RUNNING HEAD: FIFTYFORWARD Yeater, 1

Introduction

According to the Department of Human Services, adult day programs, commonly called

adult day cares, provide programs for seniors who required some level of supervision throughout

the day. They serve geriatric participants with physical, neurological, and/or emotional issues

that required specific interventions or trained care (Department of Human Services, p.1). Many

adult day services “provide support services for people with dementia and their families. For

example they may offer guidance on outside resources and arrange for supportive care in home”

(Alzheimer’s Association, 2014, p. 1). The general benefits of an adult day care are: allowing

the participant to stay within his/her community while the caregiver worked, providing needed

social interaction, and providing necessary structure and daily activities (The National

Caregivers Library, 2013, p. 1). Adult day services also generally included assistance with

eating, medication reminders, toileting, health monitoring, social activities, and transportation

(National Caregivers Library, 2013, p. 1).

According to the University of Tennessee’s Center for Business and Economic Research,

“between 2010 and 2040, Davidson’s County population of persons 60 and over is projected to

increase almost 80%, from 95,204 to 171 221 (an increase by over 76,000 seniors)” (p.2, 2010)

The U.S. Census Bureau indicated that the number of elderly- those 60 and older- who have self

help needs and rely on Home and Community Based Services (HCBS) and have independent

living needs was 88,967 people as of 2010 (p. 3, 2010). This group’s needs included

housekeeping, laundry, driving, toilet transfers, medication management, and obtaining

nutritious meals, all of which adult day services provided assistance with (U.S. Census Bureau,

2010, p. 4).

FIFTYFORWARD Yeater, 2

This research project was conducted at FiftyForward, an adult day program that is one of

the “premier nonprofit organizations serving adults 55 and older in Middle Tennessee”

(FiftyForward, 2013, p. 1). They insured that participants at FiftyForward “interacted and

participated in the programs and had access to services, remained active and involved and

experienced the highest quality of life” (FiftyForward, 2013, p. 1). This program provided all of

the services outlined by the Department of Human Services as well as emphasized the

importance of utilizing the center for caregiver respite, a major need for full time caregivers to

meet their personal needs (Alzheimer’s Association, 2007).

The purpose of this study was to conduct a descriptive research project with a goal of

painting a clearer picture of client needs for the FiftyForward Adult Day Service program.

Literature Review

The life expectancy of citizens in the United States increased from the year 2000 to the

year 2010 by one and five tenths percent, from age 76.8 to 78.3. This was expected to rise

another one and two tenths percent, to 79.5, by the year 2020 (“Statistical abstract of,” 2012). In

the state of Tennessee specifically, the projected number of senior citizens (those 60 and older)

for the year 2020 is 1,120,730 people (2010). This estimated number was expected to increase to

1,370,560 by the year 2030 and to 1,463,222 by the year 2040 (2010). Davidson County- in

Nashville, Tennessee- had a projected population increase of elderly citizens by nearly 80%

(95,204 to 171,221) from years 2010 to 2040 (2010).

FIFTYFORWARD Yeater, 3

An increase of elderly citizens in the United States has resulted in over 4,000 adult day

care programs (National Caregivers Library, p. 1, 2013). In Tennessee, the Department of

Human Services maintained certain requirements for an agency to be qualified as an “adult day

care”. The adult day service would provide a “program for adults who need some level of

supervision throughout the day” and who had “physical, neurological, or emotional problems

requiring special intervention or care” (Department of Human Service). The program would be

required to provide the senior participants “opportunity for socialization, activities that help

cognitively or physically-challenged adults maintain or improve their levels of functioning,

respite for family members” and they would maintain the goal of delaying the institutionalization

of their elderly participants as long as possible (Department of Human Services, p.1, 2014).

Presently, the average adult day service center consists of a facility open Monday through

Friday during business hours, with some centers providing weekend and evening care or

extended hours. Key principles of an adult day center include “assessments,

care planning, assistance with activities of daily living, health related services, connecting to

social services, therapeutic activities, nutrition, transportation and emergency care” (Moore,

Geboy, & Weisman, p. 18, 2006). This “expansive conceptualization” of Adult Day Services was

intended to allow a variety of different programs to fit into the category of adult day services.

