Day Care Centers for the Old

By Claudia Wallis

Doctoring and dignity for the partly disabled

A year ago Charles Crandall, 73, was spending most of his days staring at the walls of his San Francisco apartment, subsisting on solitary meals eaten out of cans. Crippled by a childhood bout with polio and suffering from heart disease, he seemed destined for a nursing home. Had that been his fate, he says, "I don't think I would be living now." Instead, California social services agencies enrolled him in a new kind of program for the elderly that allowed him to continue living in his own home. Three days a week, from 10 a.m. to 3 in the afternoon, Crandall goes to a day care center for adults. There, nurses monitor his health, a physical therapist provides him with exercises, a nutritionist plans his lunch and friends keep him interested in the world. Together, says Crandall, "they give me the incentive to live."

Adult day care centers are, for a growing number of Americans, a happy solution to the problems posed by infirmity and old age. For people like Crandall, who are disabled but not in need of full-time nursing care, they fill the vital gap between neighborhood senior citizen centers, which are generally not equipped for the handicapped, and dreaded institutionalization. For families of the infirm elderly they offer welcome relief from the strain of providing full-time care for an ailing relative at home and from the guilt that often comes from banishing that person to a nursing home, perhaps prematurely. (An estimated 25% of nursing home residents do not need to be there.) "Our goal," says Jacqueline Falk, a day care administrator in Chicago, "is to keep people living in the community for as long as possible, with independence and dignity."

Though England has had "day hospitals" since the 1950s, they are a relatively recent innovation in the U.S. Adult day care centers grew out of disillusionment with nursing homes, many of which are known for rising costs, all but endless waiting lists and neglect of patients. In 1974 the Department of Health, Education and Welfare added an incentive by agreeing to channel Medicaid funds toward programs designed to take the place of nursing homes. Massachusetts, California and Georgia led the way. Within four years some 275 adult day care facilities had been established. Today there are about 800 such centers in 44 states and Puerto Rico.

The centers are diverse. Basically, there are two types: adult day "health" centers, where the focus is on providing medical services such as physical and speech therapy; and "social" day care centers, which stress social and recreational activities, though they too may have nurses and therapists on staff. Costs range from $11.82 a day, at one notably inexpensive center in Lincoln, Neb., to $50, with additional charges where transportation is provided. Patients typically spend two or three days a week in day care. Nursing homes, by contrast, charge an average $30 to $40 a day, some as much as $70--seven days a week.

Day care centers have been set up in converted nightclubs (the On Lok Senior Health Services in San Francisco) and in revamped American Legion posts (Post No. 426 in Yucaipa, Calif.), in church basements and converted warehouses. The services they provide are equally diverse. The Burke Rehabilitation Center in White Plains, N.Y., offers two highly specialized programs: one for elderly survivors of stroke, heart attack and other debilitating diseases ($26 a day plus $16 for ambulette service) and a second program for people with moderate to severe senility ($53 a day). Says John Panella, coordinator of both programs: "Many of these people have been rejected by standard senior centers." Notes Burke Director of Psychiatry Dr. James Haycox: "Demented patients form tight bonds, have good friendships. The program keeps them out of bed, dressed, groomed and responding to people."

Some centers accept adults of all ages. The Sister Kenny Institute in Minneapolis is willing to consider those 18 or older, mobile with the aid of just one person, mentally alert, able to feed themselves, continent of bowel and bladder. A number of centers specialize in patients who need rehabilitation rather than long-term care. Patients at the Georgia Infirmary, Inc., in Savannah, for example, attend therapy classes for seven to 14 weeks, at a cost ranging from $350 to $2,000 a month. Most have been disabled by strokes, arthritis, diabetes or neurological injuries, yet 70% "can live functionally independent lives," says Program Director Hunter Hurst Jr.

Almost all centers have to struggle to make ends meet. Most operate on a nonprofit basis and offer their service on a sliding fee scale according to ability to pay. Few private medical insurance companies will provide coverage, and with only a fraction of patients paying the full cost, the difference usually has to be patched together from a variety of sources, including private donations and United Way. Medicaid money, long a mainstay for nursing homes, is available for day care, but only for health-oriented facilities meeting stringent medical requirements. Some federal funds are also available under Title XX of the Social Security Act, but under the Reagan Administration, the total has been cut nearly 25%.

All this is especially worrisome to the old, to people like Laurette Dunthy, 73, of San Francisco. Partly paralyzed and confined to a wheelchair, she was at first reluctant to try a day care center at all. Soon she found she loved it, made close friends and even won an award for poetry. "It's like having a family all over again," she says. But her daughter Grace Ann Gaskill adds: "All along there has been this uncertainty. Every year they didn't know if they were going to be funded for the next."

--By Claudia Wallis. Reported by Barbara B. Dolan/New York and Carol Foote/San Francisco

With reporting by Barbara B. Dolan, Carol Foote

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