PLATTSBURGH, NY – Sally White helps her husband of 46 years get dressed, fed and on the bus for the short ride from their home to the Senior Adult Day Center four mornings a week.
Preparing 74-year-old Rodger White to leave the house during the day can be a daunting task, as he has been in poor health for more than a decade and has severe memory loss.
“It’s like having a little kid,” said Sally White, 78. “This long goodbye is hell. I am exhausted. When he is older, I clean the house and try to do some chores.”
For thousands of older, white Americans, the Senior Adult Day Center and similar adult services provide safe, nurturing places for those who have physical or cognitive disabilities and provide respite for their caregivers.
William Zagorski, president of the National Adult Day Services Association, estimates that there are about 8,000 adult day services centers in the U.S., serving people with diverse needs who want to remain in their own homes. More than half of these centers serve seniors who need supervision and socialization opportunities.
After raising four children and retiring from teaching, each of the white men began studying for the ministry. During his studies, Rodger White suffered a brain bleed in 2013 and the memory problems he had been having for several years began to worsen. Sally White said his memory loss robbed her of the intellectually sharp, active man she knew and the life they planned as they grew old together.
To keep her husband in a safe environment while she takes care of household chores and takes a break from being a full-time caregiver, White enrolled him at the Senior Adult Day Center in January 2022.
“I can’t put a price on what this has done for us,” she said. “Rodger has a routine and a community there and I keep my sanity by paying the bills and keeping the house in good condition and tidy so it’s safe for him here.”
Adult day services are prevalent in areas across the country, especially in California, New England and southern states such as Tennessee, which has seen a 20% increase in these programs over the past 13 months, Zagorski said.
Meanwhile, Middle America and rural areas are struggling to staff or fill centers with clients.
Adult day programs cost less than $100 per day nationwide, which is cheaper than a nursing home. It’s one reason why Zagorski and organizations like the National Council on Aging are advocating for more support for day programs for seniors.
“Unfortunately, Medicare is not an option and that has been a barrier to their growth,” Zagorski said.
Medicaid covers about half of the revenue collected for these services in the US, and Veterans Affairs is increasingly supporting it, but about 15% of users still have to pay out of pocket.
That may represent only about 237,400 older Americans who participate in structured day programs, according to the Centers for Disease Control, although adults ages 65 and older make up 18% of the U.S. population.
Sally White said she struggles to pay about $2,200 a month for her husband to participate in the program, as the couple does not qualify for Medicaid. Because of her declining health, she is solely responsible for handling all the bills and the stress they bring.
Transportation also poses a problem in accessing day programs for seniors in rural areas like central Pennsylvania.
“In my experience over 36 years, adult day services are not a suitable concept for people here,” said Holly Kyle, director of the Area Agency on Aging, which serves Snyder and Union counties in Pennsylvania.
Since 1987, 13 adult day centers have opened and closed in the two counties, which Kyle attributed to a lack of mass public transportation, costs and inflexible schedules.
“Many families want services in the home, want to care for family members themselves, or even equate it to a child care setting,” she said.
Aging stigma may also play a role in the underutilization of adult day programs, said Georgia Goodman, director of Medicaid at LeadingAge, which represents more than 5,400 services for seniors.
“Many (older) people don’t seek services until they are in a crisis,” she said, adding that earlier access could offer more preventive care.
Marilyn Vargo, 79, of Milton, Pennsylvania, has been coming to VNA Caring Center in Shamokin since February. Vargo, who for years worked as an administrative assistant to several deans at Bucknell University, suffered a traumatic brain injury in a fall about five years ago and now has short-term memory loss and is unable to care for herself.
“It’s very difficult,” said her husband, Joe Vargo, 81.
Standing in the couple’s dining room filled with family photos and Christmas decorations he hasn’t yet taken down, Vargo said, “The VNA has helped in so many ways. She gets some socialization and really enjoys the bus rides. I often ask her what she did during the day, but she can’t tell me.”
