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Posted: October 06, 2004

Professional Caregiving

Day in the Life of an Adult Day Care Worker

My alarm clock goes off at 5:30 a.m., so catching the bus to the adult day center gets me there by 6:25 a.m. My kids are old enough now to get themselves off to school on their own. Before I know it, we will all be home again, sitting around the dinner table telling stories about our day.

Arriving before 6:30 a.m. will give me time to start the coffee for the 35 clients we are expecting, print the daily activities on the board in the main activity/dining room, get the frozen waffles out of the freezer in time for the first bus to arrive.

Within a few minutes, the nurse manager arrives, and by 8 a.m. the other staff start arriving, as clients come with the bus or their family members.

Two family caregivers, both nurses, drop off their mother and spouse, respectively. They probably tell me every morning that were the center's opening hours any later, they wouldn't have a way to keep their jobs which require them to be on the nursing floor by 7 a.m.

Our center had to face the facts that the working caregiver needed us minimally by 6:30 a.m. and until 6 p.m. every work day. We also expanded our hours from being a respite center (which offers a shortened day) to full 11+ hours each day. Some centers in town, here in St. Louis, are even open on weekends and overnight.

Our clients arrive by bus, and some appear sleepy when they disembark. Others muster the energy to bustle in to get their day started -- to see friends and have a warm breakfast, complete with hugs and handshakes.

Breakfast is cooking, and it smells great. It always seems to hit me when all our participants have arrived and are eating breakfast together as a group, that they -- we, actually -- are all social beings. Meals taken alone just don't do the same despite the fact that the food may be the same. It's the people who add the spice, the flavor.

When a new client joins adult day care, they are often worried on their first day that their family member has simply ?left them there.? They worry, is this a nursing home? How will I get home now? Their anxiety is seen and felt. We have a buddy system at our center, so there is another participant who has volunteered to connect with the new client and make them feel at home. This is the beginning of the socialization, engaging clients to interact and get to know one another. It continues throughout the day.

I sit with a client who is unsettled, fretting when they will be going home. ?Who will get me? When are they coming? When does the bus take me home? How will I get back to my family?? These are the questions that are expressed all day long when new participants join the center, especially those with dementia.

They just don't know yet they can trust us. ?Your daughter will be here at 4? or ?the bus will take you home at 5? are the mantras heard all day, and said as if that was the first time it had been asked. By the second or third visit, most clients feel safe and are settled at the center. That is credit to the staff continually reassuring them, redirecting their anxieties to purposeful activity and maintaining a daily schedule that soon becomes familiar.

Ever since we started programming based on person-centered care, we are much more aware of who likes what and can do what, so we have a few choices of activities ? one, to stimulate discussion and interaction and another that is designed for those with language or memory problems, but who enjoy movement, art projects or garden work. Our clients range a few generations, and a wide range of capabilities, so everything from current events, art, music, trips, and all types of exercise (t'ai chi, bowling, walks in the nearby park) are incorporated into the day.

The summer allows us to do some wonderful work in the gardens, and our clients are so proud of the results! Even if they can't describe what they have done when asked, they take pride in their planting, I wish we had space indoors to continue the gardening. Maybe that would be a great grant. I have to remember to speak to the manager about it.

The day moves quickly after breakfast, with exercise and activities, lunch, and more activities. We are forever assisting clients throughout the day to and from the activities, meals and bathrooming, and by 3 p.m. everyone is tired. Our caregivers tell us their family member gets better rest after a day at the center, because on ?non-day care days? they nap throughout the day from boredom, and lack of activity. Some, we are told, don't even get out of bed if they don't come to the center.

My day ends at 3 p.m., and I too, will probably steal a short rest before my kids come home from soccer practice. It has become a family dinner routine, that after I ask them how their day in school was, one of them, usually my youngest, asks me how my day in day care was.

I always have a story to share, and they listen. Tomorrow, it will start all over again.


Sylvia Nissenboim is a licensed clinical social worker and who has been working in the field of adult day services in the St. Louis area. She is the director of four adult care and enrichment centers for the American Red Cross and also operates a personal and professional coaching firm, LifeWork Transitions, specializing in caregiving concerns, adult day care management and other aging services, such as virtual coaching and family care giving support groups. She co-authored The Positive Interactions Program, is a national speaker, and has served as president of the Missouri Adult Day Care Association and as a member of the Missouri Governor's Advisory Council on Aging..

© 2004 Pederson Publishing, Inc. All Rights Reserved.
Commercial use, redistribution or other forms of reuse of this information is strictly prohibited without the prior written permission of Pederson Publishing.

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