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Describes an intergenerational program in which children in an on-site child care facility interact with elderly long-term care patients. Discusses the positive effects of such interaction on both the children and the seniors. (HTH)

Describes the Potteries Elderly Support Group, a small-scale, locally based initiative in England, which relieves relatives, one day a week, of some of the pressures associated with caring for an elderly mentally infirm person. Details the rationale for the group and describes how it has been funded, staffed, and operated. (JAC)

The community service/continuing education (CS/CE) departments at Michigan's 29 community colleges have developed a network of joint programming in order to share and duplicate successful programs across the state. This process has been sponsored through the Michigan Community College Community Services Association (MCCCSA), which was founded in 1969 by community service professionals in Michigan to improve communication and currently includes 25 of Michigan's community colleges as active members. Among the major programs that have been developed by the colleges are: (1) the statewide Adult Foster Care training program, which has developed 13 different training curricula and, since 1978-79, has offered 260 course sections and served 4,293 participants; (2) a community college aging consortium, focusing on staff and curriculum development, program and resource sharing, and advocacy for seniors' programs; (3) the Day Care Provider Training Project, which sought to upgrade and update the child care skills of licensed home day care providers; (4) the Foster Parent Education program, which reaches 1,700 foster parents in 28 counties in Michigan; (5) small business seminars to train store management personnel in local shopping malls; and (6) a series of free unemployment conferences, focusing on career development, financial aid, and available services and retraining opportunities. The benefits of networking have included stronger programs, increased access to information, and self-generated professional development. (HB)

This booklet reports on a community project in Texas involving a day care center for senior citizens. It contains an analysis of successes and failures in attempting to satisfy the project's goals of: (l) keeping individuals out of institutions as long as possible; (2) providing social contact and enrichment experiences; (3) making the burden lighter for younger members of a family, adult children who work, and so on; (4) providing a nutritional program and pleasant surroundings for elderly who otherwise would be much alone; (5) providing transportation in some form... for travel to medical clinics, dentists, and doctors' offices, recreational trips, therapists, adult education classes, over and above the normal travel to and from the center. Case examples are also included, as well as a review of other similar centers. (MML)

The elderly make up 11% of the total population of the United States, and senior citizens, particularly those aged 75 and over, are the fastest growing group in the country. Although one-fourth of the federal budget is allotted to their support, many older persons have difficulty in gaining access to the programs designed for their benefit. The elderly comprise a disproportionate share of all poor households as financial problems of the retirement system continue to grow. Currently plans to coordinate government programs and improve the method of financing the retirement system are receiving increased attention. Financing Social Security from general revenue funds or with actuarial reserves are two possible alternatives to the present pay-as-you-go system. Health care is also of concern to policymakers, as long-term needs of the chronically ill elderly must be considered. New program initiatives should emphasize homemaker services, geriatric day care, and compensations for families that support elderly relatives. The strengthening of informal relationships among the elderly, their families, friends, community groups, private organizations, and government at state, local, and federal levels is also necessary. (Author/NRB)

Geriatric day care which provides a continuum of care for the frail elderly is a relatively new type of service program, and client classification decisions are central to its implementation. Data on staff decision-making were obtained from clinical staff (N=7) of a state psychiatric center geriatric unit which offers programs at three levels of psychogeriatric day care (therapeutic day hospital, activities day care, community management). Clinicians ranked the importance of each of 20 variables in their decision-making process. Based on these ratings, the four most relevant variables were identified. Clinicians then considered each of these four variables in isolation and identified the programs in which they would place a person with a given degree of impairment in that area. Results revealed that the most relevant variables to placement decisions were severity of psychopathology, social isolation, activity level, and situation-emotional climate. Many factors cited as relevant also differentiated between participants in the three program levels. Clinicians reported using three of the four most relevant criteria in a way consistent with the program description and with client profiles. The social isolation variable, however, was applied inconsistently both with respect to the program descriptions and to client profiles. The findings provide support for subsequent program changes. (NRB)