However, funding providers tended to require more specific characteristics of adult day service

programs to be able to fulfill the requirements of funders (Moore, Geboy, & Weisman, p.17,

2006). This was considered as a reason for inconsistent growth among adult day services.

The FiftyForward Adult Day Service began 57 years ago as Senior Citizens Incorporated,

a three-day-a-week program for active seniors with the goal of “helping older adults in Davidson

FIFTYFORWARD Yeater, 4

and Williamson counties (Nashville, TN) live fuller, more productive lives” (FiftyForward, p.1,

2013). By 2007, it had grown into a network consisting of seven centers. Senior Citizens

Incorporated was renamed FiftyForward in 2008 and had become the “premier nonprofit

organization serving adults 55 and older in Middle Tennessee” (FiftyForward, p. 1, 2013). The

mission of FiftyForward was to “enrich the lives of adults 50+ by providing pathways to health,

well-being, and lifelong learning”. This agency’s vision included assuring seniors have access to

needed services, to remain active and involved, to experience the highest level of life, and to

educate communities about the needs and values of their senior citizen (FiftyForward, p.2,

2013). To its clients, the agency “assured financial satiability by wisely and efficiently using

resources,” “embraced all races, genders, ages, cultures, and perspectives,” and “advocated to

assure that older adults had sufficient resources, independence, and dignity” (FiftyForward, p.2,

2013).

Five factors that either impact the ability of clients to utilize an adult day service or are

significant characteristics of current participants were race and ethnicity, gender, levels of health

and disabilities, living arrangements, and income. The elderly population proved to be the most

homogenous of all groups of Americans with 89% white seniors, 8.3% black seniors, and 5.2%

Hispanic seniors (Beisgen & Kraitchman, p.21-22, 2003). Other demographically significant data

showed that gap in the gender ratio had increased and was predicted to increase significantly

more with age. Women represented 58% of the senior population (65 and older) and 70% of

those 89 and older as of 2003 (Beisgen & Kraitchman, p.21, 2003).

Health and physical/mental disability also impacted elderly adults’ abilities to participate

in adult day service activities. In A Profile of Older Adults, Beisgen and Kraitchman also

FIFTYFORWARD Yeater, 5

discovered that 30% of Americans 65 to 74 years of age reported limitations due to chronic

conditions (p.25, 2003). Fifty-two percent of the senior population reported having at least one

disability, and a third reported at least one severe disability (Beisgen & Kraitchman, p.25, 2003).

Of those 80 years and older, nearly three fourths had one or more disabilities. The most

commonly reported conditions included: “arthritis, hypertension, hearing impairments, heart

disease, cataracts, orthopedic impairments, sinusitis, and diabetes” (Beisgen & Kraitchman, p.26,

2003). Almost 90,000 Tennesseans, specifically, required assistance with self help needs such as

medicine reminders, dressing, or obtaining proper nutrition (U.S. Census Bureau, p.3, 2010).

About 50% of seniors had cognitive impairments, such as Alzheimer’s or another form of

dementia (National Caregiver’s Library, p.1, 2013). According to Designing a Better Day:

Guidelines for Adult and Dementia Day Service Centers, “the current supply of adult day

services meets only about one-third of the demand,” and it is projected that by the year 2050 the

need will increase to 30,000 centers (Moore, Geboy, &Weisman, p.17-18, 2006)

Income, due to the fact that it is associated with nutrition levels and access to health and

social service needs, was addressed in the profile as well. The highest reported income for

seniors was from Social Security. The poverty rates for elderly were 9.7% for divorced, black

women ages 65 and older and independently living Hispanic women had the highest rates of

poverty (Beisgen & Kraitchman, p.23-24, 2003). Elderly individuals living independently were

15% more likely to be in poverty than those living with families and caregivers. FiftyForward

operated on a sliding scale fee, due to the gap between services needed by the elderly and their

income averages. The average cost of adult day cares was estimated to be $64 per day as of

FIFTYFORWARD Yeater, 6

2008, though this would vary depending on the services specifically offered and the need for

extended care (National Caregivers Library, p.1, 2013).

