Katharine Orellana, Jill Manthorpe, Anthea Tinker
This work was supported by
The Dunhill Medical Trust
(grant number: RTF59/0114)
Workforce perspectives on the care and support of older people in England
Making Research Count Seminar from the Social Care Workforce Research Unit
at King’s College London
21st March 2018
Seminar structure
Background
The study
Findings: outcomes for peopleinvolved with day centres
Discussion
Seminar objectives
1To share recent evidence about generalist day centresfor older people
2To prompt reflection of currently-held perspectives
What are day centres?
✓ community building-
based services
✓ that provide care
and/or health-related
services and/or
activities
✓ specifically for older
people who are
disabled and/or in
need
✓ which people can
attend for a whole day
or part of a day.
Admission criteria
Size
Building designation
ClienteleOwnership
Day centres: background
But little English research since 2005
(for users without dementia)
➢ day centres not researched
as whole services
Largest out-of-home service used by
10% of publicly funded older people
not arranging their own services
➢ ½ physically frail/disabled, ⅕ dementia
1985 19891986
‘Classic’ day centre studies
The impact of funding restrictions,
and policy and practice change
• Fewer ‘low-level’ services funded by local authorities (LAs)
• Day centres being de-commissioned / closed by LAs
• Commissioning (not) informed by variable LA consultations
• Eligibility restricted / charges increased by day centres
• Older people losing support vs DCs offering greater choice
- reduced
social care
funding
available
- fewer older
people with
higher needs
receiving publicly
funded care
‘For such an innocuous concept, day
centres can be quite divisive. For some
social care professionals and service
users alike, day centres offer the ideal
opportunity to provide targeted
services to clients in a safe, stable
environment. But others regard them
as outdated and patronising, a service
firmly stuck in the last century.’
(Sale 2005, p30).
Perceptions of day centres …
SALE, A. U. 2005. Can a new day centre dawn? Community Care, 21 Jan, 30-31.
… and their impact
‘Having a ’reputation as an ‘old
fashioned’ and institutionalised
form of service (…) neglects the
potential of day services to adapt
and respond to contemporary
expectations.’
(Lloyd et al. 2014: 34).
Lloyd, L., Tanner, D., Milne, A., Ray, M., Richards, S., Sullivan, M. P., Beech, C. & Phillips, J. 2014. Look after yourself: active ageing, individual responsibility and the decline of social work with older people in the UK. European Journal of Social Work, 17, 322-335
To improve the understanding of day
centres’ purpose and role, how they
are viewed and their use within a
changing policy and practice context.Study aim
Who took part?
4 day centres
(generalist)
10 family
carers of
attenders
23 day centre
staff (10),
volunteers (7)
& managers (6)
13 local authority
commissioners (5)
& signposters or
referrers (8)
23 older
attenders
Sept 2015-Dec 2016:
o 14 weeks of visits
- same day each week to
each day centre (56 days, 280 hrs)
o Collected information
about day centres
o Interviewed people (n=69):
✓ able to engage with
hypothetical questions
✓ giving informed consent
✓ involved with day centres on
visit day (or in same LA area)
What I did
o Mixed methods
o Non-random sampling
o Explored outcomes:
✓ qualitatively in interviews
- attenders, carers, staff,
volunteers
✓ using a validated quality of
life measurement tool
(ASCOT INT4)
- attenders, carers
o Thematically analysed
qualitative data
For people unable to get out of their
home without support
➢ ‘stuck’ at home and/or socially isolated
Centres:
➢ focused on wellbeing & quality of life outcomes
(‘higher order’ outcomes)
➢ were a source of staying active for volunteers
(often ageing themselves)
➢ offered job satisfaction for staff
• In the face of loss
(health, partner, social contacts etc)
• When it becomes impractical to use
universally accessible facilities
• Almost all attenders gained something
they would not have experienced if not
involved with the day centre
… and so did volunteers and staff
For maintenance
Attenders
Who were the attenders? (23)
General learning disability, 2
Blind/partially sighted, 3
Mental health condition, 2
Deafness/serious hearing impairment, 8
Other (e.g. hip replacements, thrombosis), 5
Physical disability or mobility difficulties, 17
Longstanding illness or health condition, 17
Aged 68-101 years (average 83.3)
91% widowed / divorced /
never-married
78% female
65% lived alone
74% white
30% owner-occupiers
25% further education
Similar numbers receiving &
not receiving means-tested
benefits
100% health conditions/disabilities impacting
greatly on day-to-day life (91% reported ≥2)
Drivers behind day centre attendance
Day centre attendance
Social isolation
Feeling the need for activity
Loss of mobility
Poor mental health or wellbeing
Feeling a need to get out of the
house
Carer-related matters
Attendance & life outside centres
Average weekly centre
attendance 1.8 days
Only ⅓ had help with personal care from care workers
Day centre was the only
weekly outing for ⅕
⅔ at greater risk of mental ill-health because of social
support network type
Varied:
• length of attendance (6 months-32 years)
• activities outside day centres
Two attenders’ typical weeks
Wilma lived with her son & his
family (who work full time)
once weekly
4 care worker daily visits
- help with washing, dressing,
incontinence pads, meals
& refreshments.
