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Mobile day care is an innovative approach to providing social day care
in rural communities that may not have the resources to develop their
own full-time, day care program. Leaving each morning from a central
location, program staff (with materials and supplies needed for the day)
travel to a rural site. Depending on the needs of the community, each
center is open one or two days per week, for six hours a day. Day care
is held in a community building (church, senior center, etc.) in the
rural community. When possible, transportation for participants is
arranged through community resources. The mobile day care model allows
rural communities to have their own adult day care program by sharing
staff and resources that move from location to location.

# Why Mobile Day Care?

The need for specific respite for Alzheimer\'s Disease in Georgia\'s
rural areas was identified by state service agencies as a critical
social need. Georgia set out to use Alzheimer\'s Demonstration funds to
deliver respite in rural areas in a cost-efficient manner and with
well-trained staff. The initial grant addressed the need for respite
care by developing several mobile day care sites throughout Georgia. The
Atlanta Alzheimer\'s Association initially located the mobile day cares
in various chapters around the state and began to develop, direct, and
staff these rural programs from their central office. In a short time it
became clear that one central agency for the entire state did not work
well. Only one Alzheimer\'s Association chapter in Augusta was able to
develop one mobile day care program that served two counties for one day
each week. Georgia is currently learning from the Augusta model and has
replicated the program in five additional counties.

# How a Mobile Day Care Program Is Developed

Specific tasks necessary for the development of a rural mobile day care
site include hiring staff, identifying an appropriate location, and
making arrangements for client transportation and meals. The staff
described below can handle approximately eight day care clients.

Four staff positions are needed for a mobile day care program. A
Community Development Coordinator works three days per week.
Responsibilities include public relations, trouble shooting for mobile
day care operations, making local arrangements for educational programs
and community outreach. The coordinator is also responsible for
developing a coalition of community professionals and caregivers to
assist in promoting the mobile day care.

A Day Center Director works two and a half days per week for each site.
Responsibilities include development of program activities, supervising
aides, gathering supplies, and providing feedback to families about the
client, and transporting staff and supplies to mobile day care sites.

A Certified Nursing Assistant works two and a half days per week.
Persons for this position are hired from the local community if
possible. Responsibilities include assisting the director, assisting
clients with activities (crafts, meals, toileting) and providing
one-on-one contact with each client during the day.

The Case Management Coordinator works one day per week in each site.
This position is held by an experienced social worker who assesses
clients for day care attendance, assists families with other community
services and conducts reassessments.

Arrangements for a day care location, transportation, and meals must be
made. An appropriate facility must provide adequate, part-time, safe
space for persons with dementia. In Georgia, churches and senior centers
have been used. Gaining the commitment and support of a host
organization is critical to the mobile day care\'s success. This may
require educating possible host organizations about individuals with
dementia and negotiating liability concerns and insurance issues.

Transportation for day care participants is also an issue. In one county
the local aide rides in the Senior Services van to pick up clients for
the mobile day care program.

Meals need to be coordinated. One Georgia site was located in a senior
center that provided the meals on-site, which reduced the cost of meals.
Meals on Wheels is another resource for mobile day care meals.

# How Georgia Made the Mobile Day Care Concept Work

The initial step in implementing the model was to hire the Community
Development Coordinator. This person directed the education and outreach
campaign. The main venues were for general outreach, human interest
stories with pictures in the local newspapers, and the development and
distribution of flyers throughout the community. Additionally, the
community development coordinator developed a community coalition and
advisory board that included pharmacists, physicians, church leaders and
service providers to assist with marketing and oversight. The community
coalition began by providing joint educational presentations or events
at community and civic meetings.

Local agencies saw the benefits from working together. They found that
group efforts were stronger and more successful than solo efforts. They
began pooling resources to strengthen community opportunities. The
community coalition and the coordinator gave public talks to local
groups and service agencies concerned with elderly individuals, had
booths at local health fairs, and donated books on Alzheimer\'s disease
to the local library. Gaining community support is essential to the
success of the mobile day care program.

The community coalition served as an advisory committee and was
instrumental in building community awareness and trust. The coalition
included partners from local nursing homes, home health agencies, the
Department of Family and Children services and community leaders. Each
partner was represented in the coalition. This group directed marketing
efforts, monitored appropriateness of efforts for the community,
provided an entrance into community service links, held support groups
in nursing homes, and worked with the hospital to open an adult day care
center. Through these efforts the coalition members became more aware of
the needs of Alzheimer\'s families in their own community. They used
that knowledge in their own service work. They became additional local
resources. Partner agencies had difficulty freeing up staff time for
coalition meetings-until they saw positive results of teamwork.