The living arrangement of seniors was the significant factor believed to impact each of

the other key factors that affect an elder’s welfare. The number of elderly individuals living with

a family member or caregiver decreased with age. Among those 65 and older, about two thirds of

the population lived with family, while those 80 and older decreased to 45% living with

relatives. While 80% of senior men lived with a spouse, 41% of women were likely to live alone,

putting them into the category of those with the highest poverty rates (Beisgen & Kraitchman,

p.22-23, 2003).

Those who live with family and/or caregivers have been specifically addressed by

FiftyForward and other adult day services, due to the need for respite care. The Alzheimer’s

Association defined respite care as a period of rest or relief for the caregiver while the senior

received care from qualified persons (p. 2, 2007). Caregivers who work found adult day services

helpful and the seniors who participated at the centers would experience interaction with friends

or community members with shared experiences, be in a safe environment, and have their needs

met as well as be assisted in engaging in activities to remain active (Alzheimer’s Association, p.1

and 5, 2007).

Several different factors impact lives of seniors and affect their level of need or desire for

adult day cares such as FiftyForward. It is also relevant to note that the age range for senior

citizens could be any age 60 and up, resulting in a possible span of 40+ years. This age range is

larger than any other specific age group served. This would result in several different stages of

aging, stages of decline with physical and mental ailments, amount of income received, and

FIFTYFORWARD Yeater, 7

number of living family and friends that would make up a support system. These differences add

to diversity rising from demographic factors, such as race, ethnicity, gender, abilities/disabilities,

general mental and physical health, living arrangement, and income. Together, these factors

reveal complexity among individuals and across the aging population.

Methodology

Design

This cross sectional exploratory study took place during the spring semester of 2014

between the months of January and April. The researcher was a 20 year old Caucasian female

senior social work student at Lipscomb University. The study was completed as a requirement

for the Seminar in Social Work Practice course. Due to the fact that this was an undergraduate

research project, it was exempt from the university’s RBI.

Sample

The sample for this research project consisted of 28 participants with the FiftyForward

Adult Day Service at the time of project completion. All of the participants in the sample were

senior citizens, ages 60 and older. This was a convenience sample, purposefully selected based

on the availability of the participants, program supervisors, care givers, and participant files all

located at the researcher’s internship site. The researcher decided to create a sample from the

program’s active participant’s primarily because their files were current, easily accessible, and

the participant’s and any other needed participant information were available as needed. This

agency’s group of participants showed diversity in age, race, mental and physical ability,

income, and whether they lived in a group home, with a care giver, or independently. Thus, the

project sample was chosen intentionally with the goal of representing participants in different

FIFTYFORWARD Yeater, 8

living situations, at several stages of aging, with many different health issues and levels of

physical and cognitive ability.

Data Collection Instrument

The data collection instrument for this project consisted of a two-page, ten question

survey (see appendix). Both qualitative and quantitative research was gathered. The survey

included the broad categories of demographic information, physical and mental health

information, living situation and income feedback, and needs and goals inquiries.

Of the 10 survey questions, six of them regarded demographic information including:

gender, age, race, living situation, diagnosed health issues, and monthly income. The survey also

included questions regarding things such as: dates that each person began participating in the

program, special equipment that they required, whether they rely on the FiftyForward

transportation system to get to and from the program, whether they attend the day service for free

or pay privately, and qualitative data concerning specifically mentioned goals of participants

within the program. The survey also included physical and mental conditions of each participant

that had been diagnosed by a doctor.

Data Collection Process

To collect data, the researcher went to the FiftyForward Adult Day Service program at

3511 Belmont Boulevard in Nashville, Tennessee to review each active participant’s file and

retrieve data from each file to answer the survey questions. The number of participants was

limited to active, participating seniors enrolled in the day service program at the time of the

study. It was decided that using the participant files to answer the survey questions would

provide the most accurate answers and up-to-date information about each participant. Each

FIFTYFORWARD Yeater, 9

participant’s file included demographic information, a program specific assessment, listing of

health issues and needed equipment, financial information, and weekly assessments charting the

participant’s physical, mental, and emotional health levels. The researcher reviewed all 28 of the

participants’ files to collect data between the weeks of January 20, 2014 and February 4, 2014

and recorded them on a Microsoft excel spreadsheet. The participants were not directly

questioned due to the cognitive inabilities of some of the participants resulting from different

forms of dementia.

