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Support to keep a loved one at home

Evelyn Domba (left) and Devora Corman before an exercise class at the Adult Day Health Program at Hebrew Rehabilitation Center in Roslindale.

Suzanne Kreiter/Globe staff

Evelyn Domba (left) and Devora Corman before an exercise class at the Adult Day Health Program at Hebrew Rehabilitation Center in Roslindale.

When Devora Corman first started spending two or three days a week at the Great Days for Seniors program at Hebrew Rehabilitation Center in Roslindale, it was a way for her to stay socially active.

“She needed another circle of friends,” says her daughter Julie, who lives in a two-family house in Brookline in an apartment above her mother. But it took a bit of convincing to get Devora to go. “She said it made her feel old,” Julie says.

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Five years later, Devora’s Alzheimer’s disease has progressed and she needs more supervision. Though a paid caretaker lives with her, her daughter says she needs more interaction and structure than she could get at home; she now attends the program five days a week.

There’s plenty of structure at Great Days for Seniors, which occupies several rooms on the ground floor of a building at Hebrew Rehabilitation Center’s campus. In a typical day, 30 or so participants might play games or solve puzzles, sing in a group, join a current events discussion group, practice Tai Chi, and participate in crafts or baking classes. Nurses monitor their health conditions, and they have access to physical and speech therapists and a gym.

Adult day health centers – informally called adult day care – have been around for more than 30 years. But demand for them has risen, driven by a growing population of older adults and a desire for people to live with family members, not in institutions.

“People really want to stay in their homes and their communities instead of going to a nursing home,” says Anne Marchetta, director of Community Family, a nonprofit organization that runs three adult day health centers, including two with special programs for people with memory loss. Day programs offer a cost-effective alternative to a nursing home or private nursing care, and they allow family members to keep jobs while continuing to care for an aging parent at home.

They can also benefit both the participants and their families — research shows that frequent breaks from the stresses of caregiving can make it easier for spouses and adult children to keep loved ones at home. There’s also a growing awareness that social interaction, exercise, and health supervision can benefit people with dementia and aging-related chronic diseases.

Adult day programs serve a wide array of people, from middle-aged adults with mental disabilities to elderly people with serious health problems. Some programs focus solely on providing a space to socialize, but most also have nurses on staff and offer health and medical services. At Great Days for Seniors, staff members can help participants use the bathroom, take showers, and move from room to room, and they dole out medications and insulin. Staffers serve snacks and meals designed by a dietitian, and lead exercise programs to help boost mobility. They also may help arrange doctor’s appointments and serve as a link between doctors and family members regarding a participant’s health.

Suzie Kaytis, director of the program, says that health care is kept in the background; the focus is on giving people a place where they can be stimulated and engaged, no matter their abilities or health status. “One of the problems when you get older is you’re no longer the breadwinner; you’re no longer the mom,” she says. Many participants think of attending the program as going to a club or school, work or a volunteer gig.

Some programs are part of larger medical centers or nursing homes. Some cater to specific populations. The Boston area, for instance, has adult day programs that serve Russian, Cape Verdean, and Vietnamese communities.

Others specialize in caring for people with Alzheimer’s or other forms of dementia. Marchetta says that these specialty programs often have a greater staff ratio, take security measures to prevent participants from wandering away, and provide spaces where participants can pace, a common habit among those with dementia.

“The activities are designed to minimize frustration for people with memory loss and to enhance self-esteem,” she says. “On Monday, we don’t say, ‘What did you do this weekend?’ We say, ‘This weekend was Easter, what did you like to cook for Easter?”

Using an adult day service can give a much-needed respite to children, spouses, and other caregivers who are trying to keep ill or aging relatives at home.

“It’s really better if we can keep older people with disabilities at home for as long as possible, and one barrier to that is that it becomes overwhelming for family caregivers,” says Steven Zarit, head of human development and family studies at Pennsylvania State University, who has researched the stress relief that adult day services can provide. That’s particularly true for caregivers of people with Alzheimer’s, who are subject to emotional outbursts and erratic behavior.

Research by Zarit and his colleagues has found that adult day services provide stress relief for caregivers of people with dementia. One study took saliva samples from about 150 caregivers several times a day for eight days, and found an increase in levels of DHEA-S, a hormone that helps alleviate the effects of stress, on days when they used an adult day care service for their relatives with dementia.

Zarit says his team will soon publish an analysis of the same samples, looking at levels of cortisol, a hormone that rises with stress, and is finding that its daily patterns of rising and falling look more normal on day-care days. Zarit says that subjective responses fit this data, with caregivers reporting more positive emotions and less anger on days when their spouse or family member attends a day program.

Many family members worry that sending a parent or spouse to day care is demeaning.

“Guilt is a real barrier to this,” Zarit says. Another barrier is the perception that people with dementia don’t benefit from experiences they won’t remember.

Some benefits of day care programs can be noticeable — like managing stairs more easily because of a regular exercise program — but others might be hard to gauge.

Rebecca Logsdon, a clinical psychologist specializing in dementia at the University of Washington in Seattle, says that people with dementia often enjoy the programs at adult day services in the moment, but don’t remember what they’ve done when they go home, and may show resistance when it’s time to go again. But research suggests that exercise and social interaction may help people with dementia function better in their daily lives and ward off anxiety and depression.

While adult day health programs are more affordable than private aids or a nursing home — they range from $45 to $100 per day depending on the participant’s medical needs — paying for them can be complicated. Day health programs, including transportation, are covered for qualified members of MassHealth, the state’s Medicaid program. The US Department of Veterans Affairs also covers adult day health care two or three times a week, and some people can qualify for subsidies through regional elder care agencies. Most private health insurance does not cover the programs, but long-term care insurance does.

MassHealth provides certification for centers that it reimburses, but there is currently no other oversight. Madeleine Biondolillo, director of the state’s Bureau of Health Care Safety and Quality, says there are about 150 adult day health centers in Massachusetts certified by Medicaid to provide adult day health services, and about 50 more that operate privately. But in the next few months, the state Department of Public Health is planning on licensing adult day health programs, just as it does nursing homes and other medical facilities, a process that Biondolillo says will help ensure their quality.

Biondolillo says that licensing makes sense as adult day health programs are more widely used. “As people age in place, they get more medically complicated,” she says, and these programs are taking on a growing role in seniors’ health care.

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Choosing a center

Assess your needs. Decide what features are important for your loved one, such as social interaction, medical care, help with daily activities, exercise, transportation to and from a center, or communication in another language.

Locate a center that’s convenient You can find adult day health programs through the Massachusetts Office of Elder Affairs (800-AGE-INFO) or the Massachusetts Adult Day Services Association (617-469-5848, madsa.net). Or ask for referrals from a doctor, social worker, or friend.

Make a site visit A site visit is the best way to assess a program’s facilities, staff, and activities. Ask about the services available, the staff-to-participant ratio, and any questions about specific needs of your loved one.

Courtney Humphries can be reached at cehumphries@gmail.com.
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