Why would a nonprofit for older adults run a Montessori preschool? At Choice in Aging, preschoolers join the adult day programs each week for intergenerational activities, and the kids call the older adults their friends.
In Part 2, Kirsten Howe and Debbie Toth, President and CEO of Choice in Aging, explore the programs that make this Bay Area nonprofit stand out. Debbie explains how its Alzheimer’s and dementia program is designed around how the disease affects the brain, so participants can feel safe and experience joy. She also shares what happened when preschoolers brought Montessori activities into that program, and why she believes these friendships can stop ageism before it takes root. If you’re caring for a loved one with dementia, this episode shows that purpose and joy don’t have to fade with age. This is Part 2 of a two-part conversation. Listen to Part 1 to learn how Choice in Aging’s Medi-Cal programs help seniors stay in their own homes.
Time-stamped Show Notes:
0:00 Introduction
0:42 Kirsten introduces two standout programs: dementia day care and a Montessori preschool.
1:01 How Choice in Aging became a pioneer in day programs for mid- to late-stage Alzheimer’s.
1:45 Short activities, no open-ended questions, and seating in a circle: how the program reduces confusion.
2:26 Why anticipating needs, like a restroom trip every two hours, prevents difficult dementia behaviors.
3:00 Memory fades, but the emotion center stays strong: what makes a good day with dementia.
3:31 Support for caregivers, including monthly trainings and retreats for those caring for loved ones with Alzheimer’s.
4:43 Who Choice in Aging serves, and how scholarships ensure no one is turned away.
5:22 How a refugee resettlement partnership led to Russian- and Farsi-speaking day programs.
6:30 Supporting older Afghan refugees who lived through the Taliban’s first rule.
7:24 The day the Afghan women in the program claimed it as a women-only space.
8:34 Handmade baby clothes, an orphanage in Afghanistan, and the power of feeling useful at any age.
10:19 Why a nonprofit for older adults runs a preschool, and the board chair’s advice: “Just license it.”
11:44 Keeping the preschool teachers on staff, with one condition: create intergenerational programming.
12:38 You don’t need a shared language to share a friendship: lessons from the first year.
13:12 The preschoolers call the older adults their friends, and why that could stop ageism early.
14:15 Children and adults with Alzheimer’s master the same Montessori activities, and the research behind it.
15:32 Jewelry making, adaptive bowling, and an ’80s dance party: a week of intergenerational activities.
16:58 Why someone who can’t form a sentence can still sing “Row, Row, Row Your Boat.”
17:33 Why no one should age out of meaning, joy, or purpose.
18:10 How to follow, support, or tour Choice in Aging.
Get in touch with Debbie!
Debbie Toth, President and CEO
Choice in Aging
dtoth@choiceinaging.org
(925) 682-6330
https://choiceinaging.org/
Transcript:
Hello, and welcome to Absolute Trust Talk. I’m Kirsten Howe, host of Absolute Trust Talk and managing attorney at Absolute Trust Counsel. I’m here today with my guest, Debbie Toth, President and CEO of Choice in Aging. This is our second episode together. Last episode, we talked about Choice in Aging, a nonprofit here in Contra Costa County. Debbie is the president and CEO, and she’s been with the organization for a very long time. We’re very fortunate to have her back, because I want to focus on a couple of their programs that I find fascinating. Debbie, thank you, and welcome back.
Thank you for having me back.
The two programs that caught my eye are your dementia day care program and, nobody’s going to believe this, a Montessori school. Let’s start with the dementia day program you run at Choice in Aging.
Yes, thank you. We launched our adult day health care center, the 16th licensed adult day health care center in the state of California, in 1980. There was a growing need for programs that specialized in mid- to late-stage Alzheimer’s and related dementias, and there was no model for that. So the California Department of Aging funded a small cohort of day programs to operationalize a program for people with mid- to late-stage Alzheimer’s or related dementia and their family caregivers. This program looked beyond the four walls of the day program and was specific to the disease process we know happens with Alzheimer’s and dementia. It’s called the Alzheimer’s Day Care Resource Center. It actually still exists in California state statute; it’s just not funded, but that’s a story for another day.