Data Analysis

For the descriptive exploratory project, analysis was limited to descriptive statistics.

Frequency distributions, as well as modes, were computed for each variable.

Findings

Of the 28 surveys completed, 28 (100%) contained an answer to every posed question

pertaining to active participants at FiftyForward. Demographic data collected from the

participants included age, gender, and race. Participants fell into ten different age categories,

ranging from age 60 to 110 years old. Of the 28 participants whose information was collected,

the largest age group was the 81-85 range, which contained seven participants (25%). Five

(17.9%) reported to be in the 60-65 age range. Four participants (14.3%) were found to be in

each of the following categories: 66-70 years old, 71-75 years old, and 86-90 years old. In the

76-80 age option there were three participants (10.7%), and only one participant (3.6%) was in

the 106-110 age range. Zero participants (0%) identified in the 91-95 age range, the 96-100 age

option, or the 101-105 age category, signifying that there is at least a 16 year difference in age

between the oldest and second oldest participants.

FIFTYFORWARD Yeater, 10

For the second survey question, participants were identified by gender. Eighteen of the

current participants (64.3%) were female and the remaining 10 (35.7%) were male. The

participants’ races were also identified and resulted in two categories- Caucasian and African

American. Sixteen (57.1 %) were identified as Caucasian and the remaining 12 (42.9%) were

identified as African American.

Gender

FemaleMale

Race

Caucasian

African American

Then, the participants’ monthly income information was collected. Monthly income of

the participants varied extensively from the lowest income ranging between $400 and $599 to the

highest income of $23,000 per month. Fourteen of the participants (50%) reported an income of

$800-$1,099. For the $600-$799 choice, four (14.3%) participants proved to receive that

Ages of Participants(In Years)

81-8560-6566-7071-7586-9076-80106-110

FIFTYFORWARD Yeater, 11

monthly income. Two participants (7.1%) fell into each of these income ranges: $400-$599 per

month, $1,100-$1,299 per month, and $2,300-$2,499 per month. In the $1,300-$1,499, the

$1,500-$1,699, and the $1,900-$2,099 per month income ranges there was one participant (3.6%)

per income range. Additionally, there was one participant (3.6%) who received a monthly

income of $23,000, much greater than other participants, creating an outlier in the data. There is

at least a $20,500 difference in income between the participant with the highest income and the

participant with the second highest income. No participants (0%) had an income in the $1700-

$1899 or $2100-$2299 income per month ranges.

$400-$599

$600-$799

$800-$1099

$1100-$1299

$1300-$1499

$1500-$1699

$1700-$1899

$1099-$2099

$2100-$2299

$$2300-$2499

$23,000 0

5

10

15

Monthly Income

Monthly Income

Next, the year that each participant began attending FiftyForward was provided. The data

showed that current participants entered the program from the year 2000 to the year of 2014. The

highest number of participants that entered the program was eight (28.6%) in the year 2013. Five

of the 28 participants started the program in 2012, and three (10.7%) joined in the year 2011. Of

the 28, two (7.1%) became active participants in the years 2003, 2007, and 2014 respectively.

One participant (3.6%) joined in each of the following years: 2000, 2001, 2005, 2006, 2009, and

FIFTYFORWARD Yeater, 12

2010. No current participants (0%) were found to have begun the program in the years 2002,

2004, and 2008.

2000200120022003200420052006200720082009201020112012201320140123456789

Start Date(By Year)

Start Date

Next, an inquiry of participants living situation was taken. Participants were either living

with a caregiver, in a group home, or independently. The number of participants who lived with

caregivers was 14 (50%), the number who lived in group homes was 10 (35.7 %), and the

remaining four (14.3 %) lived independently. Information was also provided whether or not the

participants utilized the program’s transportation system. Sixteen of the participants (57.1%) did

ride the FiftyForward bus either to or from the program, and the other 12 (42.9 %) we either

transported by caregivers or car services.