Federal support for adult day care centers began in the United States approximately 10 years ago. To examine the counseling practices in the adult day care centers across the country and to explore how the services are affected by the staffing patterns at these centers, 135 centers completed a questionnaire. The questionnaire addressed programming, affiliation, staffing patterns and utilization, admission criteria, and family and counseling services. The results showed the diverse structures as well as the functions of the centers. Counseling services, in the broadest sense, were affected by the staffing patterns of these centers. The results also reflected the inadequacy of services offered to the families of the clients. Counseling was not recognized as a professional service needed by clients and their families, and was a rare service among the centers surveyed. The staffing patterns of these centers (e.g., health care providers versus psychosocial services providers) affected the scope and thrust of services offered. The historical argument of medical versus psychosocial models of day care centers is still unresolved as evidenced by the results of the study. The majority of the centers did not consider it their responsibility to help their clients to have access to services available through other community agencies. (This report also provides recommendations for the role of counseling in day care centers, including pre-admission counseling, on-going therapy, group counseling, and follow-up services. The survey questionnaire is appended.) (BL)

A major problem of long term care for the elderly is providing alternatives to institutionalization. An estimated 75 percent of all long term care provided to the elderly is from informal caregivers, usually family members who face numerous problems they are not trained to handle. A model program which provided 25 informal volunteer caregivers with training in caregiving skills was evaluated in terms of two hypotheses: (1) that commitment to caregiving and the caregiving group, knowledge of community services, confidence in caregiving ability, and a positive perception of community services would be bolstered by frequent attendance at the training sessions; (2) that as these factors increased, willingness to serve as informal caregivers would also increase. Pre- and post-test questionnaire data were obtained from 14 program participants. The results showed a negative correlation between attendance at training sessions and confidence in the performance of caregiver tasks, commitment to caregiving, and commitment to the caregiver group. Although some participants became more familiar with community services, regarded services more positively, gained in caregiver confidence, and became more committed to caregiving and the caregiver group, these changes were not correlated with attendance at the training sessions. (DPO)

A project proposed to organize and teach a series of training programs on nontraditional jobs for adults over age 55. Nontraditional was defined as any work situation other than full-time, historically-typical jobs in a community. Project staff developed four training classes in small appliance repair, plant care, mother's care, food preparation and three workshops in eldersitting, house sitting, and demonstration techniques. Eighteen different non-fee sessions were offered between October 1981 and May 1982. Of the 113 people enrolled in the sessions, 51 were placed into or found jobs relating to the training programs. (Appendixes include a project procedure outline, course objectives with outlines for training courses, and topic outlines for the workshops.) (YLB)

Adult day care is increasingly being offered as an alternative to institutionalization. However, this alternative is not suitable for nor is it available to all elderly. There is need to determine if elderly users of these services have distinguishable characteristics from those who do not. This study evaluates 35 impaired elderly day care clients using an enlarged version of the Duke Older American's Resources and Services (OARS) Functional Assessment instrument and compares them with 93 impaired persons taken from a random sample of community elderly measured with the same instrument. Multiple discriminant analysis is used to determine if factors exist which predict use of adult day care facilities. Results show three main domains distinguish day care participation, social resources, economic resources, and mental health. Persons participating in day care are more likely to be younger, to live with other people, to have more income, and to have fewer emotional disturbances. They are also more likely to be disoriented, but to be in better overall physical health than elderly persons who don't use day care. The findings suggest that day care clients are more often labeled as dependent by their families than are community elderly. (Author/BH)

This document describes Illinois' Community Care Program (CCP), a program which provides chore housekeeping, homemaker, and adult day care services to older persons who cannot perform some tasks basic of everyday life without assistance, in order to help them live independently. Case management, information and referral, and nursing home prescreening services also provided by CCP are described. Key events in the history of CCP are listed. Recent initiatives addressing service quality and expansion are discussed including a quality assurance program, emphasis on training, case management standards, CCP rules, demonstration projects testing new services, a review of assistance to Alzheimer's disease victims, demonstration projects in home health and skilled nursing care, and a senior companion program. A directory of planning and service areas in Illinois is included. Comments by older adults served by the program and a short vignette are included. (ABL)

This project summary focuses on the emerging social policy trend toward providing services which assist families in providing home care for their developmentally disabled family members, rather than encouraging out-of-home placement. Three project objectives encompass the issues of innovative approaches to family involvement in caring for disabled relatives, family financial planning for future care, and countering fiscal disincentives toward in-home placement. Objectives were achieved through a national survey of knowledgeable professionals, a literature review, preparation of five concept papers, and a working conference on family-based care. Among major findings were the identification of novel approaches to service design (initiation of statewide family support programs, utilization of private sector resources, utilization of tax policy, initiation of a national family allowance system), carefully worded trust arrangements as an effective means of financial planning, and an understanding of the effect of extraordinary health care costs on present placement decisions. The 13 recommendations which conclude the summary report reflect an overriding commitment to replace past biases in social policy and professional judgments that once favored out-of-home placement of developmentally disabled persons. (JW)