The program can follow an adult day health care model, where you have the same staffing as a skilled nursing facility, or a social day program model, where you don’t have medical staffing, just activity staff. It is so different from a regular day program. All of the activities are shorter in duration. They don’t have open-ended questions. They typically happen in a circle, so people have visual cues as to what they’re supposed to be doing. That way, it’s as independent as possible, it’s predictable, and it’s visible. They can see what they’re supposed to be doing, so you don’t have moments of confusion or feeling lost or like you don’t belong.
If you create programming and an environment that is tailored to what’s happening in the brain through the disease process, you can have much greater success. You don’t have the behaviors people typically see in the later stages of Alzheimer’s and dementia, because you’ve already anticipated what that looks like and corrected for it. For example, if you take somebody to the restroom every two hours who doesn’t know they have to go to the bathroom, they’re not going to be incontinent. So they’re not going to have that moment of feeling embarrassed, angry, upset, or confused.
You can prevent those things from happening, because the emotion center in the brain is still intact. The short-term memory is gone. Often, the midterm memory is gone. Executive functioning is gone. But that emotion center in the brain is strong. So if somebody can feel loved, cared for, and safe, and experience joy, they’re going to miss all the bad stuff during the day. Then they’re going to go home to their loved one at night, ready to go to sleep, and they’re going to be happy. It’s going to be a successful day.
We launched that pilot program in 1985 at Choice in Aging, and it has been a magical program for caregivers. We do community education around Alzheimer’s. We do monthly caregiver support. Now we’ve got funding for monthly trainings we call caregiver retreats. We’re doing a lot, because by far the most burnt-out caregivers are those caring for somebody with mid- to late-stage Alzheimer’s.
What’s beautiful is that our adult day health care program also has a Farsi-speaking program, a Russian-speaking program, and a general program. Anybody in any of those programs can come in with early-stage dementia, and as the disease progresses, they can move into our mid- to late-stage program without ever having to go to a different building. They’re coming to the same place on the same vehicle. The only thing that changes is the room they’re in. And we are gifted to have a coordinator in that Alzheimer’s Day Care Resource Center who speaks Farsi, Russian, and English.
Oh my gosh.
Often with dementia, if English is not your first language, you’ll revert to your native language.
Okay.
And we can accommodate that, which is a beautiful thing. Like I said, we have these multicultural programs and a general program. We serve veterans; we have a contract with the Veterans Administration. We serve people with developmental disabilities; we have a contract with the regional center. We serve people who pay privately and people who are on Medicaid, and we don’t turn away anybody who can’t afford the services. We have a scholarship fund so we can offer sliding-scale scholarships. We want to prevent people from going into skilled nursing facilities, and we want them to experience community and joy.
At first, we had just two programs: the general program and the Alzheimer’s program. Then, in the late 1990s, Jewish Family and Children’s Services came to us and said, “We have two refugee populations coming into the Bay Area in waves, and we’re helping to settle them. But there are a lot of older adults who are monolingual speakers of Farsi and Russian, and we don’t really have a place for them. Would you be interested in partnering with us to launch programs specifically in those languages?” And we said, “Sure, why not?”
The Russian program came first, in 1999. At that time, it was predominantly Jewish and predominantly Russian, although there were some people from surrounding regions. The older adults then had lived through the USSR, so regardless of what country they were from, they had to speak Russian. Today, we have people from Ukraine, Russia, Georgia, and all around that area. It’s not predominantly Jewish anymore; it’s a big mix of everyone, and it’s grown over the years.
Then, in 2001, came the Farsi-speaking program. I should say Farsi-Dari. We’ve always called it Farsi, but the Dari dialect is what they speak in Afghanistan. Folks from Iran were also in the program, but it was mostly people from Afghanistan. That population had a very high primary diagnosis of post-traumatic stress disorder. They had lived through the first round of the Taliban and seen things you and I cannot begin to imagine, so there was a lot of mental health support and a lot of work with this population.
When I started there in 2002 as the program director, there were two older gentlemen and a younger gentleman in the program. The two older gentlemen passed away, and the younger gentleman moved out of the area. Then I was touring a new man who speaks Farsi through the program: “This is Mr. Muhammad, and he’s going to be joining the program.” And the ladies said, “No, that’s his program,” pointing to the general program. I’m thinking, “No, no, he speaks Farsi.” And the women said, “We know. That’s his program.”
