Sounds of singing and laughing from another room drift into the "quiet room" where Eleanor Dye sits with her granddaughter, Dawn Jarriel.
Mrs. Jarriel has come to the Jud C. Hickey Adult Day Center run by the Augusta chapter of the Alzheimer's Association to pick up one of her two grandmothers stricken by the disease.
For a woman who is losing pieces of her past to the disease, Mrs. Dye, 81, is sure about what she wants in her future: She wants to stay at home.
"I'd like to as long as I can get somebody to stay with me," she says, looking up at the woman whose home she shares. "You know how it is; they could move off."
"We're not going anywhere, Grandma," Mrs. Jarriel says tenderly, taking her hand.
Neither, they hope, is the day center.
The national Alzheimer's Association is in the midst of a reorganization that it hopes will provide better assistance to families and patients with more consistent services and salaries for staff. Meeting the new qualifications required of an "area chapter," however, would mean raising a roughly $750,000 annual budget. This past fiscal year, the Augusta chapter's budget was about $533,000.
Like many chapters nationwide, the Augusta group must look at becoming part of a larger organization to meet the new standards by July 2002. The city briefly flirted with the idea of forming a combined chapter with the smaller organizations in Macon and Albany, but even that would not have met the new requirements, said Augusta Executive Director Candace Dunn. Recently, the Augusta board voted to explore joining the chapter in Atlanta, now called the Greater Georgia Chapter because it includes a network that stretches across the state from the Tennessee and Alabama borders to Florida.
In other states, such as Arizona and Oregon, the local chapters already have voted to form a single statewide chapter, said Patrick Maynard, associate director in chapter services/structural initiatives such as the realignment for the national group.
The potential problem for Augusta comes in what the chapters emphasize. Augusta is involved in direct services, such as running the day center and mobile units and providing in-home respite care. Augusta is one of only 12 chapters in the country running a day center. The Atlanta chapter is focused on education, training and referral.
"We're working as a large single team with a common vision and common mission and common goals," said Jan Bequeath, executive director of Greater Georgia. "The purpose of the reorganization is really to strengthen services and to kind of standardize services and to be able to reach more people."
Nationally, the most pressing need is promoting research toward a cure, Dr. Maynard said.
"Our number one goal, written into our mission, is abolishing Alzheimer's altogether, so our greatest focus is research," Dr. Maynard said. "We feel that we're close, and we're driving very hard to that end, to abolish Alzheimer's and provide prevention and a cure."
Part of the reason for the alignment is to become more efficient and help chapters raise more money.
"If you look at any voluntary health organization, they're all looking at how to position themselves to serve better because the demand for services is just going through the ceiling and the competition for funding is increasing," Dr. Maynard said.
Concentrating administration in a larger organization such as the area chapter frees local chapters to do more and provides economies of scale, he argued. Through realignment, the number of local chapters and offices has gone from more than 200 to 173 as of July 1.
"The numbers are going to be reduced, but that wasn't the goal. The goal was not to cut chapters out or abolish chapters," Dr. Maynard said. "The goal was to provide better services, and more effectively and efficiently."
And though the national chapter does not endorse running a day center, it is not precluded, Dr. Maynard said.
"It's something that not many chapters do," Dr. Maynard said. "And the research data we got back from the chapters indicated that that's not an area we want to focus on in the future. There's no policy that says a chapter can't do those things. But in the future, as realignment occurs and we become what we want to be, we will have very stringent standards for any chapters that do end up having those sorts of services."
That's something Augusta is already taking into account, Mrs. Dunn said.
"What national says is it doesn't want you to have day centers," Mrs. Dunn said. "However, if you're going to have day centers, you must abide by A, B, C. And that's what we've been doing, making sure we abide by A, B, C."
New, more stringent standards are still being formulated, Dr. Maynard said.
Kevin Howard and other Augusta board members are adamant that those services will not end.
"The Augusta chapter will be in existence," Mr. Howard said. "The services will be available. And most importantly, the day center will still be in operation."
To truly understand why that commitment is so strong, one must talk to people such as Mr. Howard, whose father, Dr. Matthew Howard, once relied on day centers.
In November 1996, family members and friends began to suspect that something might be wrong with the popular Augusta pediatrician. With a busy practice in which he shuttled between different offices, it may have taken longer for staffers and friends to piece it together, Mr. Howard said. It was little things - leaving car doors open, leaving the refrigerator door open and walking away.
He kept a calendar showing where he was supposed to be at a particular time on a particular day.
"He had difficulty reading the calendar," Mr. Howard said. But Dr. Howard was only in his mid-50s, Mr. Howard said.
"You just don't think it's going to be Alzheimer's at that age," he said.
Finally, Dr. Howard was diagnosed, confirming his own fears, Mr. Howard said. He knew what was coming, having seen his own mother suffer from the disease. And he was changed, Mr. Howard said. It was evident as he watched his father at a party soon after.
"He wasn't as talkative as he used to be," Mr. Howard said. "He was afraid he was repeating himself and what he was saying wasn't making sense."
The family became involved in the Augusta chapter immediately for support, said Dr. Howard's wife, Beverly.
"Initially, it was hard to go into that center because it's letting go of your loved one and turning them over to someone else," Mrs. Howard said. "(But) it's such a wonderful support for the patients and their caregivers."
Having grandmothers on both sides of her family affected should give Mrs. Jarriel pause, but it's not something she dwells on. Instead, she takes them three times a week to the center, where the grandmothers have developed a friendly rivalry over their craft projects.
"The day care was just something they needed," Mrs. Jarriel said. Before, "they were just sitting around watching TV and dozing. They've perked up a lot."
Without it, "I don't really know what I would do."
For his part, Dr. Maynard said, he didn't think the day center would be eliminated by realignment, although the Augusta chapter might want to explore spinning it off or some other option.
`It's a good program," he said. "Somebody is going to be running that program, I think."
Reach Tom Corwin at (706) 823-3213 or firstname.lastname@example.org.