Adult day center serves variety of ages, diagnoses

If clients weren’t able to come to Casa Colina Centers for Rehabilitation Adult Day Health Care, family members would have to quit work and stay home, hire a full-time care giver, or send them to an institution.

"We are filling a niche in the community," says Kim Mory, MA-SP, CCM, director of the Pomona, CA, day treatment program.

The program includes structured group activities designed to help clients maintain their health and abilities, such as memory, cognition, language problems, and social and leisure skills.

Clients are monitored closely by the nursing staff, who may perform regular blood pressure or blood sugar checks, handle tube feedings, and administer medications. The nursing staff have been able to catch the early stages of congestive heart failure and diabetic problems in some clients.

"Physicians are seeing that they can utilize us to be their eyes and ears. We see the patient on a daily basis, when they cannot," Mory says.

About 66 clients participate in the program each day. The youngest client is 24, and the oldest is 92. Most come to the center five days a week. All are unsafe on their own because of cognitive deficits or physical care needs. Diagnoses include traumatic brain injury, stroke, dementia, Parkin son’s disease, Down syndrome, developmental disabilities, and psychiatric diagnoses.

The center may be the end stay for clients. Some have participated in the program for as long as 18 years; others have moved on to a school setting or a sheltered workshop. Staff include nurses, social workers, a full-time activities director, and an occupational, physical, and speech therapist. Five program assistants are certified nursing assistants who help the licensed staff. When the center receives an application, the family and prospective client meet with the social worker, the nurse, and other members of the treatment team.

Clients meet to drink coffee, socialize, read the newspaper, and watch the news on television until the structured program starts at 9 a.m. They participate in group activities or exercise sessions, depending on their interests and the deficits they need to work on. Some groups serve several purposes. For instance, clients may be placed in a crafts group because they need to work on fine motor skills or attention to task or simply because they enjoy it. Afternoons include work on leisure and social skills and often involve games such as dominoes, which help clients work on taking turns and counting points. "We really try to work on social and leisure skills. At home, many have been placed in front of the television set and that’s it. We have created a lot of avid card and game players," Mory says.

Assessment visits

Staff may decide the facility isn’t the best place for some clients. For instance, one prospective client who is severely developmentally disabled would scream when she was in a room with a lot of people and activity. "We are a busy place, and we knew that our facility wouldn’t work for her," she says.

Clients are admitted on a 30-day trial basis to see if the program can meet their needs. The first three visits are counted as assessment days during which they are evaluated by nursing and physical, occupational, and speech therapy. The staff decide at what level clients are functioning and which activities would best fit their needs.

"If the family reports they are isolated and won’t talk to anyone, we put them into activities that will encourage them to be more active socially, such as playing games and group discussions, rather than individual activities, such as crafts," she says.

The center is open Monday through Friday from 7:15 a.m. to 6 p.m. and charges $66 per day to cover meals, activities, and therapy. Medicaid and some insurers cover the cost of adult day health care programs. "Once you get past 50 to 60 clients, you can do OK financially. Anything less, [and] you barely cover your expenses," she says.