February 27, 2025 • 13 mins
Jo Jo is settling into The Bridge Center, but something isn’t right. He hesitates before getting on the van, comes home tense, and even has a small unexplained bruise. His mother, Rosa, senses something is wrong—and she’s right. A newly hired staff member, Jamie Peterson, lacks the experience and training needed to work with individuals with disabilities, and it’s affecting Jo Jo and others at the center. In this episode, we explore the underfunded and underregulated world of adult day programs, why so many operate with underqualified staff and high turnover, and what caregivers can do to hold programs accountable.
Because finding the right program isn’t just about getting in—it’s about making sure it’s safe, supportive, and truly the right fit.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Welcome back to Take Care ofTime, the Tales at Exhales of
(00:03):
Caregivers.
I'm your host, Beverly Nance andthis is episode three of the
Bridge Center.
Our series Exploring Adult Dayprograms and the families who
rely on them.
In our last episode, we followedJojo's first days at the Bridge
Center.
His moments of adjustment,Rosa's unease with her new
reality and Georgia's quietencouragement for her to
(00:26):
rediscover a piece of herself.
But as we all know, transitionsaren't always smooth.
For many families, finding theright program is only half the
battle.
The real challenge begins oncetheir loved ones are inside
navigating new environments, newroutines, and new people.
(00:46):
This episode is about trust, howquickly it can be given, how
easily it can be broken, and theuneasy feelings when something
just isn't right, because todaysomething isn't right at the
Bridge Center and Rosa knows it.
(01:33):
Rosa stands by the front window.
Arms crossed watching as thebridge center's van pulls up.
It's been nearly two weeks sincejojo started, and until now
things have gone as well as shecould have hoped.
He doesn't seem thrilled toleave in the morning, but he
doesn't resist either a neutralreaction, which for jojo is a
(01:53):
win.
But today is different.
As Lisa, the transportation aideslides open the van door.
Jojo hesitates.
He stays in his seat, grippingthe edge of his hoodie sleeve
tightly rubbing the fabricbetween his fingers, his go-to
soothing motion.
Hey buddy, we're home.
(02:15):
Hey, jojo.
We're home.
Lisa coax is gently You okay?
Jojo Finally moves.
But there's no hum under hisbreath.
Like usual, no rocking, just aslow, deliberate step off the
Van Rosa notices immediately.
His whole body is tense.
(02:35):
Lisa steps down behind him andhands rosa the clipboard with
the daily notes.
She lowers her voice.
He seemed off today.
Didn't wanna go to the rec room.
He didn't eat lunch either.
Rosa's stomach tightens.
Did.
Did something happen?
Rosa shrugs.
Lisa Shrugs.
(02:55):
Not that I know of, might justbe adjusting, but Rosa isn't
convinced.
She thinks Lisa takes Jojo'sbackpack and leads him inside.
He heads straight to his usualspot by the window.
No humming.
No contented rocking, juststaring Something's wrong.
(03:15):
She just doesn't know what.
The next morning at the BridgeCenter staff members gather in
the break room at the center ofattention is their new hire.
Jamie Peterson.
Jamie is a 20-year-old juniorcollege student.
She took the job because itseemed easy, a way to make money
(03:36):
while she figured out her nextsteps.
But to the seasoned staff,something is already clear.
Jamie doesn't understand thepopulation she's working with.
Unlike teachers or therapistswho spend many years studying
autism and intellectualdisabilities, many day program
employees receive little to noformal training before stepping
(03:57):
into the role.
The pay is low.
Barely above minimum wage, andthe turnover rate is extremely
high.
Jamie received a one dayorientation, a PowerPoint
presentation on basic safety, atour of the facility, and a few
shadow shifts with experiencedstaff.
(04:18):
That was it.
Yes, that was it.
No in-depth training oncommunication strategies,
behavioral supports, or how tohandle sensory overload.
