How to get Reluctant Loved Ones to Attend an Adult Day Care Center -- Hosted by guest speaker Allison Freeman, MSW, LCSW - Director of the Alzheimer's Care & Enrichment Program (ACE) @ the Jewish Community Center

<Q> I'm a director of an adult day program here in Houston. We are owned by a hospital and party of CCRC.

<Q1> What do you tell people who come to you who say they want to bring their loved one to your program, but it's really their feelings that are keeping their loved one out of the program.

<Q> Well, we are licensed for 40 a day. We have 46 in the program and average 16 a day. I find that our free ½ day and lunch really gets people into our program. It takes them to see our bright loving environment. Meet the staff and pets and other participants.

<Q1> Is that the first ½ day is free, or everyday half the day is free?

<Q> The first ½ day. Like a trial run before all the paperwork.

<Q1> So, it's a win win situation for them.

<Q> Yes. We also have several people using the CAPS program.

<Q1> What's the CAPS program?

<Q> Care Assistance Program. It's on the Alz. ??? Texas website. It pays for day programs or sitters at home. We're a much better deal and better for the person than a sitter. CAPS is like a scholarship.

<Q1> I but you are a better deal than sitters who can be expensive but also, don't offer the stimulation a day program can. My mother-in-law went to a day program. And it was great for her. Until she began wandering.

<Q> Yeah. We try a few things with our wander people before sending them to another place. The design of an adult day program is super important also.

<Q1> What features do you feel are essential?

<Q> The multi-purpose room doesn't work.

<Q1> What is it and why doesn't it work.

<Q> It's a big room where you do activities and eat, etc. It's very difficult to have 20 people in there at different levels with noise, distractions, etc. Medium and smaller rooms work so much better for us. Having a "home-like" atmosphere, though staff is what makes our program top notch.

<Q1> How do you keep your staff? What kind of training do you provide for them? How much do you charge/day? How big is your facility?

<Q> http://www.tomballhospital.org/theheritage/index.htm is the link to our website. DayBreak is the name of our adult day center. We charge $28 for ½ day and $40 for a full day. Half day is 6 hours and 1 meal. A full day is 2 meals and 10 hours.

<Q1> Thanks. I'll check it out either tomorrow or over the weekend.

<Q> I keep staff by motivating them everyday and by creating a FUN Work environment. I look for people who have close relationships with family or elders.

<Q1> They're lucky! Although I've found that the majority of people working in the field are very sensitive to people, both their employees and the people they serve. Your rates are comparable to programs here in the New Orleans area.

<Q2> As a family member, but not the primary caregiver, how can I convince my sister to take our mother to an adult day care program? She feels that she owes it to her to keep her at home but it's wearing my sister out. I try and help her out but I have family obligations of my own.

<A> Often the value of adult day services is unknown. Families may feel guilty using a program, feeling it's their duty to do it all. Though the program will certainly offer your sister some time to replenish herself, it also offers the person who attends the program therapeutic activity and socialization with others. It's not a place where people are just dropped off or not attended to. I am sure your sister is doing a great job of caring at home, but you might emphasize to her the benefits your mother might gain from attending a structured, positive environment where she can accomplish things, feel important and enjoy others' company. That benefit is every bit as real as what the program might offer.

<Q1> Welcome Q3! Do you have any questions?

<Q3> Not really. I was trying to learn anything I could if it came time to put my wife in day care since I am retired I stay with her all the time.

<Q2> My problem is that we tried an adult day center a few months back but stopped because Ed didn't want to go. I just don't know how to follow through. I feel so bad forcing him.

<A> So sorry it didn't work. One thing we know though is that it might be different now. I don't know how you and he proceeded, but here are some suggestions for a new trial if you are willing to try it again.

Some families attend the program with their loved one initially and then slowly wean themselves out as their relative becomes more and more familiar and comfortable there. The added benefit here is that you get to witness his experience of the place and realize the benefits for him. We know that it is hard for folks with memory loss to try something new. We feel anxious in new situations too! The reluctance to attend is often an expression of that anxiety.

<Q3> How do you talk someone into day care?

<A> You, of course, know your "someone" best, but here are some things to try.

Relate the benefits, important for each of us to get out, to have some structure to our day, our week, something to do of our own, to be with other people. Talk about the health benefits. Whether you speak of this generally or specifically in regards to Alzheimer's -- good for his or her health to interact with people, stimulation helps keep us involved and engaged, exercise necessary for good health.

Encourage their participation as a way to help others. Programs often enlist folks as "volunteers." Highlight a certain activity they might enjoy. One of our attendees comes for the exercise.