Living Situation

With CaregiverGroup HomeIndependently

Utilize Transporation System

YesNo

FIFTYFORWARD Yeater, 13

Then data was collected concerning the number of equipment that each person utilized on

a daily bases. Responses included equipment such as glasses, dentures, hearing aids, canes,

walkers, wheel chairs, railings, raised toilet seats, and pacemakers. There were 11 participants

(39.3%) who indicated that they use two of the listed equipments for everyday needs. Nine

people (32.2%) indicated that they need to make use of one piece of equipment daily. Four

(14.3%) needed no equipment, two (7.1%) were in need of three of the equipments, and two

more (7.1%) showed the need to at least four of the equipments daily to function.

14%

32%39%

7% 7%

Equipment Needed0 1 2 3 4

Data was also collected concerning all diagnosed medical conditions (both mental and

physical issues). There were 27 diagnoses among the 28 participants, and nearly every

participant had multiple diagnoses. Thirteen participants (46.6%) were diagnosed with

hypertension. Twelve people in the program (42.9%) had an official diagnosis of a type of

dementia. There were nine (32.1%) diagnosed with arthritis, eight (28.6%) with a diagnosis of

depression, and seven (25%) had diabetes (types I and II). Five participants (17.9%) were

revealed to have these conditions: cataracts, schizophrenia, allergies, and heart disease. A

recorded diagnosis of high blood pressure was reported for four participants (14.3%). Three

participants (10.7%) had an official diagnosis of high cholesterol and three (10.7%) each was

FIFTYFORWARD Yeater, 14

also diagnosed with anxiety and epilepsy. There were five categories of diagnosed illnesses that

two participants (7.1%) each in which were: asthma, previous stroke, cancer (in remission),

glaucoma, and emphysema. For the following, one participant (3.6%) responded for each of

these diagnoses: bipolar disorder, ulcers, inflammatory bowel disease, kidney disease, deafness,

Parkinson’s disease, hyperthyroidism, and incontinence.

Hypert

ensio

n

Demen

tia

Arthriti

s

Depres

sion

Diabete

s

High Choles

terol

Catarac

ts

Schizo

phrenia

Allergie

s

Heart D

isease

High BP

High Choles

terol

Anxiety

Epilep

sy

AsthmaStr

oke

Cancer

(Rem

ission)

Glaucoma

Emphyse

ma

Bipolar Diso

rder

Inflamato

ry Bowel

Disease

Deafness

Parkinson's D

isease

Hypert

hyroidism

IncontinenceUlce

rs

Asthma

02468

101214

Diagnoses

Diagnoses

In each participants individual care plan and Living at Home Program: Frail Elderly

Assessment and Evaluation form, each clients main needs for being in the Adult Day Service

program. All participants (100%) identified a need for socialization and as structured day. It was

reported that 13 participants (46.4%) had an additional need for avoiding institutionalization as a

key goal for joining the program. Eleven (39.3 %) needed to maximize the participants

independence, two (7.1 %) required nutritious meals and nutrition monitoring, and one (3.6 %)

had a need for exercise and engaging activities. One (3.6%) participant’s information also

specifically mentioned the need for respite for caregiver as a priority reason for utilizing the

program.

FIFTYFORWARD Yeater, 15

Limitations

Several limitations of this project were recognized to clearly understand the results.

Limitations that applied to this research mainly centered on the sample size and limited

information available. This was a convenience sample with only 28 participants, which is not

considered a representative sample for the general public, or even the elderly population (those

60 and older) in Davidson County, Nashville which, from the 2010 census, was 95,204 people

(U.S. Census Bureau, p.3, 2010). Additionally, since this was a convenience sample it was not

random, thus, not representative.

Another limitation stemmed from the fact that many of the participants had limited

cognitive abilities and conditions such as dementia that impaired their memories. As a result of

these constrictions, participants could not personally take the surveys because information

obtained directly from them could not be considered accurate. Information was obtained from the

participant’s files which contained their initial assessment upon entering the program, medical

information, powers of attorney, important notes (such as long absences from the program),

incident reports, and weekly assessments. Only information that was available in these files

could be utilized to gather data, limiting the information the researcher could inquire about.