Daniel, the staffer who isassigned to jojo watches as
Jamie scrolls through her phone,between conversations clearly
disengaged.
(04:38):
when another staff asks how herfirst week has been, she laughs.
It's fine.
Just gotta get used to theseweird behaviors.
She says casually DanielStiffens.
They're not weird.
Their communication.
Jamie Shrugs.
You know what I mean?
But Daniel doesn't like it, andsoon neither will Rosa.
(05:02):
Over the next few days, Rosastarts noticing patterns.
Jojo once neutral about dropoffs, now hesitates before
getting on the van, his clothescome home wrinkled in a way that
suggests that he's been holdingonto them tightly throughout the
day.
Then there's the unexpectedbruise on his forearm.
It's small, barely noticeable,but Rosa notices everything.
(05:26):
Jo Jo, she says softly sittingbeside him.
Did something happened today?
He doesn't respond, but his handmoves to his sleeve rubbing
anxiously that night.
Rosa can't sleep.
Something is wrong, and she'sgoing to find out what.
The next morning, Rosa dropsJojo off instead of his using
(05:47):
the van service.
She parks outside the bridgecenter and watches as he walks
in.
Then she waits.
15 minutes later, she sees her.
Jamie Peterson steps outsidestanding near the entrance,
scrolling through her phone.
A few minutes later, she headsback inside, swinging the door
carelessly, letting it slambehind her.
(06:10):
Rosa feels her pulse Quicken.
If Jamie is this disengaged inthe parking lot, what's she like
inside?
Rosa doesn't wait.
She marches inside and asks tospeak to the program director.
She lays out her concerns.
Jojo's change in behavior, thebruises, the hesitancy to go
inside.
(06:31):
I want to know who's workingwith my son.
Rosa says her voice even, butfirm.
I want to know what's going on.
The director listens carefullynodding, then she sigh.
You're not the first parent tosay something about Jamie.
That's all Rosa needs to hear bythe end of the week.
(06:51):
Jamie is no longer employed atthe Bridge Center.
Finding the right day programisn't just about picking a place
with good reviews.
It's about ongoing vigilance,about paying attention to the
details that others might miss.
Jamie was a bad fit, but thereal danger was in what might
have happened if no one spokeup.
(07:13):
Rosa knew something was wrongand she acted.
Because being a caregiverdoesn't stop when your loved one
enters a program.
Advocacy is forever.
So you might be interested inwhy day programs are
understaffed and underpaid.
The situation with Jamie isn'tunique across the country.
(07:35):
Adult day programs struggle withstaffing issues, not because
they aren't good dedicatedworkers, but because the system
itself isn't built to supportand retain them.
Low pay and high overturn.
Most day programs rely onMedicaid funding, which set
strict reimbursement rates.
(07:55):
As a result, staff wages areoften just above minimum wage,
making it hard to attract andretain skilled professionals.
Many leave for better payingjobs in retail or food service
leading to a constant cycle ofturnover.
Minimal training.
Unlike teachers or therapistsday program, staff don't require
(08:17):
certifications.
Many receive only a one day or aone week crash course covering
safety procedures, but not indepth education on working with
people with disabilities.
Lack of oversight.
Regulations exist, butenforcement varies.
Some programs barely meet thecompliance requirements, and
(08:37):
without strong parental advocacyproblems often go unnoticed,
high demand and limited funding.
Thousands of individuals withdisabilities rely on day
programs, but funding hasn'tkept pace with the need.
That means centers are oftenshort staffed with a high staff
to client ratio, which makesquality support difficult.
(09:04):
So you're wondering what canparents and caregivers do?
The system won't changeovernight, but caregivers do
have power.
Here are a few things thatparents can push for, for better
standards.
Ask questions before enrollingyour loved one in a program.
Ask about the staff training,the turnover rates and pay.
A good program should betransparent about these issues.
(09:28):
Advocacy for policy changes.
Join parent advocacy groupswhich push for better Medicaid
reimbursement rates, which wouldallow programs to pay staff more
and improve training.
