Debate on day care centres

We asked:- Are day centres relics of a bygone age or
should more effort be made by staff to make them more stimulating
for users?

Here are some of the comments we received.

“Definitely not!

In 2005, modern mental health day centres can support people on
their recovery journey. They do this by creating an atmosphere of
empowerment for the client group, having creative activities that
are individually goal focused and skills based. The programmes of
activities offered must be determined by the clients, stretch the
mind and body while keeping a sense of fun with a social aspect.
They are places where once isolated people feel they belong and
gain strength from the support of their peers. They are places that
form active links with local communities engage with educational
and leisure facilities.

Mostly they are places that inspire confidence in people to help
them return to mainstream society.”

Glenda Munoz Cano
Senior Manager, Solent Mind, Southampton.

“As an Implementation Team we have been tasked with reviewing
and implementing a flexible and dynamic model of day provision
across the borough. Currently we have three traditional day centres
and an adult education centre that are not presenting as value for
money or responsive to the needs of service users and carers.

One particular initiative which we thought would be of interest
to you is the development of a Joint Assessment and Resources
Centre within Torfaen. This will be a joint provision with health
offering specialist facilities providing a multi-disciplinary
approach to high level intervention.

The centre will offer a base for access to clinical and
therapeutic services, one-stop assessment, re-enablement and advice
to service users and carers.

The centre will aim to provide a fully joined-up health and
social care service focussing on the whole person and will include
a range of therapies. This will support people with a range of
complex needs and complement the continuum of new day activities
delivery across the borough.

We would like to share our initiatives with you because we
believe it demonstrates an innovative and integrated approach to
day activities service delivery.”

 
Amanda Phillips
Implementation Team

“As a manager of a social services mental health day centre,
I fully endorse the new approach to day centre provision.
Social interaction and meaningful relationships are the main focus
to which we as a team are pushing forward the ‘recovery’ theme and
reducing the main focus on medical intervention only.

Initiatives and practical support help each service user reclaim
significant, critical aspects to their lives.
In my experience, day centres have moved on, improving their
function to include; preventing relapse, limiting re-admissions,
facilitating access to employment opportunities and other
meaningful community provisions.

Consultation and liaison with service-users and other professionals
provide the framework in which we become cognisant of mental health
needs.”

Catherine Chew
Manager of Bacup Road Resource Centre

“The recent article, “Can a new day centre dawn?”
certainly reflects the dichotomy of views that I have experienced
in Bristol. Logically, properly constituted day services should
form an integral part of community care for older people, but for a
number of reasons, including the fact that they are rarely visible
in policy and research literature, day services seem to have a low
priority.

As stated in the 1999 Royal Commission report on Long Term Care,
“the culture of services designed for older people
has….barely changed over the past 10 years.”

Of course, the expression, “day centre”, does not
help, indicating that it is not a client driven, person-centred
service. Older people want to remain in their own homes as long as
possible and the aim of the day services should be to assist people
in achieving that aim, as well as offering an enhanced quality of
life. The effects of marginalisation, social exclusion and loss of
autonomy on healthy ageing are well known and documented.

Given the right support and funding, and day services are cost
effective, we should be seeking to reinvent day services to meet
the challenges of the twenty first century.”

David Jones
Chief Executive
Bristol Charities

“In Suffolk, there is a new model of day care being delivered
– the Keeping Well Centre.

This is based on an eight-week programme and for one day a week,
customers are actively involved in health promotion with the aim of
signposting them to support when needed.

The overall philosophy is for promoting independence in order to
remain safely within their own homes, having made informed
choices.

For more information visit:- www.suffolkcc.gov.uk.
(on the intermediate care webpage).”

Kate Miles

“I think day centres are still an important integral part of
enabling people to remain within the community.  They provide a
good resource for socialising and ensuring people have an enjoyable
day through stimulating activities. Staff need to be aware of their
users needs and choices and provide variety to enable them to have
a fulfilling day.”

Kathryn Uren, Assistant Unit Manager, Copper Beeches Day
Centre

“Day centres largely exist because mainstream activities in
the community and public transport are not anywhere near
sufficiently accessible. 

Where day centres are arguably a necessary part of service
provision until we have a more accessible community, only limited
progress can be achieved through a wider range of activities.  So
many service users are still patronised and institutionalised –
better staff training in empowerment and the social model of
disability is a must.”
 
