BERGENFIELD, NJ — At Sunshine Adult Day Center, every morning starts with a parade through the room.
Today the theme is multicultural and the standard bearers have no shortage of countries: the Philippines, India, Haiti, Mexico, the United States. Most of them are older adults, and attendees dance around the room, waving streamers and beating drums as Pitbull’s “I Know You Want Me” blasts.
Proudly representing her home country Nigeria, Charity Wogwugwu, 87, is dressed to the nines in a pistachio green skirt embroidered with red and gold flowers, a lemon yellow floral top with puffed sleeves and a pleated gold headscarf.
“They are looking out for us. They recognize us,” said Wogwugwu, who lives in neighboring Teaneck with her daughter and six grandchildren. “I like coming to Sunshine.”
Everyone in the center has a health need, be it mobility problemsdementia or difficulty performing daily tasks independently. Sunshine employees say they have one goal: to keep people mentally and physically sharp enough so they can do that stay out of places like nursing homes as long as possible.
Adult day centers are the most racially diverse long-term care facility in the U.S., many of which tailor their offerings to the foods, traditions and culture of their clientele and serve as important resource centers for older adults of color and immigrants. Day centers also serve the fewest number of people of all long-term care facilities, partly due to cost and limited insurance coverage options; federal Medicare, the largest insurer of older adults, does not cover them.
Sixty percent of people who use adult day centers identify as people of color, according to data from the U.S. Centers for Disease Control and Prevention. Centers like Sunshine are a microcosm of their communities, attracting people from families who are especially reluctant to place their elders in residential long-term care because of cultural norms or their experiences with racism.
Generally, they are “recognized” for the role they play in communities of color, said Tina Sadarangani, an adult and geriatric nurse who studies the aging of older immigrants at New York University.
“The biggest issue facing adult day care is public perception,” she said of the centers, which are sometimes seen as equivalent to daycare centers.
On the other side of the country, He Fengling wakes up at 5:30 a.m. on days she goes to the Hong Fook Adult Day Health Care Center near California’s Chinatown district of Oakland. It serves people from Chinese, Korean and Vietnamese backgrounds.
A bus from the day center drops her off around 8:30 am. She settles into her routine of having a breakfast of toast and jam with a glass of milk, and reading the Sing Tao Daily, a Hong Kong newspaper. Then it’s time for physical therapy to relieve her arthritis and sciatica.
There are different pre-lunch activities every day. Nowadays it’s table games: mahjong, ten gow and Chinese chess, plus bingo. An automated voice says the bingo numbers in English and an employee follows with a translation.
“Everyone who sees me gives me a thumbs up to tell me how well I am doing, that I really want to come,” said He, who is in his late 80s.
Corinne Jan, CEO of Family Bridges Inc., the nonprofit that runs Hong Fook, said they serve their customers in ways other places can’t. She said the center’s focus is on the familiar: food, language and faces.
“I think all our participants are monolingual, so they don’t speak English,” says Jan. “Imagine being in a nursing home, or even just five days in a hospital or emergency room, and not being able to communicate.”
Many older adults can feel isolated even among family members as they age out of the caregiving role and need care themselves, experts say.
He came to the US in the late 1990s to help her daughter with a new baby. Now it’s the same grandson who helped get her checkups on her and takes her to doctor’s appointments.
She has memory problems and reduced mobility, which sometimes isolates her from simple interactions in her daily life, such as going to the store.
“After I came here… my thoughts are much happier,” she said of the day center.
Older immigrants who may lack transportation, education and income and face language barriers can be “marginalized and sidelined in their own households,” Sadarangani said — even if they live with relatives. Adult day centers create a “kinship network” for them, she said.
And socialization can stave off depression, motivate people to stay active and even ease the symptoms of dementia.
Sadarangani’s grandmother attended Sunshine in New Jersey before the pandemic. Her family’s experiences inspired her to study the centers. She recalled that the center gave her grandmother new experiences, including a tour of New York City in Hindi.
Proponents argue that day centers are the most cost-effective long-term care option. About 80% of the people present day centers pay for it with Medicaid, which means the centers inherently serve a population that is not only more diverse but also almost entirely low-income.
The centers are also one-stop shops where communities of color can connect to resources that are otherwise difficult to find and navigate.
Sunshine’s director of social work, Evan Heidt, talks every day with clients who have run out of food or lost their homes. He goes through Medicaid renewals and schedules surgeries and doctor appointments. In the meantime, clients visit the occupational physiotherapist to work on their mobility by pedaling an exercise bike, throwing balls and pulling on exercise bands. Nurses check vital functions, take daily blood sugar measurements and administer medications.
Many adult clients at the day center report eating one meal a day — the meal the center gives them, Sadarangani said. Heidt estimates that about 20% of Sunshine’s customers are homeless.
“We are basically the epicenter of the community,” Heidt said. “Not only the clients, but also the families come to us.”
“If someone has a problem, they solve it,” says Avtar Khullar, who goes to Sunshine with his wife Avinash. He came to the U.S. from New Delhi in 2007 and his elderly parents visited Sunshine before they died.
But there has been little streamlined in serving such a diverse population. For breakfast alone, Sunshine’s small kitchen staff prepares 120 meals with 10 different options, including vegetarian, American, Filipino, Indian, kidney-friendly and fasting-friendly (fruit and nuts).
Grant funding is critical for day centersalso, especially to transport customers there and home. Centers sent people care packages, activity books and meals during the pandemic even though they didn’t have enough money for them, said Lauren Parker, a gerontologist at Johns Hopkins University.
“A lot of programs ended up closing,” Parker said.
Sunshine has many open spots, especially in the afternoon program. Many people did not return after the pandemic lockdowns were lifted.
Those who did said the center is a crucial part of their daily routine and social life. That includes Theomene Valentine, 84, one of the Haitians arriving on Sunshine from Newark, an hour-long round-trip drive.
“I come here to talk to my friends in Creole,” she said.
Leticia Borromeo, 82, loved Sunshine so much that she recruited her friends to come with her. She is Filipino and loves how the center exposes her to different cultures, foods and religions.
“We are like one family,” she said.
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Associated Press journalist Haven Daley in Oakland, California, contributed to this report.
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