Reimagining collective forms of day care provision for older people
Research type
Research Study
Full title
Reimagining collective forms of day care provision for older people
IRAS ID
289285
Contact name
Ailsa Cameron
Contact email
Sponsor organisation
University of Bristol
Duration of Study in the UK
2 years, 5 months, 27 days
Research summary
Summary of Research
Day care services for older people in England are often seen as outdated and unattractive to potential users. Policy makers have consistently prioritised the importance of all social care services being personalised around the needs of individuals rather than providing services directly to groups of older people. However, there is growing recognition that many older people would welcome the opportunity to attend day care services if they were available. In addition, there is increasing awareness that collective forms of day care have the potential to address the needs of some older people more appropriately, for example older people experiencing isolation or living with complex, multiple health conditions. This study will explore the current role, and potential role, of collective forms of day care for older people (65+) in England. The study will have two elements: an analysis of trends in provision and uptake over time, and, in-depth qualitative research to explore different models of day care provision, including their impact on health and wellbeing outcomes for service users, to identify the wider implications these have for policy and practice development.
Summary of Results
The findings from both elements of the study are set out below.
Element 1
• There was a downward trend in the provision (Council-provided data) and use (service-user data) of day centre services by adults aged 65+ in England. Satisfaction (as reported by carers) also showed a steady decline over time, particularly during C-19.
• Council-provided data is vital in estimating the number of older adults (and their carers) using a variety of community-based services and the extent to which these impact on their independence and quality of life, as well as are imperative for service planning at local authority levels. However, changes in the recording and auditing of Council-provided services makes it difficult to compare changes over time, particularly since the major reporting changes that came into effect in 2014/15.
• Council-provided data appears to be somewhat less informative in terms of being able to carry out finer-grained analysis of the predictors of use of day centre services, both for those using local authority provided day centre services, and those who arrange care on their own.
• Nationally representative surveys have the advantage of offering for a more finer-grained analysis of use of day centres services and their predictors, but are hampered by the relatively small sample of older people reporting using day centre services.
• The predictors of use of day centre services (analysed using nationally-representative surveys) have varied over time but some key background characteristics are consistently related to an increased likelihood of using day centre services (e.g., being single and being 85+ years of age).Element 2
• People attending day care services value the opportunity and report that attendance helps mitigate loneliness and isolation and improves wellbeing. Most of the older people attending services were satisfied with the range of activities centres offered. In particular, people valued the opportunity to undertake ‘purposeful’ or ‘non-traditional’ activities, for example learning new skills, using existing skills and completing or contributing to ‘projects’ or tasks. These opportunities were reported to build self-esteem and confidence.
• Carers of people attending day care services were extremely positive. Carers welcomed its distinct offer i.e. that people attended for 4-6 hours a day, usually once or twice a week, and that transport and a meal were normally provided, therefore giving carers a ‘real’ break from their caring role. This ‘break’ was considered crucial to maintaining their caring role and was valued highly compared to other types of support available. In addition, carers valued the continuity in relationships they built with staff working in centres, these relationships were an important element in building trust and confidence in services.
• Reflecting previous research, some of the participants in the study told us that the term ‘Day Care’ did not adequately reflect the nature of the provision. Some older people and managers/ staff thought the term was stigmatising and favoured terms such as clubs or centres. However, this view was not universal.
• In contrast to the existing literature, most sites in the study had strong and enduring links with health partners. Centres supporting people with a specific medical condition, such as dementia, worked closely with specialist health partners and received funding from the NHS for particular elements of their work. However, most of the generalist day care services that participated in the study also had strong links with local health care partners and received funding to provide additional ‘preventative’ sessions, such as diabetes awareness classes, exercise groups and walking groups. One site was funded to provide long-term, community-based rehabilitation as part of an NHS falls care pathway. Several sites reported that relationships with health colleagues had strengthened since the C-19 pandemic and suggested that the preventative role of day care was better understood.
• All of the sites had strong links with a range of community organisations including carers support groups, faith-based organisations, theatre groups and sports clubs. They used these relationships in two ways: as additional sources of support to refer members/ carers onto and, as a means to develop new opportunities for members. For example, one site was working with a community gym who provided specific sessions at the gym for members. In addition, several sites were working with local theatres to provide time limited opportunities including taking part in theatre workshops. These collaborative relationships were perceived as strengthening day care provision.
• The sample included three examples of innovative provision: an adapted farm providing opportunities for men from a rural/ farming background who are living with Parkinson’s and/or dementia; a small scale day care provision for 4-5 people living with dementia who visit a ‘hosts’ home for a day and, a club run across three sites that provides a broad range of activities (educational/ cultural, fitness/ sport, wellbeing/ health) to over 4,000 members. In addition several of the sites demonstrated innovations in practice including: having closer working links with health colleagues and providing inter-generational activities.
• While several of the sites were innovating in practice prior to 2020 the experiences of sites during the national lockdown demonstrated the agility of centres to innovate at speed. All of the sites closed either before or as the national lockdown was announced and most responded by reimagining their service to support members at a distance. This included: initiating weekly welfare calls, setting up new telephone befriending services, sending out regular activity packs, transforming the normal provision of a lunch into an ad hoc meals-on-wheels service, initiating on-line quizzes and the development of online programmes of activities including exercise classes, educational programmes and carers support groups. Post lockdown, some of these innovations have been incorporated into ‘regular’ programmes.
• To ensure that we heard from people who may feel that traditional day care settings do not meet their needs appropriately, we held additional interviews with people attending an LGBTQ+ club as well as with people attending community led centres from within minority ethnic communities. These interviews affirmed the need for training in inclusive practice to ensure people feel welcome and involved in generic day care services. However, people also expressed a strong preference to attend community led services which were felt to offer a safe space with people with a shared background or experience.
• Analysis of the data collected allowed us to describe 3 models of reimagined day care: a support hub for people with complex and personal care needs which includes the provision of personal care; a membership club offering a wide range of preventative and social opportunities for all older people, and small scale bespoke groups for people with low to moderate needs. We anticipate that these models operate as part of a local ecosystem and allow members to transition between models as their needs and preferences change. The costing exercise undertaken as part of the case-studies has allowed us to identify the costs associated with elements of each of these models and can be used to illustrate the potential costs of different policy and practice choices.REC name
Social Care REC
REC reference
20/IEC08/0038
Date of REC Opinion
21 Jan 2021
REC opinion
Further Information Favourable Opinion