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Senior Day Care provides hope and respite

By From page A1 | March 20, 2013

The greatest generation suffers Alzheimer’s disease and other chronic maladies in unprecedented numbers. Caring for them places extraordinary demands on their families and the public health system.

The El Dorado County Senior Day Care Center provides treatment for chronically ill seniors, including those with Alzheimer’s and other forms of dementia, and allows them to live at home longer, relieving the family, insurance companies and, ultimately, the Medicare and Medicaid system of the cost of residential care while providing respite for their exhausted caregivers.

Research demonstrates that the socialization, physical activities and personal care provided in senior day care centers increases cognitive functioning and actually slows the progression of Alzheimer’s and other chronic diseases.

Senior day care is often mistakenly likened to day care for children. But there’s a huge difference. “We don’t babysit,” said Wanda Demarest, who runs the county Senior Day Care Center in Placerville. “We provide treatment for people suffering from dementia and other chronic diseases. This is a way to slow down these hideous diseases. It’s a last chance to make friends, to not feel isolated and alone, to love life again.”

The Day Center, as the staff calls it, is likewise thought of as an extension of the Senior Center, which is also located in the old Pioneer Hospital building on Spring Street in Placerville. But they are completely separate programs.

The Day Center is a fee-based treatment center for dementia, stroke, Parkinson’s, diabetes and other chronic diseases.

It’s not a medical facility. The center practices activity-based, social treatments which address physical, mental and emotional needs.

The benefits extend to the caregiver, whose health has been shown to decline along with those they care for.

Demarest has read the Alzheimer’s Association research and, more importantly, has witnessed the power of the activity-based treatments. She’s supervised the program since its inception.

The cost of Senior Day Care is currently subsidized by the county. Participants are considered members, and pay a sliding scale fee based on the level of care required and the number of days per week they attend.

The daily fee for most participants is $52. Those who attend more often pay $44. Those who require extra care pay $57.

Demarest recently addressed residents of the Four Seasons active adult community in El Dorado Hills, and told them she hopes to open a second center in El Dorado Hills before she retires.

That was music to the ears of Ellen, 80, whose husband Paul was diagnosed with Alzheimer’s disease six years ago, and later with vascular dementia. The disease has impacted Paul’s cognitive ability and short-term memory and made made Ellen a full-time caregiver.

Paul attends the Placerville center two days per week. A half-dozen or so other Four Seasons residents also attend. El Dorado Transit picks them up at 8 a.m. and returns them around 5 p.m., providing Ellen and the other caregivers some vital respite.

What does she do with the time off? “I turn off the TV, do some housecleaning and maybe meet some friends outside the house,” she said. “I also love just being home alone.”

Civic League members hope to expedite the opening of the El Dorado Hills Senior Day Care Center, which was largely complete as part of the Moni Gilmore Senior Center in 2006 but shelved before opening in 2008 due to the economic downturn.

The Placerville center had been operating at capacity for several years, but attendance dropped off with the economy, creating a funding shortfall but also providing openings for El Dorado Hills participants like Paul, who doesn’t seem to mind the bus ride.

Ellen attends monthly caregiver support meetings hosted by the Alzheimer’s Association, and considers herself fortunate. “Paul is very easy-going,” she said. “A lot of other caregivers I’ve met have far more difficult situations.”

She knows the bus drivers and trusts them to get her husband to and from Placerville safely, but thinks other caregivers, especially those with more difficult situations, are less likely to put their charges on a bus and have them 20 miles away all day.

They would be more likely to use a local day center than one in Placerville, she said.

The demands of caring for someone with dementia have been well documented. Caregivers struggle with their jobs, families and finances. They are prone to stress and depression, and are prone a range of stress-related health problems from stubborn skin rashes to hospital-borne viruses and chronic health problems.

The role is particularly onerous on spousal caregivers such as Ellen, who are older and less able to manage the physical demands of the role. Ellen insists she’s holding up well.

A widely cited 1999 study published in the Journal of the American Medical Association found that spousal caregivers had a 63 percent greater mortality risk than comparable non-caregivers.

The study followed 392 caregivers, 427 non-caregivers and their spouses, all aged 66 to 96 for four years.

Senior Day Care provides respite and advice to those caregivers. The county Area Agency on Aging also offers help through a Family Caregiver Support Program. For information call (530) 621-6151.

Living with a chronic health condition can be frightening for everyone, said Demarest. “We walk through it with them, and show them how much life there is to be lived after the diagnosis.”

Placerville Day Center
The Placerville Day Center opened its doors in 1989, and was recognized by the state 10 years later as a certified Alzheimer’s Day Resource Center, charged with:
• Preventing or delaying nursing home placements
• Maintaining participants’ physical and mental health
• Allowing persons with dementia to live at home
• Providing regular respite for caregivers

The Day Center is open weekdays from 8:30 a.m. to 4:30 p.m. Call for late pickup costs and arrangements. The Day Center is not a drop-in facility. Partial day participation is charged the full day rate.

Hot lunch and two snacks are served daily. Special diets can be accommodated.

El Dorado Transit busses provide curb-to-curb transportation from for an extra $6 round trip.

To participate, members must not be a danger to themselves or others. They should be ambulatory with assistance and able to bear their own weight.

A comprehensive input assessment is conducted with the family of each new member. The resulting plan of care is monitored and adjusted as needed.

