Celebrating 40 years of keeping elderly in community


Cornerstone Adult Services is celebrating 40 years of helping the elderly remain part of the community and providing their families with a trusted place for their loved ones to spend the day.

Formerly the Warwick Central Geriatric Day Care Center, the program got its start at the Warwick Central Baptist Church in Apponaug in 1973, directly across from City Hall. The day program was patterned after a similar one in Hawaii and was one of the first of its kind in the country.

When Roberta Merkle, former president and CEO and current executive vice president of strategic initiatives, came to the organization 25 years ago, she remembers the goal was to expand.

“The goal at that time was really to grow the organization,” said Merkle. “There were just a handful of adult day programs across the country.”

Over the past 40 years, Cornerstone grew from that church room to a statewide organization with a total of five centers. The original location remains, along with four others. Adult day centers were open in Coventry in 1998, Bristol in 2001 and Little Compton in 2011. Cornerstone expanded their service by opening the state’s first dementia specific day center within Pilgrim Lutheran Church in Warwick in 1987; in 2001, they moved to their state-of-the-art Alzheimer’s Care Center in Warwick Neck.

The process to create a specialized program for those with memory loss began by separating a small portion of the program’s participants who were experiencing memory loss into a smaller room within the church facility.

“People were calmer. It seemed to be working,” said Merkle.

She credits part of the growth of the success of the memory care with the fact that more is now known about memory loss.

“They didn’t know what it was,” said Merkle, recalling patients experiencing forms of dementia when she started at Cornerstone. “The medical books had a paragraph about Alzheimer’s,” and nothing more, she said.

Other notable accomplishments in Cornerstone’s 40-year history include helping to create the Rhode Island chapter of the Alzheimer’s Association (1985), participating in a nationwide program funding the development of adult day centers called Partners in Caregiving (1994), being a founding member of Carelink, a network of organizations aimed at improving senior care (1998), and affiliating with the St. Elizabeth Community to create a seamless system of elder care (2009).

The established partnership with the St. Elizabeth Community can help provide an easy transition for those Cornerstone clients who may be in need of more care to a St. Elizabeth facility that includes skilled nursing facilities, assisted living or affordable housing.

“Our goal wasn’t to save money. Our goal wasn’t to reduce staff. Neither organization was in trouble,” said Merkle, explaining that the two organizations simply decided there were ways both could benefit from working together. For example, those on the waiting list for St. Elizabeth’s programs may be able to take advantage of the adult day center in the meantime.

The participants in four of Cornerstone’s adult day center programs include a mix of individuals with stroke-related disabilities, cardiac conditions, diabetes, multiple sclerosis, developmental disabilities, Alzheimer’s disease and other physical or behavioral disabilities that require support during the day that cannot be provided by working, family caregivers. Participants spend the day at the center, and then either return to their own home or the home of a family member they are living with, depending on the level of care needed. The Memory Care Center is specifically for those individuals living with Alzheimer’s or dementia.

Dottie Santagata, Cornerstone administrator, explained that adult day centers differ from senior centers because members of a senior center are more independent; they can come and go as they please and don’t have to be there every day. Participants in adult day centers will be there on the days the caregivers need to work.

Santagata sees firsthand the benefits families who participate in Cornerstone receive, often hearing caregivers say they don’t know how they would have done it otherwise.

“It makes every day rewarding for us,” said Santagata. “Just for one more day, they’ve [participants] been able to stay in their home.”

During the day, participants are able to participate in a number of activities, including exercise classes, art projects, cognitive programs to keep their minds sharp, technology lessons on computers or iPads, and a variety of other options to address all areas of life.

“We focus on the abilities of what people can do and looking at the success in that,” said Merkle.

Participants in Cornerstone also have access to a staff of certified nursing assistants and a registered nurse.

“We have excellent clinical staff that can provide personal care and medical needs in a supportive way, with dignity and respect,” said Santagata. “The level of care is similar to a skilled nursing facility if needed; we’re able to do full range.” The staff can handle simple tasks like helping an individual eat and insulin injections to administering medication and identifying possible infections.

There is also now a physical therapist and occupational therapist available on-site for those individuals who need it.

“We’ve become a one-stop-shop for families,” said Santagata.

But the best benefit of Cornerstone is the friendships that form between participants.

“It’s something that brings love, meaning and support into their lives,” said Santagata, recalling one elderly woman who said Cornerstone gave her the only friends she ever had. “They’re there to make the days as best as they can be; the staff as well. We all need to feel like we belong.”

While most centers provide service five days a week, all participants in any of Cornerstone’s facilities are invited to take part in programming on Saturdays at the Memory Care Center, allowing caretakers the opportunity to run errands, visit other friends and family, or simply relax without having to worry about who is watching their loved one.

Over the years, both Merkle and Santagata have seen changes in the nature of adult day services. According to Merkle, when she first began at Cornerstone, she heard stories of groups going on outings and even taking a trip to Europe.

“I think the initial component was much more of a social component,” she said, adding that today the shift has been to a health care model.

During her 13 years with Cornerstone, Santagata sees changes in the challenges facing their clients.

“I’ve seen a difference in the complexity of the people we see,” she said, explaining that those living with memory loss are likely affected by a number of other medical conditions such as diabetes or heart disease.

They both also believe that regulations within an adult day center have likely changed, in the sense that there are regulations today.

And even after 40 successful years, Cornerstone continues to grow. In 2014, thanks to a grant from the Tuffs Health Plan Foundation, Cornerstone will start a Healthy Aging Through Exercise and Nutrition program for early memory loss at all five of their centers; they are also in the process of transforming a section of their administrative space in the Memory Care Center to be a holistic and comprehensive early memory loss program.

Healthy Aging, funded through July 31 by the Tuffs grant, is a program that will meet three times a week to provide exercise programs, nutrition classes and counseling for those experiencing the early stages of memory loss. In recent years, Santagata and Merkle said they have seen an increase in people and caregivers looking for information about how to deal with memory loss in the earlier stages; this new program will attempt to help those individuals remain active and independent as long as possible by keeping their minds sharp.

The new Early Memory Program within the Memory Care Center will be five days a week, allowing the support of adult day services with more independence. Santagata explained that research has shown individuals experiencing memory loss can benefit from receiving support in the early stages.

“These are individuals who are not totally ready for the full memory loss program,” explained Santagata. “It’s much more individualized; there is more choice.”

She added that this program allows them to give resources to participants and caregivers at an early stage to give them more control over their lives.

In the Memory Care Center, individuals may take part in scheduled activities, programs and classes, but those in the Early Memory Loss Program will have the freedom to choose how they spend most of their day. While the staff is there to help them if needed, they will have the freedom to do activities such as reading, art projects, work on a computer or tablet and more on their own.

Administrative space is being renovated to house the program; the space will include quiet space for reading, technology, social areas and a kitchen. There will also be Wi-Fi access available so participants can bring their own laptops, tablets or e-readers if they have them.

The Early Memory Loss program will also incorporate the exercise, nutrition and counseling aspects of the Cornerstone Healthy Aging program.

Although the organization has grown, Merkle and Santagata still believe Cornerstone is one of the state’s best-kept secrets. “Adult day [services] is now a conversation,” said Merkle, who works on a number of boards at the state level to create new health policies regarding adult day services. “But I think the depth of what we provide is still the best kept secret.”

Today, Merkle estimates that there are 21 adult day programs in Rhode Island, five of which are operated by Cornerstone providing services for over 300 individuals.


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