PLATTSBURGH, N.Y. ā Sally White helps her husband of 46 years get dressed, fed and on the bus for the short ride from their home to Third Age Adult Day Center four mornings a week.
Preparing 74-year-old Rodger White to leave the house for the day can be a chore since heās been in declining health for more than a decade and has severe memory loss.
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āItās like having a small child,ā said Sally White, 78. āThis long goodbye is hell. Iām exhausted. When heās at Third Age, I clean the house and try to get errands done.ā
For thousands of older Americans like the Whites, Third Age Adult Day Center and similar adult day services provide safe, stimulating places for those who have physical or cognitive disabilities and give respite to their caregivers.
William Zagorski, chairman of the National Adult Day Services Association, estimates there are about 8,000 adult day service centers across the U.S. catering to people with varying needs who want to remain in their own homes. More than half of these centers serve homebound seniors who need supervision and opportunities to socialize.
After raising four children and retiring from their teaching jobs, the Whites each began studying for the ministry. During their studies, Rodger White suffered a brain bleed in 2013 and memory problems heād been having for several years began to escalate. Sally White said his memory loss has stolen from her the intellectually sharp, active man she knew and the life they had planned as they grew old together.
To keep her husband in a safe environment while she handles household tasks and gets a break from being a full-time caretaker, White enrolled him at Third Age Adult Day Center in January 2022.
āI canāt put a price on what itās done for us,ā she said. āRodger has a routine and a community there and I keep my sanity by getting the bills paid and keeping the house in good condition and tidy so itās safe for him here.ā
Cost and location
Adult day services are prevalent in areas across the country, particularly California, New England and southern states, such as Tennessee, which experienced a 20% increase in these programs in the past 13 months, Zagorski said.
Meanwhile, middle America and rural areas struggle to either staff or fill the centers with clients.
Adult day programs cost under $100 a day nationally, which is less expensive than a nursing home. Itās one of the reasons Zagorski and organizations like the National Council on Aging are advocating for more support of senior day programs.
āUnfortunately, Medicare is not an option and that has been a barrier to its growth,ā Zagorski said.
Medicaid covers about half the revenue collected for these services across the U.S., and Veterans Affairs is increasingly supporting it, but about 15% of users still have to pay out-of-pocket.
That may account for only about 237,400 older Americans participating in structured day programs, according to the Centers for Disease Control, even though adults 65 and older make up 18% of the U.S. population.
Sally White said she struggles to afford the roughly $2,200 a month for her husband to attend the program since the couple doesnāt qualify for Medicaid. Because of his health decline, sheās been solely responsible for handling all the bills and the stress they bring.
Transportation also poses a problem in accessing senior day programs in rural areas like central Pennsylvania.
āItās been my experience in 36 years that adult day services are not a concept thatās right for people here,ā said Holly Kyle, director of the Area Agency on Aging serving Pennsylvaniaās Snyder and Union counties.
Since 1987, 13 adult day centers have opened and closed in the two counties, which Kyle attributed to a lack of mass public transportation, cost and non-flexible hours.
āMany families want services in their home, want to take care of family members on their own or still equate it to a child-care setting,ā she said.
The stigma of aging may also play a role in adult day programs being underused, said Georgia Goodman, director of Medicaid at LeadingAge, which represents more than 5,400 aging services.
āA lot of (older) people donāt seek services until theyāre in a crisis,ā she said, adding that earlier access could offer more preventative care.
Marilyn Vargo, 79, of Milton, Pennsylvania, has been attending VNA Caring Center in Shamokin since February. Vargo, who for years worked as an administrative assistant to several Bucknell University presidents, 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.
āItās very difficult,ā said her husband, Joe Vargo, 81.
Standing in the coupleās dining room filled with family photos and Christmas decorations he has yet to take down, Vargo said: āVNA has helped in a lot of ways. She gets some socialization and she really likes the bus rides. I often ask her what she did in the day, but she canāt tell me.ā
More than dancing and dominoes
VNA Caring Center is the only adult day services program for cognitively impaired seniors in the Susquehanna Valley. Full-day attendance, from 8:30 a.m. to 3:30 p.m. weekdays, costs $44, including meals. Although the center has the capacity for 19 clients, only five clients are enrolled, director Angela Loeper said.
Another major hurdle to expanding access to adult day services, Zagorski said, is the lack of public awareness and research about the benefits of the service, which he said helps reduce depression, loneliness and isolation.
Thereās been a nationwide effort to rebrand the program as adult day services, instead of day care, and distinguish it from child care or senior centers.
āWeāre a lot more than dancing and dominoes,ā Zagorski said. āWe do have fun and social activity is promoted, but we have cognitive-based activities, and physical games and range-of-motion exercises. Food insecurity is a massive problem for seniors and we offer nutrition. We help reduce falls and decrease medication errors because people are right there. Weāre the best-kept secret in long-term care. We offer a holistic level of care that allows people to remain healthy and with friends.ā
At VNA Caring Center, Loeper starts the day reading the newspaper aloud.
āWe recently read that students at Our Lady of Lourdes will be performing āFinding Nemo,ā ā Loeper said as two patrons watched the animated film in anticipation of attending the school play.
Reading the newspaper is āvital to keeping them engaged. It opens up memories,ā Loeper said. The center is filled with tables where clients can work on puzzles, paintings 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 fallen since the center reopened after being closed for nine months during the COVID-19 pandemic, director Salli Bollin said.
āIt is an underutilized service. A lot of family members and professionals donāt know itās available or they donāt think their family member will want to be here,ā she said. āMost people hear about it through word-of-mouth, but thatās a hard marketing strategy.ā
Bollin has worked at the center since 1998 and has seen clients whoāve attended several times a week for as long as 16 years.
Third Age Adult Day Program is the only center of its kind in the area. It's open weekdays from 7 a.m. to 2 p.m. at a cost of $20 per hour. Transportation is provided at an extra cost to clients within about a 20-mile range.
The center has operated since the 1990s, but has curbed its offerings since the pandemic, including no longer offering a daily meal, while continuing to provide activities to stimulate the mind and body and a weekly visit by clergy, director Nicholas Drown said. Thereās capacity for 50 people, but only 15 are being served because of the difficulty in retaining staff.
āWe have a wait list of 45 to 50 people,ā Drown said. āI get phone calls on a weekly basis.ā
Staffing is a major challenge, the āpay is not that great,ā and the pandemic dealt an additional blow, said Kathleen Camero, senior director of the National Council on Aging's Center for Healthy Aging.
āWe expect to see increases in need for adult day services because of the (increasing) rates of Alzheimerās and dementia and I wonder if weāll be able to keep up with demand if we donāt recruit and pay better,ā she said.
Itās a sentiment echoed by Mary Michlovich, executive director of OPICA, an adult day service program in West Los Angeles, California.
āWe need to bring an awareness that there is more support needed across the board. We have this aging tsunami coming toward us,ā Michlovich said. āEveryone is living longer and theyāre being diagnosed (with dementia-related issues) so much younger. The need has exploded but the funding support is just not there.ā
Joe Vargo said heās not able to keep up with the demand of owning the home he and his wife have lived and raised three children in since 1974. Heās considering moving them both into a nursing home soon.
Before Marilynās fall and brain injury, the Vargos never discussed how they would handle getting older together if their health failed.
āI oftentimes think about that,ā he said. āWe probably should have.ā
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The share of the U.S. population older than 65 keeps rising ā and will for decades to come. Since 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, looking at everything from adult day cares to assisted living facilities to understand the challenges in affordability, staffing and equity that exist today and lie ahead.