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as outdated and patronising, a service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, katharine.e.orellana@kcl.ac.uk

Professor Jill Manthorpe, jill.manthorpe@kcl.ac.uk

Professor Anthea Tinker, anthea.tinker@kcl.ac.uk

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