Nursing News:
Adult respite center provides caregivers a much needed break

By Ann Belser
It was a cold day recently when a woman from Forest Hills, Pittsburgh, Pa. finally had a chance to go shopping with a friend. That morning, she had also been able to sit quietly alone in her house without worrying about her husband. She has been taking care of him for seven years, ever since he suffered a seizure and lost his short-term memory. She asked that their names not be used, to protect the privacy of her husband, a retired welder for Westinghouse Electric Corp.
At 80 years old, her husband has no problem getting around, but he has to work to remember the names of his three daughters. And he can't remember where his razor is, or what to wear during the day. She has to tell him when he needs to take a shower.
³He's like a little child. You can't tell him to do two things," she said. ³Some days it really, really gets to me.² Now her husband is in day care two days a week at Sarah Adult Day Services Inc., a center that opened in November in Forest Hills.
In many ways, Sarah, the only for-profit center in Allegheny County, is like a day-care center for children. The clients are fed breakfast, lunch and snack. There are activities, games and two exercise periods. There is also a time after lunch when the clients can rest.
But, because the center is for adults, there is also a full-time nurse who can administer medications, including injections, and who can monitor feeding tubes. The puzzles, games and activities are also very different. A half-completed jigsaw puzzle is a photograph of a puppy in a basket. Beverly DiSabato, the owner and executive director, said the center is careful not to use games or puzzles that are childish.
While her clients may display childlike behaviors of frustration or tantrums, DiSabato said, the staff always has to remember that they are far from children. ³I'm dealing with adults who still demand dignity,² she said. The cost of the program, which is open from 8 a.m. to 6 p.m., is $5 an hour and includes meals. Clients can come for a full or half day. DiSabato said there are no contracts, but she prefers if clients come at least twice a week so they can get into a routine.
She hopes to maintain a client-to-staff ratio of about 4 to 1 with a total of 35 clients in the center at any time. The state-mandated ratio is six clients to one staff member. The center has been a huge help for Emma Crouse, who has been taking care of her 97-year-old mother-in-law for years.
For the last four of the 63 years that Margaret Crouse lived in her home, Emma Crouse went over twice a day to get her cleaned and dressed, to feed her and to clean the house. Then in June, when the weather got too hot, Margaret Crouse moved into her son and daughter-in-law's house and never went back home.
Margaret Crouse suffers from dementia. ³It's frustrating because she doesn't make sense,² Emma Crouse said. ³She can be annoying.² Emma Crouse has to keep her mother-in-law in sight all the time. One day Margaret Crouse didn't want to take a bath and left. Her daughter-in-law found her at a neighbor's house.
³I didn't know where she was,² she said. ³I thought maybe she took off down the street.² Now, four days a week, Emma Crouse gets her mother-in-law dressed and takes her to the day-care center. At the center, Margaret Crouse has shown that she isn't interested in eating, so to spur her along, DiSabato had her make three collages of foods she likes, one of breakfast foods, one for lunch and the third for snacks. Now, when she says she doesn't like what she is served, they can point out that she really does like it. ³I like it all right,² she said about the center. ³They wait on you. They see what you want.²
She's helpful at the center, too, setting the table for meals and cleaning up afterward. DiSabato said there are currently four clients enrolled at the center. The center has a dining room, a living room, an activities room and nurse's office. Between the men's room and ladies' room there is also a shower. The facility has two licenses, one from the Pennsylvania Department of Aging and the other from the Department of Public Welfare's Office of Mental Retardation.
Joette O'Toole, the bureau chief for Vulnerable Services in the Allegheny County, office of the Area Agency on Aging, said the dual licenses allow the Sarah center to take older people who are mentally retarded. She said most centers have only one license, and the Sarah center is the only one she knows of in Allegheny County that is not a part of a nonprofit service agency.
O'Toole said the two dozen adult day-care centers across the county have a surplus of slots available for clients. That's because the state started requiring moderate and middle-income people who are subsidized by the Area Agency on Agency to help pay for services, and limited them to no more than $500 worth of help each month. As a result, the number of subsidized people using the centers has dropped substantially -- from 301 to 183 from October 2001 to October 2002.
DiSabato said the adult day care is part of a continuum of services for the elderly. Day-care centers provide more services and direct care than senior centers. They are not, however, as intensive in their care as a nursing home. DiSabato said she started working for Sarah in Ohio, but wanted to move back to Allegheny County, so she decided to open a franchise in this area. She had been executive director of the Sarah center in Canton, Ohio, before she moved to Monroeville, Pa. in 2001.
She said she is happy to be able to offer the service in an area with an aging population. ³As far as I'm concerned, it's a necessary service,² she said. ³It's good for the community.²
This story was originally published in the East supplement to the print edition of the Pittsburgh Post-Gazette.