{"id":11,"date":"2025-04-08T15:46:41","date_gmt":"2025-04-08T15:46:41","guid":{"rendered":"https:\/\/ascjcapstone.com\/spring-2025\/vlouisja\/?page_id=11"},"modified":"2025-06-03T02:09:21","modified_gmt":"2025-06-03T02:09:21","slug":"the-domino-effect","status":"publish","type":"page","link":"https:\/\/ascjcapstone.com\/spring-2025\/vlouisja\/","title":{"rendered":""},"content":{"rendered":"
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New Sunrise, located in the city of Northridge, is just one of 187<\/strong> adult day care centers open in Los Angeles County. (Photo by Veronique Louis-Jacques)<\/em><\/figcaption><\/figure><\/div>\n\n\n

It’s 9 a.m. and Spanish music is blasting through the walls of New Sunrise Adult Day Health Care Center. Just next to the stereo, a Haft-Sin table \u2013 a set-up of decorations and offerings for Nowruz (Persian New Year) \u2013 sits on display and an array of flags hang from the center\u2019s ceiling. A sea of 75-85 year-olds have already made their way to the dance floor. Participants who haven\u2019t rushed to break out their best moves mingle at their tables, waiting for breakfast to be served. It\u2019s a liveliness that this senior population might\u2019ve missed out on had they chosen to stay home. <\/p>\n\n\n\n

\u201cSometimes when I wake up in the morning I say, ‘Oh god I don\u2019t want to [get up],'” said Maria Escobar, a New Sunrise participant. \u201cBut as soon as I start to think about how it is here, I get up and get ready to come.\u201d<\/p>\n\n\n\n

Escobar is a 73-year-old immigrant from El Salvador. After complaining of her loneliness from staying home, her daughter surprised her one day by randomly dropping her off at the center. She’s since enjoyed games of musical chairs and bowling, and you can find her sitting at the same table every day, laughing with the friends she’s gained since being here. \u201cI never had any idea of a place like this,\u201d Escobar said.\u00a0<\/p>\n\n\n\n

The National Adult Day Services Association defines adult day services as, \u201ca system of professionally delivered … services provided to individuals to sustain living within the community.\u201d These services differ from assisted living in that their institutions provide care for less than 24 hours, allowing them to be a more affordable option in the world of long-term care facilities. Genworth\u2019s Cost of Care database reported that the median daily rate for adult day care facilities in the U.S. was $101, making them significantly cheaper than homemaker services ($201), in-home health aide care ($220), assisted living ($187) and residential nursing homes ($302- $339 depending on the type of room), according to Senior Living.\u00a0<\/p>\n\n\n\n

This affordability lends itself to how adult day care centers show up for communities of color.  60% of people who use adult day care centers identify as people of color, according to the U.S. Centers for Disease Control and Prevention, making them the most racially diverse long-term care setting. <\/strong><\/p>\n\n\n\n

\u201cThese centers have done an extraordinary job of catering to the cultural preferences of these populations,\u201d said Dr. Tina Sadarangani, an assistant professor at New York University and a lead researcher of adult day services. \u201cThey typically tend to function as microcosms of their neighborhoods or like communities within communities. If they’re located in an ethnic enclave that’s disproportionately, let’s say, Latino, the center is going to have staff that speak the language, lunch that aligns with their preferences, and games that they’re used to.\u201d <\/p>\n\n\n\n

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A line of flags hang across New Sunrise’s ceiling, representative of their diverse population.<\/em><\/figcaption><\/figure>\n\n\n\n
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New Sunrise staff member serves breakfast to participants.<\/em><\/figcaption><\/figure>\n\n\n\n
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New Sunrise’s Haft-Sin table<\/em><\/figcaption><\/figure>\n<\/figure>\n\n\n\n

(Photos by Veronique Louis-Jacques)<\/p>\n\n\n\n

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New Sunrise opened in 2004, just before California’s moratorium \u2013 a one-year ban that prevented new adult day health care centers from opening. While New Sunrise began under an Armenian couple \u2013 with the center\u2019s name even being translated in Armenian on the front of the building \u2013 the center has expanded to represent a wide variety of cultures, primarily catering to three cultural populations: Persian (50%), Hispanic (40%), and Asian\/Indian (5%). \u201cYou don\u2019t choose the population, the community chooses,” said Lena Haroutunian, program director of New Sunrise since 2016 (after taking over the role from her parents).<\/p>\n\n\n\n

To accommodate these different groups, the center prides itself on conducting activities in different languages and hiring staff that is reflective of the populations they serve. Aside from English, bingo sessions are conducted in four additional languages: Farsi, Punjabi, Spanish and Armenian, and English classes are taught by participants and held throughout the week for the dominant cultural populations, Hispanic and Persian.\u00a0<\/p>\n\n\n\n

You don’t choose the population, the community chooses.”
<\/p>Lena Haroutunian<\/cite><\/blockquote><\/figure>\n\n\n\n

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New Sunrise’s calendar for the month of March. (Courtesy of New Sunrise)<\/p>\n\n\n\n

Adult day services fall under two types of licensed settings, according to the California Department of Aging: Adult Day Programs (ADP) and Adult Day Health Care (ADHC), to which New Sunrise identifies as. While both seek to provide some form of community, Adult Day Programs are solely concerned with providing aid with \u201cpersonal care, activities of daily living, and\/or supervision for a participant\u2019s protection,\u201d while Adult Day Health Care facilities provide aid for those who need more medical assistance, serving \u201c frail older adults and younger adults with chronic disabling medical, cognitive, or mental health conditions who are at risk of institutional placement.\u201d <\/p>\n\n\n\n