<Q> Day programs are a wonderful thing. There is a remarkable difference in the faces of both participant and loved one after they start attending a program.

<Q3> That's good to know.

<Q> I've noticed that once they realize that they do get to go home - and that they do have a choice of what they do - they are less hesitant.

<Q1> That's a really good point. That they do come home. I'm always amazed at what we don't think of when we're going through this. We started my mother-in-law at her day program after we went of vacation. She had spent 2 weeks with friends of hers from way back. The transition of being with people there and being with people here made things a little easier. We also used the "volunteering" angle. Although, honestly, I don't know how she bought it or not. I feel guilty because she wasn't really volunteering, or at least so I thought. Because actually she was. She still helps by wheeling other ladies around the center. But I felt queasy inside. I still wanted her to go, but boy, did I feel uncomfortable. And I fully believed and believe in the benefits of day care.

<Q> No need to feel queasy. Therapeutic lies are ok. I have people that call me their grandson, husband, boss, golf pro and I just roll with it. The end result is the same - they benefit from an adult day center.

<Q1> I know that's true, but it's not easy to live, if you know what I mean.

<Q> Yes.

<Q1> What do you do when you're talking with a person, and you know how beneficial a day program would be for them, for their family, but they just can't do it. They just can't get there.

<Q> You mean transportation or just doesn't want to go?

<Q1> Just isn't able to let go and accept the help.

<Q> Well you can't force anyone, so you have to see how you can get them in. This is where knowing the person is key. Example, if music is important, pick a day when there will be lots of music.

<Q1> I'm talking about the caregiver, not the person with AD.

<Q> Staying with them, or talking to other family members in the program works for us. We also have people call frequently during the day to check on their loved ones and that's OK.

<Q> Wow. That's a lot to keep track of. Keeping the people at your center happy, then dealing with us family members.

<Q> That's where the joy of email comes in also. Have lot of families who email. We send them digital pictures too. So they can SEE IT.

<Q4> A neighbor of mine has a 90 year old mother who is immobile and has dementia. I've tried talking to him about how she would benefit from the socialization and activities, but he dismisses that she needs to go to a day program equipped to handle dementia. He'd rather she stay by herself all day with hired sitters with no expertise interacting with people who have Alzheimer's disease.

<A> It is good of you to try. I do think many families believe a group program would never work for their relative or believe the one on one approach is more preferable. Families tell me again and again my father was never in a group in his life and I doubt this will work, but then it does work.

Dementia changes things, this we can count on. People's attitude and beliefs are more difficult to change. Would he be willing to visit a program to see what it offers? Reading material from a program explaining the benefits, how basic human needs of belonging, feeling useful and productive still exist and can be met in a group setting might be helpful.

<Q1> Does it help to have reinforcements? Have a friend or relative come with you when you're bringing your loved one to the day center?

<A> I do think it helps to have reinforcements to help you get folks there. Particularly if you are feeling ambivalent about the prospect. Someone else might be free of those feelings and carry the day so to speak.

<Q1> Thank goodness for friends.

<A> That's for sure. I am glad you are able to call on them. So often I find families are very reluctant to ask for those kinds of favors.

<Q1> Why do you think that is?

<A> Perhaps that American spirit, I should do it myself. It's a large part of our culture, I think. When you ask folks if they would mind a friend asking them a similar favor, they always seem to feel it would not be an imposition. Yet they do not want to impose on others.

<Q1> My cousin made a promise to keep her Mom at home which she did. Until her doctor told her either her mother had to go to a "home' or my cousin was going to wind up in a hospital. I tried to tell her about day programs, but she felt there were the same as a nursing home. How would you have handled this situation?

<A> It's too bad that there is not a better understanding of what might help both the person with Alzheimer's and their caregiver before a nursing home is needed. Doctors need a much better understanding of this as well and of course we need better home and community based services to support people in their homes. Had the doctor touted a day care program as a way to enrich your aunt's life and a way to support your cousin's promise, perhaps she would have managed the care at home for longer. Of course, most people do choose nursing home or other care arrangements eventually, as the care for one person is so very demanding.

<Q1> Exactly. Because even though she had to place her mother in a home, if she had given in a little at first she may have been able to have her at home longer. And there wouldn't be as much guilt for recognizing that 24/7 caregiving is exhausting and near impossible. She didn't have any help either.

<Q3> The newspaper articles with the problems in the nursing homes has made it more difficult.

<Q1> That's for sure. Especially around here.

<Q1> Thank you one and all. It's been a great evening!

<A> You're welcome.

Select your preferred format to download and print a copy of this article now