# Barriers and Obstacles

The mobile day care program had to address several community concerns.
When negotiating with the host organization about space, liability
issues were a concern. Additionally, the comfort of other groups using
the shared space with a dementia population needed to be accommodated
through education. The community coalition was helpful in guiding the
project\'s outreach and education efforts to assure compatibility with
rural culture tenets of \"taking care of our own.\" Transportation
remains a key element in rural family participation in the mobile day
care program.

Other challenges have been identified and successful resolutions are
still being sought. For instance, if Medicaid patients participate in
mobile day care, they lose \"home-bound\" status.

# Benefits to Georgia and to Families

Benefits of the mobile day care program can be seen at many levels.
First and foremost, dementia-specific respite is now available in rural
communities that previously had no dementia services. The costs of this
extension of service have been minimal. Most of the costs are in
salaries, which become cost effective as staff are integrated into
multiple sites. Additionally, less money is needed to start a new mobile
program. The craft budget is nominal, meals are purchased as needed, and
facility costs are lower when space is shared.

Another major benefit is that staff capacity is strengthened by
integrating the staff with the Alzheimer\'s Association day care program
in Augusta. Staff are cross-trained to fill in during sick and vacation
days. By making the positions full time, better-trained and more skilled
staff can be hired. By integrating staff into the central location
(Augusta) as well as the rural sites, staff experience more job
satisfaction and there is less turnover and less staff isolation.

When possible, the program aides are hired from the local communities
and work with the community development director from Augusta. Hiring
from the community means that clients know the staff member. This
facilitates an easier transition for families and clients to begin using
the program services.

A major benefit is that the community coalition brings together
individuals and agencies that have not previously worked together. Their
increased awareness of Alzheimer\'s disease filters into other community
projects. For example, Alzheimer\'s issues are being considered in
designing other service spaces and a home health agency is now opening
an office in a remote area of Georgia.

# Costs and Funding for Mobile Day Care

The Georgia program has a budget of just over \$31,000 per year (1999).
This includes \$22,000 for staff positions. The additional money covers
supplies, telephone, equipment, insurance, staff training, staff travel,
and client services. The program pays for insurance (\$500 per year) in
lieu of rent for shared space. This budget covers two sites offering
services two days a week.

Because of the success of the Augusta mobile day care, Georgia has
funded several new mobile programs using Brookdale Foundation funding.

New day care programs are frequently difficult to sustain because of
insufficient enrollment. However, the mobile day care concept spreads
staff costs between two sites thus decreasing both the cost and the risk
to each site. A major effort in our program is to make better use of
funds we have while seeking additional financial support.

# Keys to Success

1.  A well-trained, enthusiastic Community Development Coordinator.

2.  A well-developed and active community coalition.

3.  Members from diverse areas of the community.

4.  After start-up, the community coalition is maintained and continues
    in an active role in the program.

# Contacts: 

Administration on Aging: (202) 401-4547

330 Independence Ave.

Washington, DC 20201

Cliff Burt: (404) 657-5336

Georgia Alzheimer\'s Demonstration Project; Division of Aging Services

2 Peachtree St. NW Ste. 36.385

Atlanta, GA 30303

##### Other Projects that Serve Rural Populations: {#other-projects-that-serve-rural-populations .unnumbered}

Dawn Harlock: (904) 414-2073

Florida Alzheimer\'s Demonstration Project in West Palm Beach; Office of
Volunteer and Community Services; Department of Elder Affairs

4040 Esplanade Way, Suite #260

Tallahassee, FL 32399-7000

Romaine Turyn: (207) 624-5335

Maine Alzheimer\'s Demonstration Project; Adult Services; Department of
Human Services

State House Station 11

Augusta, ME 04333

Lisa Brakebill: (410) 561-9099

Maryland Alzheimer\'s Demonstration Project; Alzheimer\'s Association

1850 Yrok Rd., Ste. D

Tomonium, MD 21093

Irene Kazieczko or Dale Adler:

\(517\) 335-0226

Michigan Alzheimer\'s Demonstration Project; Michigan Department of
Health

Lewis Cass Building, 6th Floor

Lansing, MI 48913

Marian Sigmund: (919) 733-3983

North Carolina Alzheimer\'s Demonstration Project; NC Dept. of Human
Resources

693 Palmer Dr.

Raleigh, NC 27626-0531

Barbara Kelly: (803) 253-6177

South Carolina Alzheimer\'s Demonstration Project; SC Dept. of Health &
Human Services

Office on Aging

PO Box 8206

Columbia, SC 29202-8206

The Administration on Aging is the official Federal agency dedicated to
policy development, planning and the delivery of supportive home and
community‑based services to older persons and their caregivers through
the national aging network of state and local agencies on aging, tribal
organizations, service providers and volunteers.