A few years ago Kathy Tiska, of Dunlap, Tenn., took in her ailing 82-year-old aunt, who has Alzheimer's disease and no other family to care for her.

But with two daughters and a grandchild to look after as well, Tiska knew the arrangement couldn't be permanent, particularly as her aunt, Pauline Maynor, continued to decline.

"I wanted to be able to keep her home with her family as much as I can, as long as I can," she said. "It's been very hard and it's a 24/7 job. This is not something you can put down and get away from it for a while. I'm here with her all day, all night."

But with the opening of the city's first adult day care center, Caring Hearts of Dunlap, Tiska now has an affordable, local alternative to nursing home care for her aunt.

The adult day care center provides breakfast, lunch and a snack. Activities ranging from crafts to bingo, pet and music therapy to barbecues are offered five days a week, said founder Frankie Le, who lives in Chattanooga. The center is covered by a new TennCare Choices long-term care program.

Le said she launched the center in August after hearing from home health professionals about the lack of alternatives to nursing home care in the region. So far the new day care has about 10 regular clients, but Le said she expects as word gets out, demand will skyrocket.

In coming years, changing demographics will mean that more and more families -- like the Tiskas -- will need the personal relief and patient support that adult day care provides, experts say.

The need for adult day care facilities will grow as the U.S. population ages, said Carrie Ermshar, executive director for the Tennessee Association of Homes and Services for the Aging.

"Adult day services have proven to be extremely effective in many other states, and it's time that Tennessee certainly moved forward in establishing more of this type of option," she said. "We still have a long way to go in building enough resources for the population, but we're (moving) in the right direction."

Between 2000 and 2040, the number of older adults with disabilities is expected to more than double nationally, from 10 million to about 21 million, according to a 2007 study published by the Urban Institute, an economic and social policy research group.


Chattanooga has three or four adult day care options, but Caring Hearts is the only one in Sequatchie County, said Marwan Moughrabi, nurse practitioner and co-founder of Healthforce. The medical practice does geriatric home visits and operates primary care clinics in Dunlap and Hixson.

"The whole Sequatchie area is lacking in a lot of necessities," he said. "The aging population, the baby boomers are expected to just flood society ... and the needs for these people are going to be great."

Many rural families are committed to caring for their aging loved ones rather than taking them to nursing homes, but the burden on caregivers can be tremendous, he said.

"They still work and they can't be there 24-7 because they have to keep their jobs. They also would get caretaker burnout. ... The patients themselves would love to go and have some social interaction and see some people," he said.

Le said Caring Hearts staff specializes in the care of Alzheimer's and dementia patients, and the facility has contracted with Southeast Tennessee Human Resources Agency to provide daily transportation for clients.


To qualify for TennCare's long-term care program, Choices, participants must need nursing home-level care and earn less than $2,022 a month. They may have no more than $2,000 in assets besides their home. The program covers services such as nursing home care, home-delivered meals, assisted living, minor home modifications, home visits and adult day care.

Call the Southeast Tennessee Area Agency on Aging and Disability at 1-866-836-6678 for more information.


"They have been a blessing," Tiska said of the Caring Hearts program. "I see there is a difference in [my aunt's] functioning during the day. She's remembering better. They are helping her to occupy her mind and keep it busy during the day, and that is making a world of difference for her."

The Choices program, TennCare's newly expanded long-term care program, has been available in East Tennessee since August, said Terry Woods, manager of the Choices program for the Southeast Tennessee Area Agency on Aging and Disability.

The program is a result of Tennessee's Long-Term Care Community Choices Act of 2008. The legislation aimed to increase affordable home- and community-based alternatives to nursing homes and provide funding for such services.

In 1999, TennCare spent less than 1 percent of its long-term care funding on home- and community-based options. The rest was spent on nursing home care, TennCare spokeswoman Kelly Gunderson said.

By 2009, the percentage spent on home- and community-based options had increased to 9.3 percent, she said.

"We're trying to rebalance funding and enrollment in long-term care so it better meets the needs of Tennesseans [who] need long-term care," Gunderson said.

Nursing home care averages $52,000 a year, compared to from $20,000 to $30,000 for many people in the Choices program who aren't in nursing homes, Woods said.

Choices covers services ranging from adult day care to meal services to personal attendant services, she said.

"You've got people out here who can make it at home most of the day but they need somebody to come and help them get cleaned up, bathed and dressed and get them transferred to their spot for the day," Woods said.

To qualify for Choices, a person must be 65 and older, or 21 and older and physically disabled, meet financial criteria and be unable to perform at least one daily living activity such as bathing or dressing, Gunderson said.