Lessons in Caring

Volume 15, Number 3
Spring 1993


College of Human Resources meets regional needs with day-care center for the adults

by Su Clauson-Wicker

Seventy-five-year-old Vera likes reaching out to hug, caress, and pat staff and fellow participants of the new Virginia Tech adult day-care program.

But she recoils if someone should bump up against her. "Watch it," she says, "I'm getting old. I'm getting so old I'll crumple up if you're not careful."

She goes on to tell the young woman attending her that she's in school again, that her brother is coming to pick her up, that she has no children or maybe three, and two grandchildren. "I'm going to do a spot of dancing tonight," she finishes.

While some things Vera (not her real name) says should be taken with a large dollop of salt, even with Alzheimer's disease, she is aware of the frailty of her condition.

The young woman at Vera's side today is learning just how frail. She makes note of Vera's confusion as the older woman sorts through bingo tiles, her distraction from the game when maintenance workers enter the room, her agitation as she tries to make a luncheon selection from a collection of little bowls.

Again and again, she refocuses Vera's attention, often with a physical act. "Where is the 'N' column?" she queries. "Run your finger down it." "What do you do next?" she asks, touching Vera's shoulder, so that she turns away from the custodian.

For Vera's family, her mental ramblings and wanderings are taxing. The mother they knew is disappearing, leaving in her stead someone who needs increasing amounts of their time and patience at a time when careers and younger family members are also making demands. For the student working at the College of Human Resource's Adult Day-Care Center, loquacious Vera is a teacher, unraveling enigmas of the deteriorating mind and rewarding her helper's effective guiding techniques with compliance.

Vera is one of an estimated 225 people in the New River Valley (and 8,515 in Virginia) who could benefit from a day-care program for adults. Until the Virginia Tech center opened its doors in December, no care of this type was available in Virginia west of Roanoke. With the assistance of a $208,000 grant from the Jessie Ball duPont Fund, the College of Human Resources initiated the first university-based adult day-care program in the country to train students specifically for careers in adult day care. For this, Virginia Tech won the Virginia Association on Aging's Outstanding Educational Institution of the Year Award.

The center specializes in participants like Vera--those who aren't bedridden, don't need or want to be in a nursing home, and yet are too frail to be left alone safely. The typical participant may be physically impaired by stroke, be weak and unsteady, or--like Vera--be suffering from some degree of mental impairment.

Every activity offered at the center is geared to help attendees--who are assessed for levels of functioning when they enter the program--maintain or improve their physical, mental, and social abilities. Each participant has an individualized plan of care. When all 15 spots in the center are full, the staff to participant ratio will be 1 to 6; even lower with students present.

"They come here for day activities and socialization, not babysitting," says center director Puspa Das. "Everything they do is for their benefit. You won't find them sitting in front of the television all day."

At the center the television is secluded in the resting room. Daily activities start with a discussion of current events or reminiscence session, move on to a lively ball-toss or other exercise, and wind up with crafts before lunch. In the afternoon, participants may go for a short walk, do more crafts, participate in gardening,listen to music, or enjoy a cultural festival. On some days participants have a choice offered in few other centers--whether to join the children next door in the child development lab-school for creative activities.

"The point will be to keep mental and physical functions at their highest level," says Shirley Travis, associate professor of adult development and aging and project administrator. "All day long we'll try to nurture and stimulate their abilities."

More than a decade ago, the College of Human Resources anticipated the aging of the American population and planned to add space for an adult day-care center in the addition to Wallace Hall. The figures indicated strong justification: more than 30 million Americans--12 percent of the population--were 65 years or older in 1990. This group has been growing at twice the rate of the rest of the population over the last decade, and in the year 2000 will include one out of every five Americans. As the 76 million baby boomers born between 1946 and 1964 move into their elder years, an assortment of economic and business problems--and opportunities--are moving inevitably closer.

In Virginia alone, researchers at the Virginia Institute on Adult Day Care anticipate a need for 133 new day-care centers in addition to the 40 already existing in Virginia.