Blood pressure, body weight, disease symptoms, strength, mobility and flexibility are all monitored and recorded regularly and reviewed by the nurse and the physical therapist.

Physical therapy is provided through group exercise classes designed to stimulate body and mind. Members play modified golf, volleyball, hockey, shuffleboard and bowl.

Members also get one-on-one time with a program aide to addresses specific goals in their care plan.

Members that suffer injuries or struggle with basic ambulation can get restorative assistance as part of the treatment plan.

“We know how to get them up and walking safely,” said Demarest. “No one has as strong an activity program as we do.”

The program aides also assist with medication and personal hygiene care, including incontinence.

Importantly, the staff establishes a bond with the members, constantly reinforcing their efforts.

Several members were in the crafts room with Program Aide Debbie Grzeczka last week, creating hand-painted Easter ceramics for their families.

“The way the staff here handles people is really quite incredible,” said member Aubrey.

Jean was putting the finishing touches on an Easter Bunny and volunteered, “If I weren’t here I’d be at home watching TV all day.”

As Demarest describes it, the isolation could be more dangerous to Jean than a front row seat at the Jerry Springer show. Isolation exacerbates the temporal confusion which is common in early-stage dementia, she explained, describing the confusion as a merging of past experience with the present situation.

The music, conversation, crafts and games keep members engaged in the moment.

The center hosts local musicians a couple of times a week. Pete Seeger would have approved of the folk strumming coming out of the activity room last week. Demarest approved of the broad smiles and hand clapping in the audience.

Field trips, dress-up days, special events and the ever-popular bingo are all in the mix.

The barrage of physical and mental stimulation slows the progression of dementia and improves physical condition. But it can be tiring at times.

In those moments, members are free to retire to an electric recliner in the dream room. But before long a program aide will arrive to hustle them off to a water-color class, a round of golf or a chair yoga class.

Members are ultimately stronger and less accident prone, according to Demarest. The psychological benefits are equally profound. Demarest can’t resist boasting.

The depression which often accompanies a chronic illness frequently disappears, she said, and anti-depressant usage often decreases.

The Mini Mental State Examination is administered regularly to measure cognitive impairment. The 50-question test provides a reliable measure of a member’s progress or decline. Scores routinely improve over time, said Demarest. “That’s with a disease that only goes the other way.”

Chronic diseases stabilize. “We’ve had people coming in here for 15 years,” she boasted. “Think about that … in this population.”

With few exceptions, new members enjoy the program. The hardest part, said Demarest, is getting them in the door. For starters, there’s the cost. The benefits are being achieved for far less than the cost of assisted living or in-home care, and at a fraction of the cost skilled nursing, yet are not covered by health insurance, Medicare or Medi-Cal.

Attendance at the Placerville center is a direct reflection of the local employment. Unemployed family members are often assigned the role of daytime caregiver.

“That member ultimately misses out on the treatment he needs,” said Demarest.

Fear of the unknown is an even larger deterrent. Demarest describes the fear new members face.

“Imagine that your world isn’t making sense sometimes … your past is starting to merge with your present and someone suggests you leave your home, where you are comfortable and you know your needs will be met … That’s pretty scary,” she said.

But once they try it most want to come back more often, said Cody Gregory, the care center office assistant.

Ellen Morissette understands. There’s little to stimulate her husband Tony at home. Conversation is limited.

But when he returns from Placerville, “He can’t always remember what he did, but he’s always energetic and in good spirits,” she said.

She’s considering upping his participation to three days a week.

Unlike Ellen, many caregivers are reluctant to admit they need help, even when they’re visibly burned out. “They feel like they’re letting their spouse or parent down, like they’re dumping them off on someone,” said Demarest.

She likens them to the plate spinners on the old El Sullivan show. After 30-plus years in the business, she can read the emotional state of an adult child when they walk in the door.

“They feel trapped. It’s a 7/24 job. Their physical, mental and emotional health is declining. They get so caught up in the role that they don’t see what it’s doing to them until after the journey is over,” Demarest continued. “It costs some of them their marriage.”

The Placerville center’s operating budget was $340,000 last year. At its 33-member capacity it turns a modest profit. But attendance has been down until recently, and Demarest said she worries about undertaking a second center when the first one has space available.

After two consecutive months at capacity, average attendance dropped to 27.3 in March.

The El Dorado Hills Care Center will be smaller than the Placerville facility. Capacity will be determined by the fire marshal and the state. Demarest expects it to serve between 22 and 26, but worries that it could be approved for as few as 20 members, which would lead to perpetual dependence on outside funding.

She argues that the Placerville center is currently meeting the need for senior day care in El Dorado Hills, and that it will be easier to find startup funding when the current facility is at full capacity.

“I’d like to open it tomorrow,” said Demarest at the Four Seasons clubhouse, “But we need a plan, backing and startup funding.”

She expects to have a business plan available for the El Dorado County Board of Supervisors within six months. Licensing is likely to take another six months or longer, she said.

Civic League President John Raslear wants to help. After Demarest’s presentation last week, Civic League members offered to fundraise and solicit equipment donations from local merchants, or even pitch in and do some of the remaining work to get the center open.

Tax deductible contributions can be made directly to the Senior Day Care Center Fund.
The El Dorado County Senior Day Care Center is located at 935A Spring St. in Placerville, and can be reached at (530) 621-6180.

Mike Roberts


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