46%

4%39%

7% 4%

Needs AssessmentAvoid Institution Caregiver Respite Maximinze IndependenceNutrition Monitoring Exercise/Activitiy

FIFTYFORWARD Yeater, 16

This study was completed in an approximated four month period. Though there were

several new participants as well as participants who exited the program during this time, the

effects of this study are not longitudinal. With the time constraint, the researcher was unable to

produce data the reflected major changes in participant attendance and changes. It should also be

noted that many participants whose data revealed that they had started the program from 2010 to

the current year (2014) were continually attending the program until the time the research was

collected. However, the categories of participants who started the program from years 2000 to

2010 do not reflect all participants who joined during each of those years. Due to the age and

health conditions of the participants, many who joined in earlier years were deceased or had been

removed from the program due to decline in health or change in living situation (either they had

moved to be with family or gone to a nursing home/assisted living facility). Files or data

concerning those no longer active in the program were not available to the research, thus they are

not represented in this project.

Implications

Implications related to this research arise from data results and limitations. Those

resulting from limitations will be addressed first. One limitation related to the sample size

indicated that the sample size was not representative of the general public or even the senior

citizen community in Davidson County. Future researchers would survey a larger sample. The

research was also a convenience sample. Future research should strive for a random sample and

ensure more diversity in the sample.

FIFTYFORWARD Yeater, 17

Limitations created by cognitive restrictions created a barrier between the research

participants and the data collected. Future researchers would create research questions that

involve more participant involvement. An example of this would be to observe and record

participants’ main needs throughout a day to answer more questions pertaining to the main needs

of participants in the program, thus revealing more specific needs for services provided by the

program. This project had a limitation on the time span that it was conducted. Creating a

longitudinal study would allow time for those suggested observations ad recordings as well as

provide more in depth data.

An implication deriving from access to files restricted the amount of data available to

compare. Future researchers would obtain access to previous participants’ files to be able to

compare the influx of participants over the years so that they could more accurately predict the

increase in need for adult day services. Implications pertaining to internal validity should also be

noted for future research. Since information was taken from files and assessments in the files,

data resulting in the same answers of the need for “socialization and structured day” are likely

prompted, specifically mentioned by the interviewer of the assessment, or stated as goals for the

individual from the program and not necessarily by the participant. With this being the goals of

the environment the assessments took place at-FfityForward Adult Day Service-it may have

affected the answer or why they agreed with the answer. Future researchers would strive to

obtain more specific, unprompted answers for these qualitative pieces to ensure validity.

Conclusions

This project sought to evaluate descriptive data from current FiftyForward participants to

help the agency have a clearer understanding of its clients’ needs. Research was conducted with

FIFTYFORWARD Yeater, 18

a 28 person sample and a 10 question survey that gathered quantitative demographic data and

qualitative data concerning needs and goals for individuals in the program.

It was found that there was great diversity in the range of age groups participating in the

program. There is a range of 50 years within this group of participants evenly dispersed between

age 60 and 110, the mean age being 85. This encompasses people from the “young old” ages 65-

74, the “old” 74-84, and the “oldest old” who are those 85 and up (The Demographics of Aging,

2009). Each of these stages of aging represent different percentages of the population and vastly

different physical and cognitive abilities as well as extraordinary differences in life experience

between the youngest and oldest participants. Program coordinators could utilize this information

to create curriculum to address each group’s abilities and needs, and possibly to create small

groups based on this information to address the dissimilar issues that arise at these distinctly

different stages.

The research also reflects an increase of participant’s joining the program, especially in

the last year (2013) with eight (28%) participants who started at FiftyForward. With this

knowledge and the data reflecting that 57.1% of the participants utilize the transportation system,

FiftyForward can anticipate an increase in bus riders and assess their available bus seating. This

information can be used to request an increase in vehicles and drivers as participant numbers

increase. They can also use this to address a needs assessment inquiring about needed space for

necessary program activities as well as appropriate staff per number of participants ratio as the

number of participants increases.

Data collected regarding diagnosed conditions is valuable to the agency for many

reasons. This information can be used to better understand interactions between participants and

FIFTYFORWARD Yeater, 19

staff. The more prevalent conditions such as hypertension, dementia, arthritis, and diabetes

reveal physical needs for the program. There is a need for the program curriculum to

accommodate participants with these conditions by researching and creating activities that are

preventative and that help reduce symptoms of these conditions. The number of conditions

present among this group also reveals a possible need for more emotional support as many of

these conditions have the ability to cause great pain, severe confusion and complete change of

personality, loss of senses or physical abilities, and death.