Ruth Chamberlain,  City of York Council

“While I agree that day services can be institutionalised and
lacking in imagination, they do seem to fill in some essential gaps
that care packages just don’t fill.

I do feel that organisations offering specialised day services
should be very clear about exactly what is on offer, and exactly
who is able to gain access to such services.

I am shocked to discover that in my area, there are
privately-run organisations which advertise day opportunities to
adults with physical disabilities, or adults with acquired brain
injuries (which are often accompanied by physical disabilities),
but which do not provide any kind of personal care.

Should service users need assistance in using the toilet, for
example, then they are unable to access these services, unless they
can fund their own care staff (recently priced at £60 per
day). It would appear that these organisations, being private and
therefore not under the jurisdiction of the local authority, are
able to pick and choose who they are prepared to work with; so some
services are only accessible to able-bodied disabled people. I
think advertising should explain this clearly, to avoid
disappointment. I also think that any information which accompanies
funding applications should be clear about what criteria is being
used.

With local authorities moving increasingly to private services,
who knows how many services users will be left with no services,
purely because their need for personal care cannot be met?

What will happen to service-users whose only wish is to spend a
couple of days a week in a room with a few other people, chatting,
drinking tea, reading the paper, getting helped to the toilet,
having a friendly ear when needed, taking an interest in
activities, but not particularly wishing to join in? What if some
people don’t want to do anything ‘productive’ or ‘meaningful’? Who
defines ‘productive’ and ‘meaningful’?

Sometimes, all people may want, is not to be the only person in
the room for a few hours a day, but to know that the other people
in the room can be trusted, and can provide help and friendly
conversation as and when required. Although this is something most
people are quite capable of doing alone, what if they’d like to do
that, and just not be alone for two or three days a week?

Surely person-centred services, while providing imaginative,
meaningful activities, must also take into account the choices of
people who simply want to perhaps do very little – but in the same
room as others who have made the same choice? This kind of service
is only wrong if people are given no choice. In a person-centred
service, if it is the informed choice of the person, then how can
it be wrong?”

Helen Hall,  Worcestershire

“When I started work in a local authority day centre for
older people 25 years ago I was horrified that the three craft
instructors spent so little time with the service users and so much
time talking to each other, eating, cashing up etc. I was just as
horrified that even on the fairest of days the drivers were always
wanting to leave before 3 pm and if it looked as if there was a
spot of rain or a slight mist they wanted to leave after lunch.

I fervently hoped that by now things would have changed and
service managers and staff would see how day care could enrich the
lives of service users by offering varied activity which was
enjoyable and stimulating. This is certainly not my experience at
the same local day centre that I worked in all those years ago.
Managers come and go and still there is no evidence of service
users gaining positive experiences. It appears to be a luncheon
club only. Every now and again a game of bingo may take place.
Someone I knew went after suffering a stroke and was promised that
she would be able to bake the following week. Five years later she
is still waiting to bake those sausage rolls.

I really wished that someone would have the vision to see that
if day-care was responsive and flexible it may help to keep people
at home longer or help carers to carry on the caring role for
longer.  Day centres could really be so lively and exciting if the
manager and staff believed in their importance to service users. I
am sure there are some day centres somewhere that are exciting
places but not in my experience.”

Joy Johnson

“Day centres are only ‘an inadequate way of meeting people’s
needs’ if they fail to take proper account of what those needs
are.  WRVS realises the importance of focal points within local
communities, where people can come together to take part in a range
of social activities and also access advice, assessment and
support.

The way to ensure that any ‘day centre’ aspect of these focal
points meets local need is to involve the people who will actually
be using services in their development.  People attending a day
centre should feel a sense of belonging and ownership. They must
know that service providers will listen to their voice, respond to
their requests and promote their requirements.

Making day centres and community centres more vibrant, more
accessible and more service user driven is the way forward, not
abandoning them as a concept altogether.”

Carolyn Dodson, executive director WRVS

“Suffolk Social Care is undergoing a programme of day care
modernisation and our countywide forum for day services debated
your headline query “Can a new Day Centre Dawn?” in
Community Care 20-26 January. Our response is an emphatic
“Yes”.

In Suffolk we are consulting with older people and carers about
how we can provide services that meet their needs. We are reminded
through this process that the crucial element to remember in
relation to any service is that they should be individual to the
person and should be outcome focussed.  We prefer to refer to
“day services” rather than “day centres”
since the outcome may not be focussed on a particular building. Day
services coordinators in Suffolk are brokers as well as providers
of services. It is also likely that increased use of direct
payments in relation to services will increase diversity in this
respect and promote participation in the social inclusion
agenda.

