BISHOPVILLE — Ada Toney sits with her mother every day, talking her out of moving the furniture, talking her into eating.

Her brother comes over in the evenings. Another brother spends the night, to share the care of 91-year-old Anna Trapp.

Trapp is a woman who has always liked to do things for herself — and for everyone else. She raised six children, sang in the choir, made her famous coconut pies and poundcakes, and kept her hair done and her makeup perfect all the while.

Now Trapp, who has Alzheimer’s disease, no longer can cook. Her children cook for her and then take the knobs off the stove because she can’t be trusted around things that burn. She can’t put on her face, in part because she says someone keeps moving her powder and face cream.

“Somebody might have taken it out of the house,” she said, her voice rising.

Her daughter cradled her head in her hand, closing her eyes. “Ain’t nobody took it, Mama.”

Trapp is one of at least 326 people suffering from Alzheimer’s or related dementia in rural Lee County, an hour’s drive east of Columbia. Of those patients, 211 are black.

A study released Wednesday by a University of South Carolina researcher shows that black women represent a disproportionate, and ever increasing, percentage of South Carolinians suffering from the disease.

The study also showed high occurrence of Alzheimer’s in the Stroke Belt — mostly rural areas where diabetes, stroke and other illnesses linked to Alzheimer’s are painfully common. That belt includes Lee, Lexington, Richland, Darlington, Marion, Florence and Fairfield counties, among others.

Like Trapp, most Alzheimer’s victims are cared for at home by family.

It is a degenerative disease, affecting the patient’s brain and, to a great extent, the feelings and patience of that person’s loved ones.

Alzheimer’s makes you say things you don’t mean or wouldn’t say otherwise. It makes you forget things you knew without doubt — the names of your children, the place you were born, the man you were married to. It can make the docile violent. During time, cruelly fast or cruelly slow, it can take all you know, from how to speak, to how to walk, to how to swallow.

Being sick in the country comes with its own blessings and obstacles.

The main blessing? In many cases, proximity to family.

The main obstacle? Access to care.

Lee County, population 20,000, has one nursing home.

One adult day-care center.

A half-dozen doctors, none of them specialists.

A farming tradition that spreads people out, 49 residents per square mile, compared with 133 in the cities. This makes getting to and from the doctor a burden, especially if you need to travel a half-hour to Florence or Sumter. It means Meals on Wheels, with a waiting list 30 people long, can take hours to deliver.

Lee also has one of the highest illiteracy rates in the state, with almost a quarter of adults unable to read and write.

The lack of transportation and education makes it more difficult to access services or figure out what help even exists.

The Palmetto Chapter of the Alzheimer’s Association coordinates care for the Midlands and Lowcountry. But director Paul Jeter said it is difficult to know how to reach people.

“It’s very tough, and there’s not a lot of easy answers,” he said.

Among other services, the association offers grants for respite, so caregivers can take a weekend trip or make a hair appointment.

In Richland County, 43 families received grants of up to $500 last year. In Lee County, only four.

And, in rural areas, support groups tend to be segregated just as the schools and ball teams are. Lee County has one active group, which is predominantly white.

The Trapp family has not attended a support group. Toney said the topic never has come up.

SUFFERING WHILE CARING

What makes rural areas a good place to be sick, if such a thing exists, is that families such as Trapp’s tend to live near one another and see each other regularly. They improvise a schedule so they can keep sick loved ones at home as long as possible.

But that tradition is fading, as young people move to seek the work they cannot find at home. Lee County no longer thrives on its old economic engines, textiles and agriculture. Now the largest employers include the schools, the jail and the dump.

Trapp’s great-granddaughter, Demetress Adams, is an all-state basketball player at Lee Central High School. She spent this summer playing games from California to Atlanta, and is one of many grandchildren and great-grandchildren likely to seek a life outside Bishopville.

For now, Trapp, who lives on a country road near Bishopville, gets her medicines paid for by Medicaid. She receives 15 hours of care a week from a qualified sitter. Her caseworker comes by from time to time, and she gets a hot lunch delivered every day.

Her family does the rest. They hire their own sitter when needed. They share the responsibilities of 24-hour care, and have for three years since she was diagnosed.

They don’t know how much longer they can keep up with Trapp’s constant needs, and, truth be known, her increasing orneriness.

“In the back of her mind, there are some she fancied better,” Toney said. “I know now I’m not one of those.”

Toney said she and her mother meet with the doctor in two weeks to talk about what comes next.

Her mother does not want to leave her home. “I ain’t losing my memory,” she said. “I know my children. I may not recognize them when they first walk up, but I look them in the face and I know them.”