File complaints when necessary.
If you suspect neglect or poortreatment, report it to your
state's Medicaid oversightoffice.
Many states have online portalsfor filing concerns, support
(09:53):
legislations for higher wages.
Some states have introducedbills to increase wages for
direct care workers.
Caregivers can contact theirlegislators to support these
efforts.
Stay involved even afterchoosing a program regularly.
Check in on your loved one's.
Experience.
pop-in visits, reviewing dailyreports and building
(10:14):
relationships with staff canhelp ensure quality care.
Finally, day programs can be alifeline or a liability and the
difference often comes down towho's running them and who's
advocating for change.
Caregivers like Rosa aren't justfighting for their own child.
They're pushing for a systemthat works for everyone.
(10:36):
Until that happens, stayinformed.
Speaking up and holding programsaccountable is the best way to
ensure that the right people arecaring for our most valuable
loved ones.
In our next episode, we'llexplore what happens after trust
is broken.
How does the Bridge Centerregain Rosa's confidence?
How does jojo adjust after ashakeup to his routine?
(10:59):
And what can other parents learnfrom this experience?
Stay tuned for episode four ofthe Bridge Center.
If you've ever faced challengeswith the day program, I'd love
to hear your story.
Reach out and contact us atpodcast@takecaretime.com.
We'd love to hear from you.
(11:22):
Being a caregiver isn't just arole, it's a full-time
responsibility.
And while you're constantlylooking out for your loved one
who's looking out for you,that's where the take care of
time and respite box comes indesigned specifically for
caregivers.
This box is filled withthoroughly curated self-care
essentials to help you recharge.
Inside, you'll find relaxationtools.
(11:45):
Comforting treats self-careactivities to help you unwind
during your well earned breakbecause you deserve care too.
Give yourself permission topause.
Visit takecaretime.com to orderyour respite box today.
Taking care of yourself isn'tselfish is essential.
(12:05):
Please note that this episodefeatures reenactments and
dramatized details.
While in most cases the exactverbatim dialogue may not be
known.
All dramatizations are groundedin thorough research and crafted
to honor the stories shared torespect the privacy and
confidentiality of theindividuals involved names, and
some identifying details havebeen changed.
(12:28):
Until next week, take care.
Welcome back to Take Care ofTime, the Tales at Exhales of
(00:03):
Caregivers.
I'm your host, Beverly Nance andthis is episode three of the
Bridge Center.
Our series Exploring Adult Dayprograms and the families who
rely on them.
In our last episode, we followedJojo's first days at the Bridge
Center.
His moments of adjustment,Rosa's unease with her new
reality and Georgia's quietencouragement for her to
(00:26):
rediscover a piece of herself.
But as we all know, transitionsaren't always smooth.
For many families, finding theright program is only half the
battle.
The real challenge begins oncetheir loved ones are inside
navigating new environments, newroutines, and new people.
(00:46):
This episode is about trust, howquickly it can be given, how
easily it can be broken, and theuneasy feelings when something
just isn't right, because todaysomething isn't right at the
Bridge Center and Rosa knows it.
(01:33):
Rosa stands by the front window.
Arms crossed watching as thebridge center's van pulls up.
It's been nearly two weeks sincejojo started, and until now
things have gone as well as shecould have hoped.
He doesn't seem thrilled toleave in the morning, but he
doesn't resist either a neutralreaction, which for jojo is a
(01:53):
win.
But today is different.
As Lisa, the transportation aideslides open the van door.
Jojo hesitates.
He stays in his seat, grippingthe edge of his hoodie sleeve
tightly rubbing the fabricbetween his fingers, his go-to
soothing motion.
Hey buddy, we're home.
(02:15):
Hey, jojo.
We're home.
Lisa coax is gently You okay?
Jojo Finally moves.
But there's no hum under hisbreath.