The document reports results of a needs assessment of the incidence and prevalence of developmental disabilities in New Mexico, in conjunction with estimates of the probable demand for residential services. An introductory section outlines the scope of the study and distinguishes among three types of demand for services: potential demand, expressed demand, and unexpressed demand. Estimates of the potential demand, up to 1995, for residential and related support services for individuals with developmental disabilities are presented in Section II. Section III analyzes the expressed demand for residential and related support services as of March 31, 1985. A conceptual diagram summarizes the breakdown of demand for residential and related day services. Seventeen tables, a bibliography, and five appendices are included. The methodology used to estimate size of the developmentally disabled population in New Mexico is described in Appendix A, while Appendix B outlines the procedure used to estimate the number of developmentally disabled adults receiving Supplementary Security Income payments and Social Security Disability Insurance benefits. (JW)

The New Jersey State Department of Health, Gerontology Program, awarded grants to 32 adult day care centers statewide for the provision of specialized service for victims of Alzheimer's disease and related disorders and their caregivers. The primary goals of the programs were to reduce caregiver burden through providing social supports and to improve the management of dementia behaviors. An ongoing longitudinal study was initiated during the start-up phase of the grant period to examine the impact of adult day care on caregiver burden. Data were collected from a nonprobability sample of clients (N=30) with a confirmed diagnosis of Alzheimer's disease or a related disorder and their caregivers (N=30). Information was obtained using three instruments to measure the caregiver's behavioral status. Demographic data revealed social supports and health and social service utilization. Measurements were taken prior to admission into adult day care and quarterly thereafter over 12 months. Preliminary findings showed strong support for the hypothesis that the degree of burden experienced by caregivers of demented elders is reduced by participation in specialized adult day care programs. (Author/NB)

This paper describes the continuum of comprehensive services offered by the social work department of the Long Island Jewish Medical Center to a high risk elderly population, i.e., those who are widows, widowers, older divorced individuals and singles, particularly those who have difficulty caring for themselves. Following a brief review of the literature dealing with the frail elderly, the Center's programs are described including the Enriched Housing Program (an alternative housing and support program in the community); a day care program providing medical monitoring and a socialization and activities program; and an advocacy program. The process of gaining support for the programs is briefly described and the advantages of the program approach are discussed. (MCF)

During the last century the population over age 65 in America has increased fourfold. This dramatic increase requires careful economic and social planning and preparation by society, and consideration of specific programs and policies by Congress. Areas needing special consideration are: (1) employment and retirement; (2) allocatoin of health care resources; and (3) long-term care. In the employment and retirement field, policy makers must consider ways to keep older workers in the labor force without penalizing those who, because of health reasons, unemployment, or age discrimination must retire early. In regard to allocation of health care resources, the government must reconsider its present policy since the escalation of health care costs and rising senior population will tax the government's health care provisions as well as demand greater proportions of the elderly's income. In the third area, long-term care, institutional care will not be available for many individuals and so the most effective use of available facilities must be made and assistance must be given for family and community care. Other factors which must be taken into consideration by policy makers include the facts that in the future, seniors' life patterns will be different, there will be more elderly, and the elderly will be predominantly female and alone. (ABB)

The problems and usefulness of an evaluation plan used to evaluate the adult day care services at Parkside Human Services Corporation are examined in this report. After the initial agreed upon objectives of the evaluation are given, the basic problem of disagreement between practitioner and researcher on operation of the program during the evaluation is detailed. Modified objectives and a method of evaluation suitable to both practitioner and researcher are then listed. The three types of data collected (trend data, tracking data, and data on clients' and family caregivers' satisfaction with the day care program) are mentioned, followed by a description of how each type of data was used in the evaluation. An assessment of the evaluation methods concludes that although not scientifically rigorous, the method is practical because of its easy implementation. It is noted that this method can be used to determine progress in achieving desired changes in clients and to suggest hypotheses about modifying program activities to help clients maintain or resume progress. (ABB)

