By Katharine Orellana, Jill Manthorpe and Anthea Tinker
Review written by Dr David Wilkins
What question does this study focus on?
This paper argues that day centres for older people are often assumed to be outdated or too expensive, particularly given the Care Act 2014’s focus on choice, control and person-centredness. The authors explore what professionals and older people think about these services, and the extent to which person-centred support can be enacted at day centres.
How did they study it?
The study ran for three years in total, with a focus on four generalist day centres. The centres were chosen purposefully, so that they spanned the local authority, housing association and voluntary / not-for-profit sectors. Two of the centres were in highly urban areas, one in a small town and one in a rural area.
The lead author for the paper undertook weekly visits to the centres between September 2015 and December 2016. During this time, interviews were conducted with 13 local authority staff, including social workers, commissioners and those making referrals, 23 older people, 10 family carers and 23 day centre staff, including managers, volunteers and carers.
What did they find?
The paper presents its findings across three themes – professionals’ views of day centres, the enactment of person-centred care, and older people’s views of day centres.
– Professionals’ views
Practitioners viewed day centres as relevant to their work, on the whole more so than local authority commissioners. Practitioners noted the importance of having a range of services available in the area, including day centres, so that older people can make meaningful choices about what they want. However, some commissioners thought that within day centres themselves, choices would be limited by the availability of activities, meal options and impersonal staff rotas.
– Enactment of person-centred approaches
Practitioners talked about the importance of matching people to the right centre for them, which meant knowing about the centre, and its activities, as well as the individual. Day centre managers also noted the importance of taking a personalised approach. Older people attending day centres talked about being able to choose where to sit, what drinks and meals to have, and what activities they wanted to do. On the other hand, some older people had not been offered the choice of other centres or services, and individual needs and preferences were not always provided for. Sometimes the choice available was to do an activity or not, rather than choosing between different activities, and in one centre, there was no choice of meals. Some commissioners and practitioners felt that the use of day centres was largely needs-driven.
– The views of older people
Older people said they valued the communal nature of the day centres, and the continuity of relationships with staff. However, some older people also said they found it difficult to live with other residents, particularly if they exhibited upsetting or disturbing behaviour. Sometimes staff were too busy helping people with physical or medical needs to organise and take part in social activities.
What are the implications?
These findings suggest that day centres can help enact personalisation and choice for older people and can have some advantages compared with individualised support packages. However, they may not represent a genuine choice, either at the macro level (because there are no other services available) or the micro level (because choices within the centre are limited or superficial).
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