So I finished the tour, dropped Mr. Muhammad off with the social worker, went back, and asked, “Can somebody tell me what’s happening here?” And the women said, “We are Muslim, and in our culture, when men are in the room, we can’t remove our headscarves. We can’t dance. We can’t talk about certain topics. We love the men, and we love our culture, and we’re fine with that, but not here. This is our own space. Moving forward, this program is women only.” And it has been women only ever since.
I share this because building communities around the people creates things we never anticipated. We have so many lessons learned, unintended positive outcomes of creating person-centered spaces, and this was one of them. The women were getting a lot of therapy, and the therapist came to me and said, “Part of our challenge in getting these women to the other side of their trauma is that they feel like they’re just a burden to their families.” In Afghan culture, as a woman ages, she lives with her son, but her daughter comes over and provides the care. Most of these women had not been educated and couldn’t read or write. Now they were at an age where they needed support. They weren’t cooking or cleaning in the house. They were living with their sons, and their daughters were caring for them. They just felt like a burden.
Our therapist, Mona Afari, bless her heart, said, “We’ve got to focus on the things they can do.” They can needlepoint, knit, crochet, and sew. They make incredible things with their hands. Our program coordinator took the baby sweaters, booties, and hats the women had made and sent them to an orphanage in Afghanistan. Mind you, this was the early 2000s, before social media. The orphanage took a picture of the children wearing the sweaters, booties, and caps the women had made and sent those pictures back. The women were looking at orphaned kids in their home country wearing things they had made with their own hands, and it was life-changing for them. They started crocheting slippers, selling them at our crab feed, and buying more yarn. It was the most beautiful evolution.
If you give people the space and they feel they belong, it’s amazing what they can create and the agency they find in themselves. Feeling like they’re contributing in some way is an incredibly beautiful thing. We should never age out of that. That was our big, beautiful lesson there.
And then you mentioned our Montessori preschool. Most people say, “Wait, Choice in Aging, why do you have a preschool?” Listen, I asked the same question.
How did that come about?
We were leasing space to a preschool because, as I mentioned, Medi-Cal doesn’t pay what it costs to provide the services, so we had to find ways to bridge that gap. When we started launching our Aging in Place campus, we didn’t renew our tenant leases for five years; we renewed them for two. The preschool that had been leasing from us for more than 20 years said, “We’re out of here.” And my board chair said, “Gee, Deb, didn’t you always want to do intergenerational programming?” Why, yes, I did. And he said, “Then just license the preschool.”
Just license the preschool. I said, “That is insane. I’m not licensing a preschool.” Two weeks later, we were licensed. It was a lot of paperwork, but it was relatively easy. The space was already licensed, so I could look at that license and replicate some of it. I don’t know if I should admit this on a recorded show, but I plagiarized some other preschool handbooks to put ours together. I used what was out in the universe to assemble a package, and we were approved in literally two weeks.
And bless Gina, who was the site director at that preschool. The preschool had given its teachers notice, so they were, I think, a little desperate for a job. I went over and said, “How would you like to stay at this preschool and keep doing everything you’re doing now, but work for Choice in Aging? We’ll keep you whole with your benefits, your pay, everything. But there is a caveat. You need to do intergenerational programming.” She said, “What is that?” And I said, “I don’t really know. You’re going to figure it out.” I didn’t say I would figure it out. I said she was going to figure it out, and she did.
And it wasn’t just in our general program. It was intergenerational programming in the general program, the Russian program, the Farsi program, and the mid- to late-stage Alzheimer’s program. You don’t need to share a language to share a friendship. It wasn’t easy in the beginning. “We’re going to do an activity together for an hour.” No, that’s way too long for preschool students and older adults. There was a lot of iteration in that first year, but by the end of it, Gina knew which activities worked in which programs, how long they should last, and which kids really thrived in that environment.
When the preschool had been part of Choice in Aging for a year, I went over with balloons and bagels to celebrate the teachers’ one-year anniversary. I walked in, the kids were in circle time with Gina, and Gina said, “Do you know who this lady is?” And the kids said, “Yes, she works with our friends next door.” They called the older adults their friends. I thought, “Oh my gosh, that’s so sweet.” I was blown away, because to me, the AARP-style intergenerational model is one where the older adult pours into the child, teaching them to read. It’s a one-way street. But no, this was a friendship.
