‘It Gives People Options’ : Adult Day Care Aids Those Caring for Elderly

SCRANTON, Pa. —  Michael Chickillo has lost weight and developed high blood pressure as his wife’s Alzheimer’s disease has progressed to the point where she often forgets what she had for lunch by the middle of the afternoon.

“I told the doctor I’d give my right arm to make it stop,” Chickillo said recently, choking back tears.

To give himself time for chores around his home in this northeastern Pennsylvania city, Chickillo has joined the growing number of Americans who turn to day-care services for adult family members.

Health officials say that such care is less expensive than a nursing home and keeps the elderly at home longer. They said it also provides a respite for people like Chickillo, who must keep a constant watch on his wife, Lena, when she is home.

A Growing Industry

There are 1,700 adult day-care centers in the United States, serving more than 50,000 people--nearly three times the number of centers that were open in 1980, authorities say.

Such centers now operate in all 50 states and the District of Columbia, said Dorothy Howe, program coordinator for the National Institute on Adult Daycare.

“It’s across the country, but it’s still quite small,” Howe said of the industry.

Cherry Hospital in Goldsboro, N.C., was a pioneer in the service in 1969, when it recruited an English physician to start a gerontology program.

Dr. Lionel Z. Cosin, who taught at Oxford University’s medical school, began a day-care center for patients in the hospital 50 miles east of Raleigh, said Lulu Jolliff, an administrator who worked with Cosin. Cosin had opened a number of the centers in England.

About 2.2 million people care for a spouse or relative who has a problem with at least one aspect of daily routine, such as bathing, dressing or eating, said Lynn Osterkamp, editor of Parent Care, a national newsletter.

About 5.8 million of the 29.2 million Americans 65 or older are living in nursing homes, she said, and health officials say an aging population is one reason adult day care will continue to gain clients.

Aging Population Bulge

(By 2030, 65 million Americans will be 65 or older, according to an estimate by the American Assn. of Retired Persons.)

Three days a week, Chickillo drives his 75-year-old wife to Community Day Services in Scranton, where she joins about 30 other elderly people who are unable to care for themselves.

There they watch television, sing songs, play games and get physical, speech and occupational therapy under the supervision of a staff that includes two full-time nurses.

“We try to make it as much like a senior center as possible,” said Janet Ann Melnick, who runs the 4-year-old center.

On a recent afternoon, Kathy Herne, a volunteer, strummed “Harvest Moon” and “Singing in the Rain” on a guitar while half a dozen elderly men and women sat in front of her clapping, singing or just listening. At one point, two women danced together on the tile floor.

Helga Hartman, who suffers from diabetes and walks with difficulty, sat at a table toward the back of the room and worked on a puzzle. Others sat silently at different tables.

Left Out of Medicare

Howe and day-care administrators said the number of centers will increase even though their fees are not covered by Medicare.

“There are a number that have to get out of the business simply because of funding,” Howe said.

Bills pending in the U.S. House and Senate would extend Medicare coverage to adult day care. Low-income people are eligible for Medicaid for adult day-care expenses in 25 states, but not in Pennsylvania, Howe said.

The state has budgeted $5.2 million through county agencies to subsidize day-care costs at the 118 state centers, said John Holloway, who is in charge of adult day care for the state Department of Aging.

Adult day-care costs an average of about $28 a day, less than half the cost of a nursing home, authorities say.

“It gives people options where, before we had the centers, they didn’t have those options,” said Mary Ann Outwater, executive director of Windsor House Adult Day Care in Cambridge, Mass.

Corporations are beginning to pay attention to the growing need for adult day care.

Employer Referral Offer

Hallmark Cards Inc., based in Kansas City, Mo., in 1986 began offering its employees free referral service to day care and other health services for their children, elderly parents or disabled family members.

Meg Townsend, a company spokesman, cited the problems of the two-job couple with dependent elders at home.

“There’s just not as much time to address family concerns, but they’re as important as ever,” she said.

Stride Rite Corp. of Cambridge, Mass., is considering expanding its two subsidized nurseries to accommodate elderly dependents as well.

A survey of personnel at the company found that 25% of employees were taking care of an elderly relative and 13% more expected to be doing so in the next five years, said Amy Derbedrosian of Stride Rite.

Some nursing homes have responded to the demand by offering adult day care. A 1985 survey of 847 centers nationwide found that 22% of them were operating in nursing homes, Howe said. Churches ran 18% of the centers; 12% were at senior centers, 7% at community centers and 5% at hospitals, the survey showed.

States Set Standards

Howe said 40 states and the District of Columbia have developed standards for such operations.

Elderly people suffering from Alzheimer’s disease or other forms of cognitive impairment make up a majority of adult day-care clients, authorities say.

A 1987 survey conducted by the Pennsylvania Adult Day Care Assn. found that two-thirds of those who use day-care centers in the state fit this category, said Barbara K. Visconti, president of the organization.

In Pittsburgh, Council Care Adult Day Care designed one of its three centers just for people with Alzheimer’s, an irreversible neurological disorder that afflicts 2.5 million Americans.

Ruth Kaplan, executive director of the centers, said staff members at Council Care II play games with their charges to help them remember the events of the day and talk about youthful memories.

“They are being stimulated. If they sat at home and were not stimulated, it is our feeling they would lose their skills more rapidly,” Kaplan said.

Husband Keeps House

In Scranton, Chickillo washes the dishes, does the laundry and cleans the two-story, century-old house in an ethnic, working-class neighborhood while his wife is at the day care center.

“She likes it there, and I tell her she’s going to the club,” said Chickillo, who is 71.

Even with the help of the day care center, Chickillo, a retired quality control engineer, has had to give up bowling with the local league.

“It’s a burden. My friends, they think I’m dead,” Chickillo said.

In the three years, his wife’s memory has faded and her disorientation has grown worse. Chickillo said he has lost more than 20 pounds and has started taking medication for high blood pressure.

He said the day-care center, nonetheless, has eased the stress of taking care of his wife of 38 years.

“This is heaven sent for me, because I’m a 24-hour nurse at home,” he said.