Most activities are run by volunteers, with as many as eight to 10 helping each day, many of them seniors themselves. A typical day begins with a snack and a volunteer reading the newspaper to participants. The arts and crafts activities are focused on making items for the center’s fund-raisers. After a hot lunch, there is time for a walk or light exercises. Most afternoons feature entertainment or a sing-along; sometimes the staff shows a movie or offers bingo. The support group for caregivers is mandatory and takes place biweekly.

Bernardi Multipurpose Center for Seniors (6514 Sylmar Ave., Van Nuys, 818-781-1101). The program is open Monday through Thursday, from 10 a.m. to 2 p.m., to adult residents of the mid-Valley who are diagnosed as having some form of dementia. The daily fee on a sliding scale is $15-$25. Regular activities include crafts, exercises, current events discussions, sing-alongs, walks and field trips. On most days, there are 10 to 12 participants. A hot lunch is served.

East Valley Multipurpose Senior Center (5000 Colfax Ave., North Hollywood, 818-766-5165). Doors are open Monday, Wednesday and Thursday from 10 a.m. to 2 p.m. Participants must be at least 60 and attend all three days. There are now 10 in the program, which is run on a donation basis. The rest of the funding is provided by the Los Angeles City Department of Aging. Space is available for five more people. The service area is the East Valley and families must provide transportation.

The program is run primarily by volunteers, who lead the group in a schedule of crafts, mental stimulation exercises, passive exercises and music appreciation. A hot lunch is provided.

Fitzgerald House (592 E. Hillcrest Ave., Thousand Oaks, 805-497-0159). This program is licensed for 20 participants with 12 to 15 in attendance most days. Most attend two or three days a week. Many are physically handicapped, but the site cannot accommodate wheelchairs. The minimum age is 60. Eligibility is limited to the Conejo Valley. The five-day program, open from 9 a.m. to 3 p.m., is run on a donation basis. Transportation is available through Dial-A-Ride in Thousand Oaks or provided by the participant’s family.

Daily activities include crafts, chair exercises, sing-alongs, occasional movies and afternoon entertainments.