At Cedar Acres, the day begins with homemade muffles and coffee. A staff member reads the newspaper aloud and urges the seniors to talk about current events. “The favorite part of the paper is Ann Landers–it sparks a lot of interesting discussions,” says director Lois Oliver. Set in a Victorian farmhouse, the center gets visits from friendly livestock. There are pine cones to collect for craft projects, and exercise games in the yard. Hoisting a colorful parachute gives the elderly clients a full range of motion on stiffened joints. A hot lunch is served. The men sometimes do yardwork. “We keep ourselves busy,” says Dick, a retired machinist who can still handle some questions. Does the program make him feel like a child again? “I spent enough time working for Uncle Sam that [nothing] bothers me anymore,” he says.
The idea of adult day care is catching on all across America. The number of centers has grown from a handful in the early 1970s to more than 2,100 today. The programs are in the vanguard of efforts to keep elderly people out of nursing homes and in their homes and communities as long as possible. Most are run by nonprofit organizations such as churches or senior centers; increasingly, hospitals and nursing homes are starting day-care programs. In August ElderCare, Inc., plans to open the first of 12 for-profit adult day-care centers in Texas; eventually it hopes to go nationwide. President Earl Fitzgerald is a former executive of Kinder-Care, Inc., the national chain of child-care centers. “We’re planning to do ElderCare the same way,” he says.
Many of the centers provide transportation, and some have medical personnel on staff. Most are open from early morning to midafternoon; a few even offer overnight and weekend services. As such, they provide needed respite for family caregivers– allowing them to work, run errands or spend time with their children. And at an average cost to patients of $37 a day, the programs are “a real bargain–less than the cost of one nursing visit to your home,” says Rick Zawadski, principal investigator for the National Adult Day Care Census, recently completed for the federal Health Care Financing Administration. (Most nursing homes charge more than $100 a day.) For the aged participants, the centers offer structure, stimulation, social life and a chance for new self-esteem. “We have [grown] children bringing in their mother, saying, ‘She can’t do this anymore, she can’t do that’,” says Oliver. “Within a day or two she’ll be in the kitchen making muffins and feeling very good about herself.”
Fenced paths: A few centers will not take clients who are incontinent or disruptive. Some offer a variety of programs, depending on the level of care patients need. But most accept at least some people with dementia, and some are specifically designed to serve them. At the Elderday Alzheimer’s Care Center in Santa Cruz, Calif., the lighting, color scheme, furniture and background music were all chosen to minimize agitation. There are fenced paths for patients who feel compelled to wander; an alarm goes off, however, if someone exits through the door. The Robert Wood Johnson Foundation is giving $4.45 million in grants to 17 dementia day-care centers. Dr. Burton Reifler of Bowman Gray School of Medicine, who oversees the grants, says some centers can even handle combative patients. “As we get more experience,” he says, “we may find that adult day-care programs can handle all stages of dementia.”
Alzheimer’s experts say the extra stimulation of a day center seems to help stave off some mental deterioration in patients. If nothing else, they are enjoying themselves more than they would at home. At the Santa Cruz center, one woman, Loretta, swore she came everyday in a buckboard. When activities director Roxane Siddens explained about the LiftLine van, Loretta said: “Honey, I know that. Please let me have this.”
To date, there have been scant reports of abuses. Unlike board-and-care homes, the day centers stay in close contact with family members, many of whom deliver and pick up their aged relatives each day. Some centers, in fact, most closely resemble summer camp. At St. Elizabeth Senior Day Care Center in Pompano Beach, Fla., director Ina Koenig occasionally makes popcorn and rents “Cocoon” or other videos. Other than that, the 52 seniors are so busy with bingo, volleyball, trivia games, picnics, lectures, spelling bees and daily live entertainment that the bigscreen TV is rarely turned on. Once a month, the seniors gather with local preschoolers for activities like barbecues or finger painting with colored shaving cream. “It’s an unwritten love agreement,” says Koenig. “The little ones–their parents have to work, so they’re not here to give them warmth. The seniors are in the same situation, so we bring them together to fulfill the needs of both.”
A few centers have a more formal relationship with kids. The Stride-Rite Corp. in Cambridge, Mass., which opened the first on-site corporate child-care center in 1971, expanded this winter to serve both those under 6 and over 60. Since some patients relate better to animals than to other humans, a few centers employ “pet therapy.” Sasha, a black Labrador, and Trevor, a golden retriever, have the run of the Elderday Adult Day Health Care Center in Santa Cruz. The center also has a shower. “It’s easier sometimes to have a nurse tell you to take a shower than your wife,” says founder Majel Jordan. Unlike many understaffed nursing homes, most day centers draw liberally on the services of volunteers. Local beauticians run a free beauty parlor at The Weinstein Center for Adult Day Services in suburban Atlanta. Almost all feature exercise programs. “Legs, stumps, move it all!” exhorts recreation specialist Denise Steele at the Northwest Focal Point Senior Center in Margate, Fla. “She makes them laugh, and that’s what it’s all about,” says adult-day-care coordinator Karla Machacek.
Lack of awareness: For all the benefits of adult day programs, many centers are struggling to attract customers. One problem is simple lack of awareness.* “A lot of people think of day care and they think of children–they think, ‘That’s not for my mother’,” says Betty Ransom of the National Institute for Adult Daycare, part of the National Council on the Aging. Physicians have been surprisingly slow to refer patients to such programs. And some family members are reluctant to seek respite- even for a few hours or days a week. “The caretakers feel they’re failures if they can’t manage their spouse or father or mother,” says Kathleen Terlau, director of the OPICA Senior Day Center in West Los Angeles. “It takes them a long time to recognize they need some help and to let go.”