Not only were these two groups coming together and becoming friends, but it dawned on me that these little humans are never going to grow up to be ageist, because they have friends who are older adults. You can bust ageism before it takes hold. Think of how much it takes to eradicate racism, sexism, and all the other isms. But here we are: if we just bring these populations together, we can prevent an ism from ever taking root. It was the most beautiful thing.
Then add to that, something magical was happening in our Alzheimer’s program during intergenerational activities. These are people with mid- to late-stage Alzheimer’s. Many of them aren’t putting together full sentences anymore, and they need quite a bit of support. Gina was packing carts with Montessori activities from the preschool room and towing them over to the Alzheimer’s program, and in they would go. It was magic. Whatever the Montessori activity was, whether it was putting little balls into boxes or something else, both the older adult with Alzheimer’s disease and the young child were successfully navigating it on their own.
I said, “What is happening in here?” And Gina said, “I don’t know.” So I googled it: what is this thing between Montessori and Alzheimer’s? It turns out there’s a whole body of study on that in Australia, and there was a certification program. Gina took the course, and she’s now certified in Montessori and dementia practices. When we build our Aging in Place campus, the preschool will connect by a breezeway to the Alzheimer’s program, and we’ll have a dedicated space where they can share their Montessori activities, so they no longer have to bring over a cart.
That’s fantastic. Tell me, what does the intergenerational piece look like on a daily or weekly basis?
We typically do one or two intergenerational activities a week, because the kids are in school. It’s a Montessori preschool, not a day care, so the kids have curriculum all day long. They’re not combined all the time, but once or twice a week, the kids come over to the general program, the Russian program, the Farsi program, or the Alzheimer’s program. We do it in all the rooms, and different activities really stick in different rooms.
With the Farsi women, making jewelry and art are two really loved activities they do together. What’s cute is that the little humans find their older human. They run in, they know which person they want to sit with, and they develop these friendships. In the Russian program, it’s games, storytelling, and seated exercise. In the general program, we’re now doing bowling. That’s a new activity this week, with adaptive bowling gear. We sit in a circle and partner an older adult with a child, and they bowl together. It’s very precious. We do seated yoga. We do mindfulness with the littles and the older adults. We do live music and dance. We do theme days, too. We had an ’80s dance party where everybody dressed up, a singer came in to perform ’80s music, and we played an intergenerational ’80s dance game. That’s all in the general program.
In the Alzheimer’s program, we do story time, seated exercise, and music. We sing “Row, Row, Row Your Boat” together, songs you can teach children that older adults remember. Somebody with mid- to late-stage Alzheimer’s may not be able to put together a sentence anymore, but they can still sing a song. They can still sing “Row, Row, Row Your Boat.” Finding those intersections and capitalizing on them is what makes the magic happen. It’s worth coming for a visit, because I promise you, you haven’t seen anything that touches your heart in this way.
That’s great. Lately on the podcast, I’ve been trying to highlight people who are doing interesting, different things to make older adults’ lives better. Not doctors, but people asking how we make life better and how we honor older adults.
Yes. Because you shouldn’t age out of meaning, joy, or purpose in your life.
Right. This intergenerational program of yours caught my eye, and that’s why I invited you. Thank you so much for coming to talk with us. Remind listeners how they can help Choice in Aging.
Thank you. Our website is choiceinaging.org, all one word, and that’s our handle on all our social channels, too. You can find us on Facebook, LinkedIn, TikTok, and Instagram. We’re on all the channels. If you ever want a little splash of joy in your life, go to our social media. We have an incredible social media manager, Rachel. I call her a unicorn. She shares videos, pictures, and stories on all the different platforms so people can see and feel what we do. You can donate, volunteer, come in for a tour, learn about the revolutionary Aging in Place campus we’re going to build, or just tag along with us for joy, however you want.
There you go. Remember, everyone, Choice in Aging is a nonprofit organization, so any financial support is welcome. Thank you so much.
You’re absolutely welcome.
My guest today has been Debbie Toth with Choice in Aging. Thank you all so much for watching and listening. I look forward to connecting with you next time.
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