The growth of the Virginia Tech day-care center has been slow--perhaps because day care for adults is a new concept for the area. But Das remains convinced that it will catch on because there is a local need for such care.

The overriding goal of the center, however, is to serve as a research and training facility, a site where students can gain practical experience in planning, implementing, and evaluating adult day-care activities. Because the center is a working research facility, it offers day-care centers and other community programs research-based information, Travis says.

The center hopes to produce a cadre of professionals to staff expanded adult day- care services in the coming decades. Faculty and students from design, nutrition, architecture, and psychology may also use the facility as a resource.

Student field placements, including the graduate student working with Vera, began assisting at the center in February. The facility offers them a wealth of practical experience under the kind of close supervision not offered anywhere else in this end of the state. Students in the gerontology and long-term care administration certificate programs are vying for spots at the center next semester.

"Students are very interested in the job opportunities in this field," says Travis. "The frail are very service needy."

Frail adults don't evoke the same feelings in students that children in the adjoining child development lab school do, Travis admits. But many students enjoy elderly people for their own special attributes. "Personally, I like working with adults," says Travis, who appreciates the conversations she can have with adults.

Students who work most effectively with the frail elderly are mature, confident, patient, and possess leadership skills, Travis says. "These students aren't dependent on adults to lead the conversation," she says. "They see themselves as leaders, helpers. The less mature students tend to look for validation from adults. They want to hear that they're pretty, funny, nice; they want to play the grandchild role. Mature care-givers don't need re-affirmation of themselves. They are very observant and very patient."

The keynote of care at the Virginia Tech center is respect for all participants, regardless of their condition. "There is a tendency for some people to treat older adults like children as their language and dependency level regresses," says Travis. "We resist this in the center. An 80-year-old has led a very productive life before she or he developed an illness that took away control. We need to be very patient and respectful of the elders in our care."

Participants have a right to refuse any activity they aren't comfortable with. "If they don't want to take part in a socialization activity, we respect their wishes," Travis says. "It is not appropriate to draw them into a group discussion if they don't want to be involved. They've established their patterns and preferences by this age."

Nor will the center make elderly people do anything Travis terms "age, gender, or personality offensive." You won't see elderly folks there being forced to wear cute, little paper hats for birthdays or elderly men creating paper flowers.

Travis, who holds a degree in nursing in addition to her Ph.D., remembers an Alzheimer's patient she worked with in a Roanoke facility. "She was a former university department head. The nursing home staff addressed her by her by her first name. Most of the time she'd sit slumped in a chair, not saying or doing much, but when I'd come in I'd greet her, 'Good morning, Dr. --.' She'd pull herself up straight, extend her hand, and look at me. She was offered a lot of respect when she was younger, and that's what she still deserves. That was the only thing she still responded to."

In addition to elderly day care, Travis foresees a whole array of community-based services for elderly arising in the future--from services for the relatively independent, such as assistance with car-buying and arranging estate sales to the skilled nursing assistance provided by local residential units.

The services of the Virginia Tech Adult Day-Care Center extend beyond the participants themselves to their families. A support group for those caring for elderly relatives is being formed. Staff professionals meet regularly with family members to provide counseling and teaching. They discuss the participants' progress and suggest techniques to improve their mobility and other skills.

Soon the center anticipates it will be approved for Medicaid reimbursement, allowing participants covered by this provision to have their day-care expenses paid by the state. Even transportation may be provided for these clients. The center is open from 7:30 a.m. until 5:30 p.m. Monday through Friday, but some participants have chosen to attend several times a week or on a bimonthly basis.

"It's a new idea," says center director Das, "and new ideas take time."

Vera and the other woman who started the program with her have made easy transitions into day care. "She agreed to come grudgingly, but now she talks all the time about how wonderful the staff are," says the husband of a participant. "I thought I only needed a break once or twice a month, but she wants to come more often." "I love them. They love me," says Vera.

Virginia Tech Magazine Volume 15, Number 3 Spring 1993