As they move through life, parents and children often reach a point when their familial roles reverse. Suddenly it's a parent who needs care and children who need to provide it. But when the "kids" are all grown, working one or two jobs, and perhaps even raising children of their own, how can they add responsibility for a parent to their already busy lives?

Three years ago, the family of Sally Masamune, then 83, found an ideal solution. "I felt so hopeless and like I was beginning to get old and I was depressed. I only sat home watching TV," Masamune said. She was shy and withdrawn, living a somewhat isolated, though independent, life in her granddaughter's home in Kapolei.

It's hard to believe because today, at age 86, Masamune is affectionately referred to as "Miss Aloha" by her many friends and admirers at Maluhia Adult Day Health Center. Sometimes when people first arrive at Maluhia, she explained, "They feel they are losing their independence. But I'm so happy to see them because I feel I'm gaining more family, so I try to convince them they will feel the same way, too."

You hear a lot of stories like Masamune's at Maluhia. It's a place where older people can go for therapeutic socialization and mental stimulation as well as fitness and nutrition. There are bingo games, shopping and fishing excursions, arts and crafts, and as much fitness activity as each individual can handle. Whether seated or standing, on a walker or in a wheelchair, everyone gets as much exercise as is physically possible for them. Simon Says is a favorite, as are crossword puzzles and sudoku — anything to keep minds and bodies active and engaged.

At Maluhia, core and upper-body strength are priorities, as is walking. Walks are taken several times a day, whether unassisted or with a cane or a walker. Masamune echoes the thoughts of many others at Maluhia: "I don't want to go into a wheelchair because that will make an invalid of me."

Tsumayo Tsuneyoshi, who is 92 and lives in Pacific Heights, nodded with passionate agreement. About five years ago, she was running (yes, running) for the bus and fell, breaking her hip. Although there were times when she thought she might be restricted to a wheelchair, she determinedly kept walking, throughout her recovery and rehabilitation and once she was home again. During her daily walks at Maluhia, she may use a cane or a walker, but she definitely gets around.

Jeri Takamiya, program manager at Maluhia, said the center's goal "is to keep frail elders who have had health problems active and in the community, to keep them out of long-term-care centers."

"Interestingly, we often find that when an elder has an illness, disability or chronic disorder, the tendency is for the caregiver to do everything for that person. Unfortunately, this innocent response tends to promote a sedentary lifestyle for the elder, which in turn leads to the loss of even more muscle tone and body flexibility," Takamiya explained. "We always try to find that motivating factor to make them want to be active and continue with life."

Maluhia participants range in age from 64 to 96, with an average age of 83. Nurses, recreation therapists and social workers are part of the staff so they can assist with whatever may be needed: medication administration, tube feeding, wound dressing or behavioral needs for those with dementia.

A sister facility that offers a similar adult day health center is Leahi in Kaimuki (see box for details).

The care and personal attention at Maluhia do not come cheap. The cost per day is $87. However Medicare, Medicaid and long-term-care insurance plans will usually pay much of the fee.

One of the greatest benefits of a place like Maluhia or Leahi is that the family caregivers can go to work, or take a break, without guilt, knowing their elder is having a ball — and probably playing with one, too.