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Mixing With Care
Intergenerational Programs Offer Lessons for the Ages Twice a week, a dozen preschoolers burst into a room at the Brookland Intergenerational Day Care Center in Northeast Washington to join some unlikely playmates. "Good morning, seniors," they call, before settling in among 25 men and women. Many of the elders are in wheelchairs, and roughly half have vacant expressions, lolling tongues or other signs of dementia. But the children, ages 2 through 4, do not seem put off. They're soon immersed in a game of Pictionary, identifying scribbles with shouts of "igloo," squeals of "teddy bear" and giggles at "toilet," as their older companions either watch with amusement or seem oblivious. When the youngsters prepare to head back to their room across the hall, the instructor tells them the seniors enjoyed their company. "We surely did," exclaims a wheelchair-bound woman who hadn't appeared to even notice the children's presence. "Yes, indeed! That's good." The woman's response reflects some of the pleasant surprises emerging from experiments in caring for the young and the old in the same setting. Researchers and advocates say the idea of "shared care" is gaining ground nationwide as communities seek to conserve resources, enrich lives and perhaps make up for a decrease in regular contact between young and old as many families live farther apart. A 1998 AARP survey found several hundred shared-care sites nationwide, including Brookland. Although perceptions of benefits have outpaced research documenting them, initial studies suggest that shared care may enhance seniors' mental health and children's social awareness. Reported benefits for seniors include diminished depression and loneliness, an increased interest in activities and a heightened sense of self-worth. Children appear to get a valuable lesson on aging, some added attention and a boost to developing social skills. But experts also warn that, if assembled carelessly, shared-care sites have the potential to do harm -- spread illness, overwhelm some seniors' mental resources, stir children's fears about death and dying or confuse children if seniors forget or disregard them. "It could be a very positive experience or it could be negative," said Sally Newman, founder of the University of Pittsburgh's Generations Together program and editor of a new intergenerational journal scheduled for publication in 2003. Yet awareness of the risks hasn't dampened pioneers' enthusiasm. "You're just seeing things percolate and start to move forward, and you know you're in the forefront of something," said Vicki Rosebrook, director of intergenerational studies at the University of Findlay in Ohio. "I think it's going to be a way of life in 10 years." Encouraging Signs Brookland's founder, Alfred O. Buckley, made a point of having young and old on the same premises when he launched the center in 1993. As a small child, Buckley had lived with his grandmother, and their time together convinced him that seniors can play an important role in young children's lives, and vice versa. His master's in social work prepared him to carry out that vision. In a sense, "shared space" is a misnomer: While children and seniors in facilities like Brookland's occupy the same building, they generally inhabit separate spaces within it. Outside of structured activities -- such as games, music, stories and cooking -- the groups see one another primarily when they pass in the hall or other common space. Besides fostering intergenerational activities, the various day care models have another thing in common: a very small body of peer-reviewed research to draw from. One person poised to contribute to that fledgling research is Shannon Jarrott, an assistant professor of human development at Virginia Polytechnic Institute and State University in Blacksburg and research director of the school's Adult Day Services program in the same community. In 2000, Jarrott conducted a preliminary study of children and seniors at ONEIntergenerational Daycare in California's San Fernando Valley. The center serves about 60 seniors with mental or physical impairments and about 60 children, ranging from infants to 5-year-olds. Jarrott asked the seniors questions such as, "Do you like doing things with the children? What do you like? Are there things you don't like?" She also interviewed the seniors' family members and the children's parents. She found that the seniors, including those with Alzheimer's, felt happier, more engaged and had a greater sense of purpose after interactions with the children. Interviews with seniors and their families, combined with observational analysis, revealed that seniors who participated in intergenerational activities seemed more cheerful than those who did not, regardless of mental condition. Parents reported that their children appeared to benefit from the additional attention. Also unpublished is a recent study by Findlay's Rosebrook, who compared 100 children in an intergenerational program with 100 children who attend standard preschool or child care. Using an index that assigns discrete behavioral abilities to specific ages -- a 4 1/2-year-old, for example, should say "excuse me" when interrupting or disturbing others -- she measured children's responsiveness to their social environment. Rosebrook found that children in intergenerational programs surpassed their peers socially by about six months, displaying greater self-confidence and self-control. Older published research also includes some positive findings. In 1996 a study published by Pittsburgh's Newman in the journal Activities, Adaptation and Aging examined the impact of intergenerational activities on 21 long-term-care