By Katharine Orellana
Day centres are the largest out-of-home service in social care. They are used by around 10% of older people in receipt of local authority provided or commissioned services. But a changing policy focus and restricted public funding mean many have limited their provision or shut their doors entirely.
My study of the purpose of day centres for older people, carried out during 2014-17, found day centres still play an important role for the people involved with them. There is clear evidence that they deliver valued outcomes that are highly relevant to social care and health policy themes, such as: promoting wellbeing; preventing/delaying deterioration; supporting people to retain independence; supporting carers; providing information, and ensuring people in receipt of care and support have a positive experience. And there is much potential to develop their role within social care and the NHS and offer the choice and control that older people and carers want.
Centres supplement or replace struggling informal care, social networks and opportunities for older people who are very restricted in getting out and about but are not necessarily frail. For some lonely or isolated individuals day centre staff and volunteers become their ‘chief non-familial carers’. Day centres are taken up when it becomes impractical to use universally accessible facilities, such as ‘drop-in’ community centres or leisure centres, without dedicated transport and meeting other support needs. Almost all participating attenders, volunteers and staff in my study gained something they would not have experienced if they hadn’t been involved with the day centre.
With today’s emphasis on outcomes, centres’ focus was on those ‘higher order’ outcomes associated with wellbeing and quality of life. For their volunteers, who are often ageing themselves, they are a source of staying active. For their staff, they offer much job satisfaction.
Not everything is perfect, of course. In some centres, more consideration is needed to providing suitable opportunities for the increasing proportion of people with dementia. Although not normally perceived as disruptive, they can affect other attendees’ experiences.
Visiting local centres
Social workers suggesting or making referrals to day centres, and care managers, commissioners and others making decisions about their future, should consider visiting centres in their area to better understand what each one offers to their users. The frontline local authority social workers who participated in my study said day centres supported service users as part of a package of care. Familiarity with local centres and what they offer helped social workers to better respond to service users’ individual preferences and needs. However, despite referring or signposting to day centres, mainly to reduce social isolation or for carer respite, all the frontline social work staff interviewed were unaware of the research evidence about outcomes. Their views and actions were influenced by having worked in or visited day centres, by having heard positive testimonials, by their social work training or having been involved in day centre reviews. No formal information or evidence sharing mechanisms were in place within their teams.
Adult social care teams, more broadly, could consider setting up outreach sessions at some day centres (such as weekly community social work sessions). They could provide information and advice and carry out assessments or reviews there. Or they could enable direct referral by centres into certain services (eg toenail cutting, telecare, handyperson services) and to safeguarding teams. There was a view that direct referral may reduce first contact demand.
Reports that centres are receiving fewer referrals and applications for day centre attendance, as part of a wider care package being rejected by panels for unclear reasons, may be linked to financial constraints. But not only does this counteract the choices older people may be voicing during care and support planning, it suggests day centre attendance is not always being considered as part of a wider package. It also suggests a lack of understanding of the evidence concerning day centres and the relevance of their outcomes to policy goals.
Within the principles of personalisation and the Care Act 2014, it is important to ensure older people know how their attendance is paid for. None of the publicly-funded attendees in my study were aware they held a personal budget, or knew the cost of the day centre as a whole.
My findings are based on data collected during regular visits to four day centres (totalling 56 days) in different local authority areas. I interviewed 69 people: older day centre attenders (23), family carers (10), day centre staff, volunteers and managers (23) and local authority social care staff (13). I undertook my study at the Social Care Workforce Research Unit at King’s College London and was supported by The Dunhill Medical Trust (grant number: RTF59/0114).
I am hugely grateful to those who helped with this study, including the social workers and commissioners I interviewed.