weekly cleaning help
weekly visits from 2 daughters
- sometimes also
granddaughter
monthly Holy Communion
from visiting priest.
twice weekly
food shopping
once weekly
- with son or alone.
Bob lived with his son
Outcomes (qualitative) (23)
Social Care-Related Quality of Life (ASCOT) (22)
Outcomes: ASCOT INT4 (22)
Average
SCRQoL
gain 0.18
* Dignity /
sense of significance
Biggest gain
2nd
2nd
3rd
3rd
Social Care-Related
Quality of Life
(ASCOT) (22)
Overview of outcomes
Outcomes - qualitative
* Dignity / sense of significance
2nd
2nd
3rd
3rdBiggest gain
Activity/occupation
Something (different) to do
I just sit here from when I get
up to the time I go to bed. Ruby)
I like to be doing
something.(Lenny)
…just quite different to
what you are doing at
home. (Kaye)
It’s enriched my life
(…) Well I suppose it gives
me an interest, doesn’t it?
It’s a big interest. And it
gives me something other
to talk about and to think
about. (Jenny)
I enjoy the art. I enjoy the singing.
I love to sing. I don't mind whether
there is one or two singing. (Wilma)
something to wake up in
the morning to do. (Nellie)
Getting out & a change of environment
I used to like going here, there
and everywhere. Now I can't do
that so I don't mind coming here…I
am happy with it…It gives me a
chance to come out. (…) if I could go
round and do things that I would like
to do and so I’d go shopping and
maybe walk around. Right now
I'm stuck indoors. (Dorothy)
Well, it gets me out of
my four walls for a start.
(Nellie)
Well, it gets me out once
a week, which I wouldn't
do otherwise. (Ruby)
It's like being a prisoner in my
house now … That's how it feels
now and again, because you don’t
see nobody there now. (Olive)
Saying hello to an
acquaintance in passing
is ‘not the same as
actually going to a
function with the people’
(Bob)
✓ As part of service
✓ Via occasional/regular visitors,
visiting professionals/speakers
✓ Offered by same provider
Practical support, information & other services
Before that I was buying the batteries because… I could get them free from the hospital but I'd have to take a taxi to the hospital to get them. So I used to buy them from Boots. But [manager] said “oh no, don't buy them. We'll give them to you.” … That's another thing that's been a great help. (…) I can clean part of it but I can't take the things apart and clean it
properly. (Francine)
And then eventually heard about the holiday (…) I mademyself go and it did me the world of good because since then, my dark side seems to have lifted. Although I’ve physically got all these problems, mentally I’m fine now, really. (Ruth)
✓ Facilities in same building:
- library
- church
- Citizens’ Advice Bureau
Physical wellbeing & safety
✓ Informal health & wellbeing monitoring (& follow-up)
Well, I come to the club when I not in hospital. You feel more safer. If I here and anything happened to me, they will call the ambulance. (Norma)
Interviewer: So what is it about being here that helps you feel less depressed?Well, I do exercise three times a week. (Denzel)
They come around. “Are you alright? What's the matter?” (Thomasina)
✓ Exercise
✓ Felt physically safer & less vulnerable than at home
Attenders’ feelings about their centres
✓ ⅔ looked forward
to or loved going(3 made themselves go)
✓ All 23 planned to
continue attending
✓ All 23 would
recommend their
centre to others
✓ Good value for
money (for ⅔)
Oh, I love going. Oh
yes. Yes. (Kenneth)
All I can say is that, anyone who
doesn't go there is missing out on
something. I like it there and I think it's
wonderful. (Kathleen)
I don't think I'd rather be
anywhere else but here. I really do
enjoy being here (…) I am glad I
come. (Isobel)
Well it’s my life. It’s all I’ve got.