Government officials and medical care providers often misinterpret the influence that adult day care centers can have on the aging population, undermining them as services built purely for socialization. Yet the services these centers provide extends beyond a game of bingo or dominoes, providing critical health services to those in need.\u00a0\u00a0\u00a0<\/p>\n\n\n\n

At New Sunrise, core services include case management provided by social workers, health services provided by the nursing staff, physical therapy and access to dieticians, pharmacists and transportation. <\/p>\n\n\n\n

\u201cWe want to make sure that they don\u2019t go to nursing homes or hospitals,\u201d said Lori Barsoumian, New Sunrise’s charge nurse. \u201cWe\u2019re relieving caregivers from exhaustion… because we\u2019re taking care of [these individuals] between our program hours of 9 a.m. to 2 p.m.\u201d Barsoumian has worked at New Sunrise for the past three years and has witnessed first hand the impact that adult day care centers can have on the aging population.<\/p>\n\n\n\n

Each morning, Barsoumian and her team check the vitals of the center’s participants. Their main priority is monitoring the participants throughout the day, so that any health concerns or abnormalities can be properly taken care of. As the individuals that see them the most, the nursing staff is in constant communication with the families and primary caregivers, providing necessary health updates.\u00a0In some instances, Barsoumian and her team have had to handle extreme emergencies (i.e. strokes), stabilizing the situation and contacting the proper channels (paramedics, family members, etc.). “[It’s the] same way I send my kids to daycare and I know that they’re safe and… in a good place,” said Barsoumian. “That’s exactly how my patients’ families feel like. Their parents [or grandparents] are being dropped off and they’re in good hands.<\/p>\n\n\n\n

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New Sunrise offers a wide variety of health services, including daily blood pressure monitoring, insulin checks and physical therapy. (Photos by Veronique Louis-Jacques)<\/p>\n\n\n\n

However, it’s important to give those domino games some credit, as the socialization of these individuals is a crucial part to maintaining their health and overall wellbeing. Research<\/a> has shown that social isolation amongst the older population increases their risk of physical and mental illnesses like Alzheimer’s, obesity, high blood pressure, anxiety and depression, according to the National Institute of Aging. It is the social aspect that distinctly separates adult day care centers from nursing homes, or even assisted living facilities that might not enforce that same sense of togetherness.<\/p>\n\n\n\n

Ali Moore, a 76-year-old Persian participant, returns to Cedars Assisted Living each day after attending New Sunrise’s programming and notes the differences between the two. “\u201cIt is completely different,” Moore says. “When I live over there, I sleep every day. I have my own room, my own bathroom\u2026 When I come over here, they have exercises and sports and things like that.”<\/p>\n\n\n\n

\u00a0As participants returned to the center following the COVID-19 pandemic and two years of social isolation, Haroutunian was left shocked by just how drastically the health of her participants had declined. “Yes, naturally someone can say, ‘Well they got older,'” Haroutunian said. “But we’ve been operating for 20 years and have participants who have been [coming] for 20 years. The drastic decline we saw in those two years, we’ve never seen before. So, the social component goes hand-in-hand with the health care component, where both of them together are very necessary for our programs.”<\/p>\n\n\n

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In honor of Nowruz, New Sunrise participants and staff partake in the Chaharshanbe Suri, also known as the “Festival of Fire”. (Photos by Veronique Louis-Jacques)<\/p>\n\n\n\n

While California has the most adult day care centers – 302 operating centers as of 2024 – these numbers don’t represent how many of these centers struggle to stay open. \u201cAn overwhelming majority are at risk of closure,\u201d said Brian Rutledge, the newly appointed Executive Director of the California Association for Adult Day Services (CAADS).\u201cIf something big happened to them, if their HVAC system or some random thing busted, they could literally close down forever.”<\/p>\n\n\n\n

\u00a0<\/strong>Haroutunian knows of this struggle all too well, as looming payments have led to multiple conversations surrounding New Sunrise’s capability to remain open. “There was a point where we had to get multiple loans back to back just to survive [and] I\u2019ve spoken to multiple centers who are in the same boat,” Haroutunian said. <\/p>\n\n\n\n

Part of this struggle is due largely in part because of care plan system changes, resulting in delayed payments from participants. In L.A. County, adult day care centers are required to contract with five or six managed care plans (aka insurance companies). Managing all these care plans simultaneously makes it extremely challenging for the operators of these centers.\u00a0\u201cThey have different timelines, they have different paperwork, they have different everything.\u201d Rutledge said. \u201cSo, you have to do everything like five or six times just to exist day-to-day.\u201d<\/p>\n\n\n\n

Since 2012, for every five centers that have opened, three have shut down, according to Rutledge. This is largely due to lack of funding and government support, as 97% of participants who attend adult day care centers in California pay through Medi-Cal, relying on the state for funding. Through their “Raise Our Rates” campaign, CAADs has spent the last two years advocating for the state to raise the amount of money given to adult day care centers, as 90% of these facilities are operating within a regular deficit (they are not gaining income).\u00a0\u00a0<\/p>\n\n\n\n

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