We have a varied approach to provision, working closely with a
variety of partners in health, education and the voluntary sector.
An example of is a new Keeping Well Centre that addresses health
promotion for older people. This seeks to enable people to make
informed choices about their lifestyle and care and offers an
eight-week programme of health promotion and falls prevention
activities, including Tai Chi.

Day services are part of our community and you will often find
teenagers joining older people in activities. We work with local
schools to provide IT training within our Day Services. Once we
have broadband this will enable those grandparents who want to
email grandchildren in far off (also not so far off) places to do
so. With the addition of a web cam we hope to improve this method
of communication. There has been much excitement from older people
– who are now demonstrating to their younger generations that
they are not excluded from any forms of communication.”

Marie Adams.
Day Services Modernisation Manager, Suffolk Social
Care

“Without a doubt more effort should be made by staff to make
day centres stimulating.
Day care can be and should be an exciting option for older people. 
All it takes is the motivation and will to make it so. We at The
Grange Day Centre in Throckley Newcastle upon Tyne enjoy shattering
stereotypes of aging and images of day care provision. Yes we do
have bingo, quizzes, dominoes, entertainers, trips out, craft
sessions and people who just come each week to meet and socialise
with old and new friends but we also have workshops led by
professional artists which allow people to develop new skills and
participate in activities that they would not normally have the
opportunity to take part in.

During the past six years (with the support of Kellett Fund at
Community Foundation, Northern Rock Foundation, Scottish and
Newcastle Breweries and Newcastle City Council) our service users
have worked with various artists to produce seven stained glass
windows, a stained glass door and ceiling, several woodcarvings and
four solid oak carved doors, mosaics to the entrance of the centre
and a sign for the club, which is also part of the centre.

Service users have worked with creative writers and produced a
book, worked with silk and oil painters, a ceramicist, digital
artists, musicians, story tellers, reminiscence and life theatre
artist and created a web site www.grangearts.org.uk which
shows images of their achievements. Some of this work has been
intergenerational, as we have worked with several schools sharing
skills and life experiences. The art works are of a high standard
and are a great source of pride for centre users and staff.
At the moment service users are working with a digital artist, a
ceramicist and a glass artist and are designing a steel fabricated
fence (with glass and ceramic insets), which will be installed at
the entrance.

During the next three years they will be working with a stained
glass artist to produce two more windows, an artist who will run
workshops exploring self portrait work by making moulds in clay or
wax and a film maker and writer to produce a play about their
lives. We are all looking forward to the challenge.

The arts have successfully brought people together and have
provided an opportunity for individuals to work together towards
shared goals and end product. They have acted as a catalyst for
confidence building through the realisation of new skills or
improved past and present skills; which ultimately has created a
more improved and active quality of life for participants. So much
so that service users were more receptive to physically challenging
activities and have undertaken several days abseiling, canoeing,
archery, curling and bike riding which we will be continuing this
year. One participant (who also went down a slip wire) abseiled two
days before his 90th birthday and said it was one of the most
exciting days of his life.

Their courage and motivation has also shattered an illusion of
aging I had. I thought you were never too old to learn but possibly
had to take a lot longer before the new knowledge or skill was
internalised. How wrong I was. A group came back from abseiling
saying they had a new challenge they wanted to conquer a fear of
water. One woman of 83 had never been in a swimming pool in her
life was afraid of water but had always wanted to learn how to
swim. We arranged a tutor and a group started to go to a swimming
pool every week. To our surprise she learned to swim after 4
sessions. I would like to add that our oldest abseiler was
93-years-old and several people who have to use wheelchairs also
took part. These are not groups of really fit third agers. They are
people who thought they were too old or frail to undertake such
activities. It is a wonderful feeling when a 93-year-old man who
has never had the opportunity to paint picks up a paint brush for
the first time and discovers with his first painting that he is an
artist. The reflected pleasure that staff receive is
immeasurable.

I agree with Sheila Bell, day services co-ordinator for Suffolk
Council when she states ‘that services should be needs led.
Whatever you do has to reflect those users.’
 If not it will only serve to contain or warehouse people who have
so much more to offer. Day care should be reciprocal. People do not
want to be passive receivers of services. Their lives culture and
history are important resources that should always be
included.”

Michele Wright
Day Centre Manager