Some older people themselves are wary of joining day programs=especially if they feel weak or incapacitated. But most change their minds once they sample the activities. “This place saved my life,” says Camille Occhipinti, 93, who has made herself indispensable at St. Elizabeth in Pompano Beach, helping the less able to eat lunch and get to the bathroom. “We call her ’the Mayor’,” says Koenig. Idleness is the worst thing that can happen to an old person, says Occhipinti. “Here, there are always activities. It takes my mind away from myself.”
The biggest problem most centers face is financial. More than half the programs are operating at a deficit, says Zawadski; 15 to 20 percent have closed because they could not pay their bills. Fees do not cover costs, so most centers rely on private charity, foundation grants, funds from the United Way or a combination. “It’s a house of cards,” says Jordan of the Elderday Alzheimer’s center, which gets funds from the Robert Wood Johnson Foundation, the federal Administration on Aging, state bonds obtained through the county and MediCal, the California Medicaid system. “If any one piece fell out, we’d be in trouble.”
In some states Medicaid will cover fees for elderly people who meet income requirements. And most centers charge on a sliding scale, based on ability to pay. Still, “it’s the middle-income group that can’t afford to participate,” says Ransom. Attending five days a week can cost $700 or more a month–far more than some socialsecurity checks. Some long-term-care insurance providers are considering covering adult day-care expenses. Several bills in Congress would expand Medicare to include such programs. But prospects for passage anytime soon are bleak. “This is not a very expansive time,” says Zawadski.
‘Country club’: ElderCare, inc., meanwhile, is convinced there is a strong market for day care among affluent seniors. Officials describe the atmosphere at the centers as more like a “country club” than a nursing home. “Members” will be charged $40 a day–no discounts. ElderCare is also counting on economies of scale. The first facility can serve up to 75 people, while most nonprofit centers average only about 20. ElderCare has amassed about $450,000 from outside investors–and officials plan to go public within three years. Can they succeed where the nonprofits haven’t? “Most adult day-care centers are run by social workers and they’re wonderful, caring people, but they’re not business people,” says ElderCare chairman Bryant Jensen. To those who fear that the franchise concept (Kentucky Fried Parents?) might lose the altruism that marks the nonprofit centers, Jensen says: “Profit and caring are synonymous.”
Whatever the means of financing, adult day programs seem certain to grow more popular as the population ages, people live longer and family caregivers face ever greater demands on their time. “I think that by the early 21st century, adult day care will be just as accepted as day care for children is now,” says Reifier. Most participants agree: “I look forward to being here,” says Ethel Greenwald, 76, a blind, wheelchairbound retired schoolteacher who attends the OPICA center once a week. “Some people are perfectly satisfied to sit home and do their rocking. But this is a wonderful place to come.”
title: “A Home Away From Home” ShowToc: true date: “2022-12-12” author: “Robert Lara”
The concept has long been popular with business travelers who have to spend months in a foreign city. Serviced apartments generally come with several rooms, a fully equipped kitchen, a private entrance and the option to entertain. “There’s something a bit depressing about hotels and all that elevator music,” says Vincent-Gave. “It’s nice to come back to a place that feels like your apartment.” Now serviced-apartment facilities are upgrading their packages to compete with long-stay rates offered by traditional hotels, in an effort to appeal to shorter-term travelers. The blocks of shabby apartments with token weekly maid service are giving way to smaller, more intimate establishments with an emphasis on contemporary design and serious service.
Take the newly opened Hong Kong JIA–“home” in Mandarin–designed by Philippe Starck. The one-bedroom apartments measure 72 square meters, with work, living and dining spaces separated by sheer curtains. The fully equipped kitchen is concealed behind sliding screens. Guests can either prepare meals there (with in-room delivery of gourmet groceries), order from the 24-hour room-service menu or dine at the hotel’s restaurant, Grain. The monthly rate of $2,565 is less than half the cost of the same stay in a one-bedroom suite at a four-star hotel like the Excelsior.
Conventional chain hotels are changing to keep up with the trend. In the past few years Ritz-Carlton hotels have started transforming whole floors of rooms to luxury long-stay apartments. Marion Schumacher, the chain’s European PR director, says business guests don’t want the hassle of finding their own place when they move to a new city for a short- or medium-term stay. At the 44-story Hotel Arts Barcelona, guests in the duplex apartments on the upper floors have their own private reception area and 24-hour butler. The vast, airy living spaces are filled with contemporary Catalan art and panoramic views of the Mediterranean, while the ground floor features a swank lounge for business meetings or entertaining. (Daily rate from $972, monthly from $23,699).
Some facilities are courting families with young children. The Treetops Executive Residences in Singapore has 24-hour guest services and broadband Internet access plus hardwood floors, baby-sitting and a children’s playground. (Daily rate from $184, monthly rate from $4,144.)
For business travelers who visit a city regularly for short bursts, London’s new Guesthouse West in Notting Hill might be the answer. You actually buy the hotel room, use it for up to 52 nights a year, and rent it for the rest (going half-and-half with the hotel’s management).
Other frequent travelers to London prefer 51 Buckingham Gate, situated between 10 Downing Street and Buckingham Palace. It offers three courtyard townhouses with spacious apartments, each with its own front door and a personal butler. Unsurprisingly, no one wants to leave: the average stay is 25 days. (Daily rate from $572, monthly rate from $9,078.)