Like usual, no rocking, just aslow, deliberate step off the
Van Rosa notices immediately.
His whole body is tense.
(02:35):
Lisa steps down behind him andhands rosa the clipboard with
the daily notes.
She lowers her voice.
He seemed off today.
Didn't wanna go to the rec room.
He didn't eat lunch either.
Rosa's stomach tightens.
Did.
Did something happen?
Rosa shrugs.
Lisa Shrugs.
(02:55):
Not that I know of, might justbe adjusting, but Rosa isn't
convinced.
She thinks Lisa takes Jojo'sbackpack and leads him inside.
He heads straight to his usualspot by the window.
No humming.
No contented rocking, juststaring Something's wrong.
(03:15):
She just doesn't know what.
The next morning at the BridgeCenter staff members gather in
the break room at the center ofattention is their new hire.
Jamie Peterson.
Jamie is a 20-year-old juniorcollege student.
She took the job because itseemed easy, a way to make money
(03:36):
while she figured out her nextsteps.
But to the seasoned staff,something is already clear.
Jamie doesn't understand thepopulation she's working with.
Unlike teachers or therapistswho spend many years studying
autism and intellectualdisabilities, many day program
employees receive little to noformal training before stepping
(03:57):
into the role.
The pay is low.
Barely above minimum wage, andthe turnover rate is extremely
high.
Jamie received a one dayorientation, a PowerPoint
presentation on basic safety, atour of the facility, and a few
shadow shifts with experiencedstaff.
(04:18):
That was it.
Yes, that was it.
No in-depth training oncommunication strategies,
behavioral supports, or how tohandle sensory overload.
Daniel, the staffer who isassigned to jojo watches as
Jamie scrolls through her phone,between conversations clearly
disengaged.
(04:38):
when another staff asks how herfirst week has been, she laughs.
It's fine.
Just gotta get used to theseweird behaviors.
She says casually DanielStiffens.
They're not weird.
Their communication.
Jamie Shrugs.
You know what I mean?
But Daniel doesn't like it, andsoon neither will Rosa.
(05:02):
Over the next few days, Rosastarts noticing patterns.
Jojo once neutral about dropoffs, now hesitates before
getting on the van, his clothescome home wrinkled in a way that
suggests that he's been holdingonto them tightly throughout the
day.
Then there's the unexpectedbruise on his forearm.
It's small, barely noticeable,but Rosa notices everything.
(05:26):
Jo Jo, she says softly sittingbeside him.
Did something happened today?
He doesn't respond, but his handmoves to his sleeve rubbing
anxiously that night.
Rosa can't sleep.
Something is wrong, and she'sgoing to find out what.
The next morning, Rosa dropsJojo off instead of his using
(05:47):
the van service.
She parks outside the bridgecenter and watches as he walks
in.
Then she waits.
15 minutes later, she sees her.
Jamie Peterson steps outsidestanding near the entrance,
scrolling through her phone.
A few minutes later, she headsback inside, swinging the door
carelessly, letting it slambehind her.
(06:10):
Rosa feels her pulse Quicken.
If Jamie is this disengaged inthe parking lot, what's she like
inside?
Rosa doesn't wait.
She marches inside and asks tospeak to the program director.
She lays out her concerns.
Jojo's change in behavior, thebruises, the hesitancy to go
inside.
(06:31):
I want to know who's workingwith my son.
Rosa says her voice even, butfirm.
I want to know what's going on.
The director listens carefullynodding, then she sigh.
You're not the first parent tosay something about Jamie.
That's all Rosa needs to hear bythe end of the week.
(06:51):
Jamie is no longer employed atthe Bridge Center.
Finding the right day programisn't just about picking a place
with good reviews.
It's about ongoing vigilance,about paying attention to the
details that others might miss.
Jamie was a bad fit, but thereal danger was in what might
have happened if no one spokeup.
(07:13):
Rosa knew something was wrongand she acted.
Because being a caregiverdoesn't stop when your loved one
enters a program.