VNA Caring Center is the only adult day services program for seniors with cognitive disabilities in the Susquehanna Valley. Full-day service, from 8:30am to 3:30pm on weekdays, costs $44, including meals. Although the center has capacity for 19 clients, only five clients are signed up, director Angela Loeper said.
Another major obstacle to expanding access to adult day services, Zagorski said, is the lack of public awareness and research into the benefits of the service, which he says helps reduce depression, loneliness and isolation.
There has been a national effort to rebrand the program as adult day services, rather than day care, and distinguish it from day care centers or senior centers.
“We are much more than dancing and dominoes,” said Zagorski. “We have fun and social activity is promoted, but we have cognitive-based activities, physical games and range of motion exercises. Food insecurity is a big issue for seniors and we provide nutrition. We help reduce falls and reduce medication errors because people are there. We are the best kept secret in long-term care. We provide a holistic level of care that allows people to stay healthy and with friends.”
At the VNA Caring Center, Loeper starts the day by reading the newspaper aloud.
“We recently read that Our Lady of Lourdes students will be performing ‘Finding Nemo,’” Loeper said as two patrons watched the animated film, hoping to see the school play.
Reading the newspaper is “vital to keep them engaged. It opens up memories,” Loeper said. The center is filled with tables where customers can work on puzzles, painting, and arts and crafts. It also has space for daily exercise.
MemoryLane Care Services in Toledo, Ohio, serves about 34 people a day despite having capacity for 50. Attendance has dropped since the center reopened after being closed for nine months during the COVID-19 pandemic, it said director Salli Bollin.
“It’s an underutilized service. Many family members and professionals don’t know it’s available or don’t think their family members will want to be here,” she said. “Most people hear about it through word of mouth, but that’s a tough marketing strategy.”
Bollin has worked at the center since 1998 and has served clients who have been coming several times a week for 16 years.
The Senior Adult Day Program is the only center of its kind in the area. It is open weekdays from 7am to 2pm at a cost of $20 per hour. Transportation is provided at an extra cost for customers within a 20-mile radius.
The center has been operating since the 1990s but has reduced its offerings since the pandemic, including no longer offering a daily meal, while continuing to offer activities to stimulate the mind and body and a weekly visit from clergy, said the director Nicholas Drown. The capacity is for 50 people, but only 15 are being served due to the difficulty of retaining staff.
“We have a waiting list of 45 to 50 people,” Drown said. “I get calls weekly.”
Staffing is a big challenge, the “pay is not that great” and the pandemic has dealt an additional blow, said Kathleen Camero, senior director of the Center for Healthy Aging at the National Council on Aging.
“We expect to see an increase in the need for adult day services due to the (rising) rates of Alzheimer’s and dementia and I wonder if we will be able to meet the demand if we don’t recruit and pay better,” she said. .
It’s a sentiment shared by Mary Michlovich, executive director of OPICA, an adult day service program in West Los Angeles, California.
“We need to raise awareness that more support is needed at all levels. We have this ancient tsunami heading our way,” Michlovich said. “Everyone lives longer and is diagnosed (with dementia-related problems) much younger. The need has exploded, but the financial support simply isn’t there.”
Joe Vargo said he is unable to meet the demands of owning the home where he and his wife have lived and raised three children since 1974. He is considering moving them into a nursing home soon.
Before Marilyn’s fall and brain injury, the Vargos never discussed how they would handle aging together if her health worsened.
“I often think about this,” he said. “We probably should have done that.”
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The percentage of the US population over the age of 65 continues to rise – and will continue to rise over the coming decades. Because nearly half of Americans over 65 will pay for some version of long-term health care, CNHI News and the Associated Press examined the state of long-term care in a series called The High Cost of Long-Term Care, analyzing everything from day care providers to adults in assisted living facilities to understanding the accessibility, staffing, and equity challenges that exist today and lie ahead.
This story originally appeared on ABCNews.go.com read the full story
