Collaboration, facilities and communities in day care services for older people

Abstract

Collaborative working in care for older people is often seen as a desirable goal. However, there can be problems with this approach. This paper reports on a single blind randomized controlled trial which was carried out to compare outcomes of rehabilitation in two settings: a day hospital and social services day centres augmented by visiting therapists. The subjects were 105 older patients. Principal outcome measures were the Barthel Index, Philadelphia Geriatric Centre Morale Scale and the Caregiver Strain Index. Two aspects of the trial are examined here. Firstly, we investigated whether trial patients were more disabled than regular day centre attendees. Levels of health and well being amongst trial patients were compared with those of a random sample of 20 regular attendees from both of the participating day centres and an additional voluntary sector day centre. Secondly, key staff from the different settings were interviewed to assess how well the day centre model had worked in practice. Trial patients were significantly more disabled than regular day centre attendees according to the Barthel Index (P < 0.001), but this difference was no longer significant after three months of treatment. The day centre model had several problems, principally discharge policy, acceptability, facilities and attitudes of staff and regular attendees. Positive aspects of the day centre model, as well as successful rehabilitation, included shared skills, knowledge and resources. This paper suggests that collaborative working in day centres requires multipurpose facilities. If health staff maintain a permanent presence, benefits can include improved joint working, easier access to health care and the use of rehabilitative therapy as a preventative strategy. Day care settings can be analyzed as representing different types of communities. Allowing older users a greater degree of choice in facilities may increase the acceptability of care.

A systematic review of the effectiveness and cost-effectiveness of different models of community-based respite care for frail older people and their carers

“…However, in some studies the proportion with cognitive impairment was low; for example, this comprised just over one in five in the study by Burch and Borland. 89 Physical impairment was also apparently common, although this was inconsistently reported. No study of respite services for carers of cancer sufferers met the review protocol inclusion criteria.…”

“…The effectiveness of day care (or 'adult' day care) was evaluated in eight studies ( Table 4), 35,89,93,95,[101][102][103][104] and a further three studies included day care as part of the respite package on offer to carers (see the section 'Respite packages', p. 31). 76,116,117 Further information on study characteristics is presented in Appendix 4 ( Table 29), with quality assessments in Table 36 (Appendix 5).…”

Conceptualising successful partnerships

“…It could include both horizontal equity, where people with the same needs receive the same attention and resources, and vertical equity, where people with different needs receive commensurately different attention and resources (see Dowling 2000, Baker 2003). Improvements in the efficiency, effectiveness or quality of services delivered through partnerships (Burch & Borland 2001). Possible indicators used in research include the impact and standards of services, taking into account their costs, and including measures such as reductions in duplication and overlap between services. Improvements in the experiences of staff and informal carers (Gulliver et al .…”

“…Improvements in the efficiency, effectiveness or quality of services delivered through partnerships (Burch & Borland 2001). Possible indicators used in research include the impact and standards of services, taking into account their costs, and including measures such as reductions in duplication and overlap between services.…”

“…Nor were the present authors able to identify any empirical studies that established the overall cost-effectiveness of partnerships. Burch & Borland (2001) did consider whether costs had been contained through reductions in the duplication of services, but this still falls well short of a full demonstration of cost-effectiveness. Indeed, measuring costs is a difficult task in itself if this involves comparisons between current and discounted costs, or the estimation of opportunity costs.…”