This document describes the Alzheimer Case Management and In-Home Respite Program begun in 1985 in California. Training provided to nurses and selected homemakers in the program is discussed and sources of referrals are identified. Initial nursing visits which involved physical and behavioral assessment of the patient and discussions with stressed and exhausted caregivers are described. The need for respite for caregivers, the screening of patients for the day care center, the use of the Alzheimer Day Care and Resource Center for respite, and linking caregivers to support groups are described. The program is briefly analyzed and changes implemented during the second year of the program are explained. Fundraising for the second year is also described. Numerous tables are included which summarize referrals and patients open to care, monthly visits and in-home respite, funding secured for the second year of the program, a statement of revenue and expense for the first year, and the second year budget. (NB)

This document contains an annual report on Illinois' Community Care Program (CCP), a program which provides in-home and other support services to help older persons to remain living at home and avoid premature institutionalization. Three levels of care provided by the CCP are described: (1) chore housekeeping, consisting of basic household tasks such as cleaning floors; (2) homemaker services, including personal care tasks, and more complex household tasks; and (3) adult day care. Other services which support the CCP are discussed, including case management, toll-free information and referral systems, and nursing home prescreening. The history of the Community Care Program since its inception in 1979 is briefly reviewed. The CCP's commitment to high quality service is discussed in the areas of a quality assurance program; the emphasis placed on training; case management standards; CCP rules; and demonstration projects concerned with special programming for victims of Alzheimer's Disease, skilled nursing and home health care, and companion and supervision services. (NB)

This "gray paper" asserts that the physical, emotional, and financial needs of unpaid caregivers--usually women--have been largely ignored in our national health care policy regarding care for the severely disabled elderly. It discusses the problem of the caregiving role for wives of severely incapacitated husbands, noting that the present health care delivery system is inadequate to address and solve the problems of the caregiving wife for the following reasons: (1) Medicare, the largest government health care program for the elderly, focuses almost exclusively on "acute" care, which in practice means hospital care; (2) Medicaid allocates 40 per cent of its nationwide budget to nursing home care, but a couple must impoverish themselves to qualify the disabled spouse for Medicaid coverage; and (3) other sources of assistance, such as Social Services (Title XX of the Social Security Act), private insurance plans, private nursing agencies, adult day care, or mutual support groups, are either too expensive or too limited to address caregivers' needs. The paper therefore provides a set of strategies to alleviate the burdens of caregiving wives, in view of the inadequacy of our present health care system. Six basic principles affirming the rights and needs of caregivers are outlined, and a strategy for legislative and regulative reform at the federal and state levels is presented. Footnotes are included. (TE)

This report recommends a 10-year plan for changes in services to people with intellectual disabilities in Victoria, Australia. Intended key outcomes of the plan include: increases in the numbers of clients receiving direct residential support in community-based accommodations; reductions in numbers of adult clients resident in large scale congregate facilities; more clients in adult day programs; development of the case management system; expansion of local residential service teams; greater numbers of trained staff; and new specialist services. Following an overview of the plan and its principles and philosophies, a framework is given for changes in commonwealth, state, and local government activity. The report makes recommendations regarding residential services; housing; specialist child and family services; education; employment; the justice system; behavior and psychiatric services; other services; prevention of intellectual disability; community education; and human resource development. A plan for implementation as well as costing and financial analysis are provided. Seven appendices are given, including: models for local residential service teams and an equity housing cooperative system, a statement regarding future directions for specialist child and family services, a statement from state trustees, recommendations regarding vocational services, population assumptions and a glossary of terms. (JDD)

This pamphlet describes a multi-purpose day-care center for the elderly in Abilene, Texas which is intended to fill the "extended family" role of offering companionship, medical attention, and other aspects of concern to older persons in the community. The goals of the program are as follows: (1) to keep individuals out of institutions as long as possible; (2) to provide social contact and enrichment experience; (3) to make the burdens lighter for the younger members of a family; (4) to provide a nutritional program and pleasant surroundings for the elderly who otherwise would be much alone; and (5) to provide transportation in some form--for travel to medical clinics, dentists, and physicians' offices, recreational trips, therapists, and adult education classes--over and above the normal travel to and from the center. Other functions of the center include advocacy, a convalescent facility, initiation of programs, counseling, and volunteer coordinators. The final section provides a look at day care patterns throughout the nation, and recommends federal policy changes to promote day care for older persons. (TE)