The number of adult day care centers, advocates say, are still far too few, even though the "graying" of America has accelerated dramatically.
Nationally, there are only about 1,500 such centers for the "fragile elderly," according to the Washington-based National Institute on Adult Daycare.
In California, there are but 416 state-licensed centers serving about 20,000 elderly. Of those, 62 are the larger centers that provide extensive medical, therapy and counseling services, as well as social activities, hot lunches and transportation.
And in Orange County, the number is 13 state-licensed centers, serving about 400 elderly.
This crucial shortage, advocates argue, underscores the annual National Adult Day Care Week, which this year is being observed Sept. 18-24.
"We simply don't have enough of these centers, and most of ours (in Orange County) have waiting lists," says Peggy Weatherspoon, director of the Orange County Area Agency on Aging. "It's a matter of constant fiscal struggle for these centers--a year-in, year-out challenge."
The biggest reason for scarcity of such centers, backers say, is the sheer newness of the movement, which started in 1969 but did not reach significant numbers nationally until the late 1970s.
"Too often, people confuse us with the traditional day care for children. They tend to think of the elderly ones as a baby-sitting program," explains Dorothy Howe, program coordinator with the National Institute on Adult Daycare. "They don't realize the range and depth of services, which go far beyond the conventional image."
Howe and other advocates contend these new day centers are an essential "pre-institutional alternative" on the continuum of care for the elderly.
The new centers provide one more program, they say, to enable the "fragile elderly"--those who do not require placement in such programs as a board-and-care facility or a full-care nursing institution--to stay at home with their families.
About 8% of the senior citizen population--about 25,000 in the county--are in that "home care" category, including those confined to their homes under the care of family members or nursing specialists.
Participants in adult day care also fall under this "fragile elderly" category--they are still able to get around outside the home, even though they suffer from infirmities brought on by such conditions as strokes, heart ailments and the early stages of Alzheimer's disease.
There are nine state-licensed "social model" centers run by nonprofit groups in the county. The licensed capacity ranges from 16 to 32 people. Rates range up to $25 a day but are subject to lower ability-to-pay payments. Participation in these centers is not covered under federal medical benefits or usual private insurance provisions.
"Social model" programs include family counseling, speakers, crafts, entertainment, current-events discussions and some field trips, as well as van transportation and meals.
Also, there are four nonprofit, state-licensed "health model" centers in the county. Licensed capacity is 40 to 50 people (although most are elderly, these centers also have people in their 40s and early 50s). Rates are $40 per day, but most participants meet low-income requirements for reimbursement under the state-federal Medi-Cal program. There are also ability-to-pay reductions for others.
In addition to the social activities similar to the other day centers, the "health model" versions provide staff members who are nurses, rehabilitation therapists and social workers.
The "health model" centers are considerably more expensive to run. For example, it costs about $280,000 a year to operate the 50-member VIP Adult Day Health Care Center in Santa Ana, but $40,000 a year to run Buena Park Senior Day Care, a 20-member "social model."
The Buena Park center and three other "social" centers are supported in part with federal grants from the Area Agency on Aging. The VIP "health" center in Santa Ana was established with some state funds, while the just-opened VIP facility in Anaheim has received federal revenue-sharing money through the county Board of Supervisors.
No adult day care programs are offered by for-profit organizations.
ADULT DAY CARE CENTERS
IN ORANGE COUNTY
* Adult Day Health Center of South Orange County
324 Avenida de la Estrella, San Clemente
Anaheim Senior Day Center 250 E. Cypress St., Anaheim
Buena Park Senior Day Care 8150 Knott Ave., Buena Park
Garden Grove Adult Day Care Center 12741 Main St., Garden Grove
Harbor Area Adult Day Care Center 661 W. Hamilton St., Costa Mesa
Huntington Valley Adult Day Care Center 18685 Santa Ynez St., Fountain Valley
Orange Adult Day Care Center 1250 E. Heim Ave., Orange
Rehabilitation Institute of Southern California 1800 E. La Veta Ave., Orange
Saddleback Valley YMCA Adult Day Care 24772 Chrisanta Drive, Mission Viejo
* St. Joseph Hospital Adult Day Health Center
23565 Moulton Parkway (Suite A),
Southwest Fullerton YMCA Day Care 1414 S. Brookhurst Road, Fullerton
* VIP Adult Day Health Care Center--Anaheim 1158 N. Knollwood Circle, Anaheim
* VIP Adult Day Health Care Center--Santa Ana
1101 S. Grand Ave., Santa Ana
*Denotes the larger centers that are also licensed as "health model" facilities.