May 2001
Understanding Ada

At Bridgeport Hospital's REACH Day Center for Adults, the staff understands the special problems that rob seniors of their memories. The Center helps older adults to maintain their independence while staying safe and enjoying their days.

Ada Johnston, age 77, arrives at the REACH Day Center for Adults at 9:30 a.m. As she walks down the ramp at the back of the brightly lit room, she's greeted by name with cheery smiles by several people about her own age, who are seated around a table chatting.

"Now where should I hang my coat?" Mrs. Johnston asks. "You'll have to help me, because this is my first day here." She has been coming to the Center every weekday for five months, but she doesn't remember that. What she does know is that she feels safe here, and welcome.

Ada Johnston has been diagnosed with Alzheimer's Disease, a cruel condition that eventually robs people of their memories of family, friends, and even of how to perform daily tasks.

For the Johnston family, their first inkling of a problem came in 1994, when Mrs. Johnston got lost for several hours on her way to a familiar restaurant in her home town of Bridgeport. Another time, she was driving to her job as a beautician at a hair salon in Stratford, and wound up in Greenwich. "Her train of thinking seemed to change," says her younger daughter, Beverly Amosah, a nurse who lives in Sturbridge, Massachusetts. Soon it became clear that Mrs. Johnston could not manage her daily life without help.

Ada Johnston is the center of a large family—three children, 11 grandchildren, 18 great-grandchildren, and 1 great-great-grandchild. It was hard, at first, for the family to accept the change in her. "She was always such a strong, independent woman throughout the years," her son George says. "And talented—customers at the salons where she worked always asked for her. She's a real people person."

Ada's warm personality still enfolds everyone around her. But by 1999, her memory had gotten less and less reliable. She had retired, was living by herself—and was depressed. She even stopped watching her soap operas. "I came in one evening and found her just sitting there with the lights out," recalls Beverly.

Ada's children discussed their concerns with her physician, Yousuf Ali, MD. Dr. Ali examined Ada and ordered a CAT scan of her brain, which showed no physical cause for Ada's changing behavior. Dr. Ali referred Ada to neurologist Kanaga Sena, MD, and to psychiatrist Gale Anne Levin, MD, for further specialized evaluation.

Meanwhile, the Johnstons arranged for their mother to go to a highly regarded senior center in Bridgeport during the days. For a while, that helped. But soon Beverly, who has power of attorney for her mother, began receiving upsetting phone calls from the senior center.

"They kept telling me that my mother was taking things from the other seniors!" Beverly says. This was terribly disturbing, and completely unlike Mrs. Johnston. And this personality change confirmed something that was becoming clear to Ada Johnston's doctors: she had some form of dementia (loss of mental ability)—probably Alzheimer's Disease.

Recognizing the changes in behavior as a need for additional help, a social worker from the housing complex where Mrs. Johnston lives helped the family contact the Connecticut Home Care Program for Elders (CHCP), a state and federally funded home care program administered by the Southwestern Connecticut Agency on Aging (SWCAA).

"Our SWCAA care manager helped us to get Medicaid funding and to determine how many hours of care Medicaid would pay for," says Beverly. "Then they suggested a network for our mom: in the mornings, a home health aide from United Visiting Nurse Association, plus a visiting nurse twice a month; the REACH Day Center for Adults during the day; and then a homemaker in the evenings."

Beverly promptly called REACH, and was invited to have her mother come in for a day's visit. (This is a service most adult day care centers do not provide, and it's an indication of how REACH goes out of its way to be helpful.) Ada enjoyed the day, and the Johnstons decided that REACH offered what their mother—and they—needed.

"REACH offers more than safety and special understanding for the parent," explains Ellen Shultz, director of the REACH Day Center for Adults, "We also provide support and relief for the family.

"For instance, what the senior center was calling 'taking things,' we understand to be 'hoarding,' a typical behavior of Alzheimer's Disease patients," Ellen explains. "They can't help it—they don't really know they're doing it. Ada tends to save napkins and plastic spoons. And sometimes she takes things that belong to other patients. But here, no one gets angry. Even the other clients understand that she doesn't do it on purpose. When she wants to save napkins, we let her. When she wants to take something that belongs to someone else, we distract her, or suggest that she use something else instead. And she's perfectly willing."

At the REACH Day Center for Adults, Ada and her friends are supported by a structured routine. Each activity is designed to enhance and preserve their abilities. Crafts encourage dexterity; exercises promote strength; even the simplest conversation helps to keep the brain active and engaged. Everyone has tasks to do. Ada makes the toast for the morning snack. Someone else may get out the spoons or the napkins. Others help with the cleanup. There's a piano for sing-alongs. "I enjoy it," says Ada. "Everyone's a friend!"

In November, when her mother began coming to REACH, Beverly used to call the Center every day to see how her mother was doing. She was so accustomed to the daily calls from the senior center about her mother's "stealing" that she couldn't at first believe that it wasn't a problem for the staff at REACH. For Beverly, one of the greatest benefits of the REACH program has been the sense of relief that she feels knowing her mother is happy and is fitting in well.

One of the first steps in caring for Ada Johnston was an assessment with REACH geriatrician Beata Skudlarska, MD, known to her patients and staff as Dr. Bea. This first assessment gave Dr. Skudlarska a handle on Ada's mental and physical condition.

"An initial geriatric assessment does so many things for the patient, the family, and the caregivers," says Dr. Skudlarska. "It provides a baseline for future evaluations to check the progress of Alzheimer's. It identifies bothersome behaviors and helps us to advise family and caregivers what to do and what not to do about daily problems with patients. It helps us understand what to watch for as the disease progresses. And it helps us identify legal issues, such as the need for a power of attorney to manage the patient's affairs.

"The assessment should be repeated every six months or so," says Dr. Skudlarska, "to follow the patient's progress and determine whether changes need to be made in his or her care."

Ada Johnston's care situation is ideal, according to Dr. Skudlarska. She has a home health aide in the morning from 6:30 to 9 a.m., when the REACH van comes to pick her up. She's at REACH until 2:30, when the van takes her home, and she has a homemaker from 3 p.m. to bedtime. She's alone only during the night, and her caregivers monitor her progress to make sure she can continue to be left alone at night.

For now, Ada is doing well. When changes occur, her network of support will be there for her and her family.

Their strong spiritual beliefs, says Ada's older daughter Mayda, together with REACH Day Center for Adults, are helping the Johnstons to get through a difficult time with warmth, gr