It literally is my life. (Nellie)
Improved mental health & wellbeing
Feeling valued & respected a personal sense of significance
Feelings of independence
freedom & control
‘Feeling better ‘
(better inside oneself, happier, less
depressed, less lonely, more
relaxed, more confident, less
frustrated, sanity maintained)
Something to look
forward to
Enjoyment & fun
Sense of
belonging
Sense of
purpose
Family
carers
• Mainly attenders’ adult children (n=6)
➢ 2 spouses, 1 grandchild and 1 sibling
• Aged 28–82 years
➢ half aged 55-64
• Mostly White British (n=8)
• Mainly worked full or part time (n=6)
➢ 2 were retired and 2 were homemakers
• Only 4 co-resided with attenders
Who were the family carers? (10)
Outcomes: ASCOT INT4 Carers (10)
Social Care-Related Quality of Life
(ASCOT)Average
SCRQoL
gain 3.10
Mainly wellbeing-related:
✓ Feeling reassured /
peace of mind
✓ Having a break
✓ Improved relationship
✓ Lifeline
✓ Practical information
• No gain (1)
Qualitative interviews
Biggest gain
2nd
2nd
3rd3rd
***
**
*
Feelings about day centres
✓ All planned
continued
attendance
✓ All would
recommend the
centre to others
✓ Good value for
money (for 9)
I know she will be safe
and looked after. (Wilf)
I think they're great, they’re
super (…) They're all so friendly
and lovely and [relative] enjoys
that. (Frances)
Quite frankly, if she couldn't afford it
we'd make sure we did. (Evelyn)
I love that she goes there. It
makes her so happy. (Nancy)
I think it's good for her. (Simon)
I look forward to it all the time.
(Linda)
Day
centre
personnel
• Aged 22-60 years
• All but one female
• Ethnicities:
➢ White 7 - British/English (4),
Irish (2), Any Other (1)
➢ Black 3 - British (2), African (1)
• 6 UK born
➢ Others had lived in UK
for 1, 10, 12 & 30 years
• Average 8.7 years in job
Who were the they?
• Aged 57-77 years
• All but one female
• All White British/English
• All had at least one type of
health condition or disability
• Average of 3.7 years in role
➢ average 6.7 hours weekly
Staff (10)Volunteers (7)
Mental wellbeing & health
SATISFACTION
Vols: from doing something
useful & feeling needed
Staff: from seeing impact of
work – making a difference
IMPROVED MENTAL HEALTH
- (and confidence)
- re-gained identity (staff)
FEELING PART
OF A TEAM
(BELONGING)
SOMETHING
TO LOOK
FORWARD TO
Volunteers Staff
PLEASURE
FROM
WORKING
WITH PEOPLE
ENJOYMENT
(work is fun!)
* *
*
*
Volunteers Staff
Skills & knowledge
‘People’
Met people & made friends
with other volunteers
Opportunity to: - use skills/ knowledge from former work- transfer skills learnt from volunteering elsewhere
Potential isolation
counteracted
Contact with older people
Learn from the older
people they supported
Chance to be involved in lives
of & build relationships with
the people they supported
Feelings ….
✓ All would
recommend
volunteering/working
at a day centre
✓ All vols & 9/10 staff
planned to stay
✓ 7/10 staff looked
forward to, loved,
enjoyed, were
happy in or proud
of their work
I'd miss it if I didn't have this. It’s the best voluntary work I've done
and I've tried different voluntary sectors. (…) I definitely, I would use it as a place to come to not be at home isolated. If my legs are wobbly and the transport could pick me up. What more could you ask for in a day centre? (…) In relation to all jobs I've had in my life, I've never known anything
like it. (Vol4)
… every day is what you make it.
You get out what you put in and it's always
slightly different’ (Staff5).