residents with dementia. Researchers found that these seniors exhibited more touching and less head-nodding when children from a nearby child care center were present for weekly music activities. Newman did not examine a shared-care site, but a smaller 1996 study did. That report, published in Educational Gerontology, observed 10 seniors in an adult day care enter that included a nursery school and found that the seniors' social interactions increased when school was in session. Life and Death Issues While children appear to draw valuable lessons from interactions with seniors -- learning to lower their voices and to avoid bumping or jarring frail older people -- one recurring area of concern is whether mixed-care settings confront young children too graphically with issues of death, dying and disability. The deciding factor, say proponents, may be the staff's ability to answer children's questions and address their fears. A 4-year-old boy recently told Rosebrook that he had learned something amazing from his "grandfriend" that day. "Do you know," he continued, "that Earl has to take his teeth out to brush them?" The boy appeared satisfied by Rosebrook's reply: "You know, we all do things in different ways, don't we?" At Brookland, a 3-year-old asked his teaching assistant why one of the seniors needed a wheelchair. She replied that she wasn't sure what had happened to the man, but he needed the wheelchair to get around. "Do I need a wheelchair, too?" asked the boy. "Hopefully you will never need one, especially if you take care of yourself," came the answer, "but sometimes you don't know what's going to happen later in life." Amy Goyer, an intergenerational specialist at the AARP, said seniors' wheelchairs and canes also might scare some young children. "So you explain," Goyer said. "There are a lot of good children's books that have characters who walk with a cane or have memory impairment. Then you talk about it. You can give them an empty wheelchair to sit in. Someone from the older adult community may come and talk about it. And soon they'll be wanting to take rides in the wheelchair." Staff can also minimize children's distress about the death of a senior they've befriended in day care by discussing life span and the inevitability of death. "Too many people fear growing old or fear the end of their own lives," said Donna Butts, executive director of Generations United, a nonprofit group in Washington that promotes intergenerational programs. "They're going to experience death" as they grow older. Likewise, seniors can experience loss and sadness when children they treasure grow too old for day care or move away. Staff members can help seniors recover by acquainting them with younger arrivals or by fostering a mentoring relationship with another child. Research suggests that the value of shared care also depends on the staff's willingness to permit any unenthusiastic participants to withdraw from shared activities -- and to quarantine children or seniors with contagious illnesses. Experts recommend temporarily stopping all intergenerational activities if chickenpox or flu seems to be spreading. They also advise that both children and seniors have separate spaces to retreat to when needed -- when noise and energy become too great for seniors, or when children become fidgety and need more movement. An AARP guide suggests involving all participants in planning activities. Some facilities use glass dividers so children and seniors can see each other without interacting directly, said Valerie Kuehne, an expert in intergenerational programs at the University of Victoria in British Columbia. Kuehne said researchers need to explore further the most suitable physical environments for shared care. Pittsburgh's Newman advises parents or caregivers interested in shared care for a family member to spend some time observing. "I would go in and see what the activities are, how gentle and how sensitive is the staff looking after children and adults," Newman said. She advises parents to study whether anyone's feelings are getting hurt, whether activities seem appropriate and whether participants are having fun. It wasn't hard to tell what senior Rosa Broadus thought of the program at Brookland. Smiling, she shushed her peers to let her young playmates guess during Pictionary. "They entertain the seniors," she said. "They have a lot of energy." Rosebrook hopes that the spread of shared-care sites eventually will reduce the generations' growing isolation. But she said researchers will need some time to document results. The field is "wide open right now," she said. "We're pioneers." Washington
area sites that offer mixed senior and preschool activities: •
Brookland Intergenerational Day Care Center, Northeast Washington, phone
202-526-3976. The only shared-space site in the area, it combines adult
day care services, including those for seniors with Alzheimer’s and
Parkinson’s disease, with a child day care program. Structured
intergenerational activities take place several times each week. Children
and seniors’ areas are across the hall from each other. •
Sunrise of Fairfax Assisted Living, Fairfax, phone 703-273-8000.
Assisted-living facility shares a campus with Merritt Academy, a private
school and preschool serving children from six weeks of age to eighth
grade. Children have daily activities at the assisted-living facility as
part of the school curriculum. •
Senior Connections, Owings Mills, phone 410-581-3030. Adult day care for
seniors located near several preschools. Seniors and children celebrate
holidays and special events together. Such activities take place at least
once a month. For
more information, contact
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