Advocacy is forever.
So you might be interested inwhy day programs are
understaffed and underpaid.
The situation with Jamie isn'tunique across the country.
(07:35):
Adult day programs struggle withstaffing issues, not because
they aren't good dedicatedworkers, but because the system
itself isn't built to supportand retain them.
Low pay and high overturn.
Most day programs rely onMedicaid funding, which set
strict reimbursement rates.
(07:55):
As a result, staff wages areoften just above minimum wage,
making it hard to attract andretain skilled professionals.
Many leave for better payingjobs in retail or food service
leading to a constant cycle ofturnover.
Minimal training.
Unlike teachers or therapistsday program, staff don't require
(08:17):
certifications.
Many receive only a one day or aone week crash course covering
safety procedures, but not indepth education on working with
people with disabilities.
Lack of oversight.
Regulations exist, butenforcement varies.
Some programs barely meet thecompliance requirements, and
(08:37):
without strong parental advocacyproblems often go unnoticed,
high demand and limited funding.
Thousands of individuals withdisabilities rely on day
programs, but funding hasn'tkept pace with the need.
That means centers are oftenshort staffed with a high staff
to client ratio, which makesquality support difficult.
(09:04):
So you're wondering what canparents and caregivers do?
The system won't changeovernight, but caregivers do
have power.
Here are a few things thatparents can push for, for better
standards.
Ask questions before enrollingyour loved one in a program.
Ask about the staff training,the turnover rates and pay.
A good program should betransparent about these issues.
(09:28):
Advocacy for policy changes.
Join parent advocacy groupswhich push for better Medicaid
reimbursement rates, which wouldallow programs to pay staff more
and improve training.
File complaints when necessary.
If you suspect neglect or poortreatment, report it to your
state's Medicaid oversightoffice.
Many states have online portalsfor filing concerns, support
(09:53):
legislations for higher wages.
Some states have introducedbills to increase wages for
direct care workers.
Caregivers can contact theirlegislators to support these
efforts.
Stay involved even afterchoosing a program regularly.
Check in on your loved one's.
Experience.
pop-in visits, reviewing dailyreports and building
(10:14):
relationships with staff canhelp ensure quality care.
Finally, day programs can be alifeline or a liability and the
difference often comes down towho's running them and who's
advocating for change.
Caregivers like Rosa aren't justfighting for their own child.
They're pushing for a systemthat works for everyone.
(10:36):
Until that happens, stayinformed.
Speaking up and holding programsaccountable is the best way to
ensure that the right people arecaring for our most valuable
loved ones.
In our next episode, we'llexplore what happens after trust
is broken.
How does the Bridge Centerregain Rosa's confidence?
How does jojo adjust after ashakeup to his routine?
(10:59):
And what can other parents learnfrom this experience?
Stay tuned for episode four ofthe Bridge Center.
If you've ever faced challengeswith the day program, I'd love
to hear your story.
Reach out and contact us atpodcast@takecaretime.com.
We'd love to hear from you.
(11:22):
Being a caregiver isn't just arole, it's a full-time
responsibility.
And while you're constantlylooking out for your loved one
who's looking out for you,that's where the take care of
time and respite box comes indesigned specifically for
caregivers.
This box is filled withthoroughly curated self-care
essentials to help you recharge.
Inside, you'll find relaxationtools.
(11:45):
Comforting treats self-careactivities to help you unwind
during your well earned breakbecause you deserve care too.
Give yourself permission topause.
Visit takecaretime.com to orderyour respite box today.
Taking care of yourself isn'tselfish is essential.
(12:05):
Please note that this episodefeatures reenactments and
dramatized details.
While in most cases the exactverbatim dialogue may not be
known.
All dramatizations are groundedin thorough research and crafted
to honor the stories shared torespect the privacy and
confidentiality of theindividuals involved names, and
some identifying details havebeen changed.
(12:28):
Until next week, take care.
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