I am proud of what I do. I feel I am proud that I am able to come here and just be myself as well. (Staff8)
Running themes….
Attenders Carers DC personnel
Practitioners
Broad range of roles spanning people’s contact with social services:
Who were the practitioners? (8)
1 Access & Support
Officer - first point of access duty work
and screening, assessment and
signposting work with allocated
people
2 Case Officers - managed assessments, care and
reviews of their caseloads of
clients
1 Support Planner- arranged individual support
2 Social Workers - adults (all ages) with complex &
longer term needs
– no specific client group
1 Care Manager- worked with adults (all ages)
doing assessments, reviews and
safeguarding investigations
1 Special Projects and
Service Manager- led on projects
- scrutinised & authorised
care/support plans
Views on
day centres
influenced by
✓ Having worked in them
✓ Having visited them
✓ Positive testimonials
✓ From social work training
✓ A day service review / closure which had positively impacted on one’s
referring behaviour.
✓ Informally by email
✓ In person
✓ At team meetings service providers sometimes invited
✓ Internal newsletter just started in one.
Information
about services
shared in LAs
• Enjoyment / fun
• Something to look forward to
• Change of environment /
getting out (vs ‘a place to go’)
• Dignity / sense of significance
/ feeling respected & valued
• Feelings of freedom & control
• Feeling better
• Sense of belonging
Missing from practitioners’ views
Gave more importance
to than attenders
• Nutritious meal
Attenders did not
mention
• Being an active citizen
• Warm
• Supporting to remain
at home
(i.e. stay independent,
prevent care home
move)
Attenders
Missing from practitioners’ views
• Feeling supported & encouraged
• Improved relationships
• Information
• Self-care
• Personal safety
• Occupied
Carers
Surely it can’t
ALL be
positive!
• Nothing added to 1 attender’s life (but…..)
• Experiences affected by co-attenders’
memory problems or learning disabilities & falling numbers
• Sight & hearing impairments not always catered for
• 10 attenders made suggestions for change
• 3 attenders less keen on one staff member
• Lack of awareness of day centres before attending
• Low awareness of opportunities to feed back / get involved
• (Dis)pleasing activities: exercises, bingo, card games
• Charging & cost (not vol sector)
• Attending DC was compromise for some
Attenders
• 8 made suggestions for improvement
- carers could be included / communicated with more
- longer operational day / additional day
- more trips out
- make trained counsellor available
- transport on time *
- visitor identity checks *
- more varied food *
• Some perceived reluctance to go to day centres –
at start (3) or regularly (1) despite enjoying it
Carers
• No volunteer would change anything to improve their
role, but these were brought up by 1 person each:
❖ shared building background noise & interruptions
❖ uniform-related niggles
❖ occasional favouritism towards attenders
❖ feeling overloaded / insufficiently appreciated – too
competent at taking initiative!
❖ (pleased not to have to provide personal care)
• Staff:
❖ insufficient time (under-staffing?)
❖ regular supervision / staff meetings important
❖ emotionally exhausting & sad when attenders die
Volunteers & staff
• Referring may have been limited by internal
unofficial guidelines
• Not all commissioners and practitioners had
visited participating day centres
• Attendance apparently not necessarily considered
with other services received (if any) in mind?
Practitioners
In-depth
Diversity of day centre typologies
Common themes emerged
Focus on generalist DCs
Focus on entire experience & outcomes
Multiple perspectives
Mixed methods
Attender sample mixed & high participation
Regular day centre visits
Interviews recorded & transcribed
Validated scale data are comparable
Data analysed systematically
Positive & negative findings reported
Study Advisory Group
Study strengths ……. & limitationsCross-sectional
Outside scope: DC finances
Excluded health
professionals’ perspectives
Not all day centre typologies
reflected
Small samples
Carers mainly middle class
Frailer and less cognitively
able attenders under-
represented
Gatekeeping among
managers in LAs
Risk of bias - day centre
quality
Do you know what day centres offer as whole services?
Have you visited local day centres to learn more about them?
Do you understand the relevance of day centres’ (broader) outcomes to policy?
Questions for practitioners (potentially)
referring to day centres & those taking
management decisions about these
Katharine Orellana, [email protected]
Professor Jill Manthorpe, [email protected]
Professor Anthea Tinker, [email protected]
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