Five miles away, in downtown Bishopville, Trapp’s sister also suffers from Alzheimer’s. Her children take turns watching her as well.

FAMILIAR FACES

McCoy Memorial Nursing Center sits just outside downtown Bishopville, a mile from town, four miles from I-20.

Eva Johnson, assistant director of nursing, makes her rounds every morning, tennis shoes squeaking down the mural-lined halls, patting patients on the arm, solving minor crises.

One patient took another man’s candy then became convinced it was his and the other man, a thief.

Another flagged her down to say he had won the lottery and finally had enough money to get married.

A former teacher caught Johnson’s arm and whispered in her ear a plan for escape. “She said, ‘Hey, there’s some money involved, if you help me get out of here,’” Johnson said. “And I had to say, ‘I don’t think so.’”

Statistics on Alzheimer’s are fickle — it is difficult to diagnose the disease definitively and to track patients’ care.

But Johnson estimates almost 100 of the 120 patients at McCoy suffer from Alzheimer’s or another form of dementia. The nursing home, like most, has a waiting list — in McCoy’s case, 10 people are waiting for beds.

Johnson has known many of her patients for years, long before they were sick. She grew up in Bishopville and cares for two of her former teachers, her former school nurse, the grandfather of a girl she went to school with, and a man who sat in front of her in church.

“You know who they were before they came here,” she said.

The nursing home is one of nine owned by Cooke Associates, operating mostly in rural South Carolina.

Polaroids and artwork line the walls. Patients gather in weekly group sessions to talk about what’s on their minds. A pet setter mix, Laney, sits on a couch by the front door. Some patients keep parakeets in their rooms, part of a plan called the Eden Alternative that encourages patients to take care of animals.

Patients roam the halls freely. Some sit by the nursing station, watching people go by.

Brenda Kinsaul of Darlington said she visited every facility in the Pee Dee before deciding on McCoy for her parents. She and her brothers and sisters moved their father Julian E. Gaskins to McCoy in December after he was diagnosed with pancreatic cancer.

“It’s not as new and as fancy, but it’s the feeling you get when you come in the door,” Kinsaul said.

Her mother, Lena Gaskins, moved in the double room with her husband in April. She has Alzheimer’s and could not live at home without her husband to care for her.

They slept in twin beds, side by side, until July 11, when Lena Gaskins said she heard her husband rustle during the night.

“I knew something was wrong and I said, ‘What is it?’ And he said, ‘I don’t know. But don’t be scared.’”

He had a heart attack, Lena said.

Her daughter paused, and said, “No, Mama, Daddy didn’t have a heart attack.”

“He didn’t?” her mother said. “He just passed away?”

Gaskins acknowledged her memory is not too good. “Sometimes I forget things. I guess I didn’t want to remember that.”

Kinsaul visits her mother every day at lunchtime, and her siblings come several times a week.

Kinsaul’s mother-in-law died five years ago after a long fight with Alzheimer’s. Her father-in-law has just been diagnosed with the disease.

“It’s one of the worst things you could possibly come up against,” she said. “You watch the person who nurtured you, brought you up, was wise to the world, lose contact with the world.

“You have to be the person who nurtures them, who cares for them.”

Gaskins is one of the lucky ones, Johnson said. Even in a small town, with traditions, Johnson estimates only a fifth of her patients have regular visits from their families.

“I guess they know they’re taken care of, so they leave them.”

A GROWING DISEASE

The number of Alzheimer’s patients continues to rise.

The Lee County Council on Aging serves an ever-older population. Of its 381 clients, 165 are older than 80 years old.

“With more people getting older and living longer, and with the baby boomers coming on, you’re going to have lots more people with Alzheimer’s,” said Carol Cornman, director of the S.C. Alzheimer’s Disease Registry.

One positive outcome of the USC study, Cornman said, could be increased awareness of the scope of the problem, and of the assistance available for patients and families.

The origins of the disease are still a mystery — what causes it, why some people get it and others do not.

But Cornman said another good outcome would be underlying research that links healthy habits early in life with the prevention of Alzheimer’s later on.

“If you exercise, watch your weight, cut down on stress, you’re less likely to develop this disease,” she said.

For Kinsaul, it is difficult to say what she has learned from watching three of the people closest to her fight Alzheimer’s.

She sets her jaw and speaks deliberately.

“You appreciate your health,” she said. “You appreciate those around you that support you. Your friends, your church. That’s much more important than the material things.

“People who got good health? You’re lucky. You got everything.”

Reach Bauerlein at (803) 771-8485 or vbauerlein@thestate.com.