The findings showed that 100% of participants revealed a need for socialization and a

structured day. In addition, 46% of participants showed a need for nutrition monitoring and 39%

of participants wanted to maximize their independence. The data reveals these as the top needs

and goals of current participants, and likely goals of incoming participants. FiftyForward’s

values of being mission focused and “setting goals and measuring results to meet this standard”

can be met by utilizing these data results to adjust program activities to better meet these needs

(FiftyForward, 2013). In addition, the agency can also use the data to reach goals pertaining to

their vision of educating the community about the seniors’ needs and value that they bring to the

community (FiftyForward, 2013). The agency could also use this data to educate participants by

helping them understand the strengths and limitations of each other and work towards making

the group more supportive of each other, increasing their value for one another and instilling a

sense of dignity by breaking stereotypes of those with issues such as mental illnesses. This would

create a better environment and encourage lifelong learning (another goal of the program)

(FiftyForward, 2013).

References

Alzheimer's Association. (2014). Adult day centers. Retrieved from http://www.alz.org/care/alzheimers-dementia-adult-day-centers.asp

Alzheimer's Association. (2007). Respite care guide: Finding what's best for you. Retrieved from http://www.alz.org/national/documents/brochure_respitecareguide.pdf

Beisgen, B. A., & Kraitchman, M. C. (2003). Senior centers:opportunities for successful aging. New York, NY: Publishing Company, Inc. Retrieved from http://web.ebscohost.com/ehost/ebookviewer/ebook/bmxlYmtfXzI0NjE5OV9fQU41?sid=5c690f44-51aa-4e17-9245-67796ffc1079@sessionmgr4001&vid=1&format=EB&lpid=lp_vii&rid=0

Department of Human Services. (n.d.). Adult day care- services. Retrieved from http://tn.gov/humanserv/adfam/afs_ads.html

FiftyForward. (2013). Mission/vision/core values. Retrieved from http://www.fiftyforward.org/about/missionvisioncore-values/

Moore, K. D., Geboy, L. D., & Weisman, G. D. (2006).Designing a better day: Guidelines for adult and dementia day service centers. John Hopkins University Press. Retrieved from http://web.ebscohost.com/ehost/ebookviewer/ebook/bmxlYmtfXzIxNTg3M19fQU41?sid=88ba75e5-ccdd-43a0-b23c-c79669cfe3d7@sessionmgr4004&vid=1&format=EB&lpid=lp_11&rid=0

National Caregivers Library. (2013). What is adult day care?. Retrieved from http://www.caregiverslibrary.org/caregivers-resources/grp-caring-for-yourself/hsgrp-support-systems/what-is-adult-day-care-article.aspx

The Demographics of Aging.... (2009). The Demographics of Aging. Retrieved April 1, 2014, from http://www.transgenerational.org/aging/demographics.htm

U.S. Census Bureau, (2012). Statistical abstract of the united states: Births, deaths, marriages, and divorces. Retrieved from website: http://www.census.gov/compendia/statab/2012/tables/12s0105.pdf

Westerberg, K. (2004). Workplace development and learning in elder care – the importance of a fertile soil and the trouble of project implementation. Outlines. Critical Practice Studies, 6(1), 61-72. Retrieved fromhttp://ojs.statsbiblioteket.dk/index.php/outlines/article/view/2150/1895

Appendix A

Survey Template:

1. What is the participant’s age?

2. Is the participant male or female?

3. What race is the participant?

4. What is the participant’s monthly income?

5. What was the participant’s starting date at FiftyForward?

6. Does the participant live with a caregiver, in a group home, or independently?

7. Does the participant utilize the FiftyForward transportation system to get to and/or from

the program?

8. What equipment does the participant use?

9. What are the participant’s health issues that have been diagnosed by a doctor?

10. What are the participant’s needs for the adult day center, as stated in the individual care

plan and LIVING AT HOME PROGRAM: Frail Elderly Assessment and Evaluation

Form?