After outlining the day centres’ main characteristics, aims, model and their locality, centres’ internal environments are described, and formal and informal care provided summarised. Next, operational hours, daily timings and available ‘extras’ are set out. Finally, charges made to attenders are then set out.
Contextual aims and funding models
Table 1 provides an overview of the case study day centres organisational and funding characteristics.
All centres aimed to improve their attenders’ quality of life by focusing on their mental and physical wellbeing, mainly by making available social opportunities and a range of activities. Additionally, two aimed to offer nutritious meals and physical rehabilitation (DCLA, DCV2), two to provide information and advice (DCHA, DCLA) and one to support family carers and be a resource for the local community (DCLA). Two set their overall aims within a framework of enabling attenders to remain at home (DCLA, DCV1). Centres’ differences extended to their providers, premises, operational days and hours, access arrangements, attendance numbers, funding and charges, activities, staffing, meal provision, links with the voluntary and community sector, social care and the NHS. One voluntary sector centre specified that it also aimed to work in cooperation with other agencies for the benefit of its attenders.
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Locational contexts
Few of the day centre studies reviewed provide a sense of centres’ location yet, for older people accessing any services, proximity is often an important factor in what they see as accessible (Van Dijk, Cramm, Van Exel et al. 2015). Likewise, being located in, and part of, the local community can be an important consideration in providing a sense that such a service is a community resource. Therefore, data were collected on the local environment, noting indications of being part of local communities or otherwise, visible in localities or set aside and segregated (Goffman 1961).
DCHA was near a busy road of shops in an urban district close to former heavy industry sites and near large public housing estates, in an area being developed and increasingly gentrified. DCLA was in a residential urban area, midway between two district High Streets. Both were in poorer communities, classified as being in areas included within band of the 30% most deprived areas, according to the English Index of Multiple Deprivation3 (IMD) (Ministry of Housing 2015). DCV1 was in the middle of a small town in an area of socio-economic extremes with more social housing than the national average. DCV2 was close to the middle of a rural town surrounded by villages, and in area of socio-economic extremes, classified by IMD as being in the middle band of deprivation.
The day centre environment
One distinction between day hospitals and day centres lies in their ambiance and the messages it gives about the building’s purpose, the role of staff and volunteers, and the people who go there. Day hospitals are sites of treatment and clinical activity with single use and purpose (Smith and Cantley 1985); day centres may convey a sense of socialisation and multiple usage. Some are purpose built; others adapted to new functions.
DCHA’s purpose-built building was designed to have flexible usage by having an activity room and three main areas that could be separated by folding doors (which were left open): one was the television area with upholstered armchairs, coffee tables and a goldfish tank; the second a recreational area, with wooden tables and plastic-cushioned wooden chairs, equipment and games cupboards, a small pool table and a table tennis table; and the third a dining room shared with the extra care facilities’ residents. The main room overlooked an accessible garden. Toilets were off the corridor to the centre; one had a ceiling hoist track. The centre had been recently decorated in bright, homely colours. At the building’s entrance were two sofas, another fish tank and a leaflet stand. Facilities communal to the extra care building also used by the centre were a hairdressing salon, the bathroom with a hoist and a Consultation Room. Tenants were able to join attenders for lunch in the dining room, and, for a small fee, could join the group for afternoon refreshments and bingo. The building thus shared aspects of a communal age-specific building; with attempts to spatially separate different domestic activities; recreation, eating, and relaxation.
Similarly, standalone DCLA’s central area was a large L-shaped room (the ‘dining room’), set with groups of tables with plastic-padded wooden chairs, surrounded by recreational activities: a dedicated jigsaw table, a games table, shelves with more games, books and playing cards, a pool table, a table tennis table and a two-seater sofa. Leading off this room were an arts and crafts room (with a piano), a computer room, a conservatory, a small meeting room with a kitchenette, a television room, a quiet room with books and videos on shelves, a treatment room (housing a hair-washing sink, a bed, lockers and a massage table), a large kitchen with heated serving containers and a serving hatch to the dining room, and toilets. The room overlooked an accessible garden. Down a small corridor were a small office, a room with a bed for attenders feeling tired or unwell, and a bathroom with a toilet, an accessible bath and a changing table; both the latter had mobile hoists. Through this was a laundry. Fabric-upholstered chairs suffering continence ‘accidents’ were steam-cleaned by staff. At the entrance was the receptionist’s and staff office.
In contrast, the long, rectangular hall where DCV1 operated adjoined the church’s main worship area via a folding partition wall, making use of a community asset. With a high ceiling and windows, the room was bright and airy but not cold. There was a raised stage and a kitchen with a serving hatch. Toilets, shared with other building users, were across the lobby through the main hall entrance door. The hall was set up in the morning by a volunteer and one ‘active member’ (a status assigned by the centre’s manager to people indicating a wish to be actively involved in providing the service). Three trestle tables were laid out at different angles for lunch and dressed with flowery vinyl tablecloths, small blue vases with artificial daisies, cutlery and flowery plastic tumblers containing a folded napkin providing an atmosphere of hospitality. On the other side, near the stage, was a semi-circle of fabric-upholstered wooden chairs with small, folding tables in front of pairs of chairs. On the stage was the day’s paraphernalia (e.g. magazines). This fully accessible building also had several meeting rooms, a café (opened twice weekly), a vestry, the church office and the provider’s office. Although in a shared building and in a hall with three doors, attenders did not get lost. However, at the end of the day, vigilance was key for the volunteers and managers as one attender with dementia repeatedly tried to leave before the driver was ready. Occasionally, chairs suffered continence ‘accidents’ and were placed aside to be cleaned by building maintenance staff.
The ‘community hub’ building DCV2 operated in was the site of a variety of community facilities and organisations and may be one of those buildings increasingly described as an ‘anchor institution’ (Jackson and McInroy 2015). Shared users included a library, a church, a housing association’s offices, an Advice Bureau, a young people’s organisation offering recreational activities and advice, a sensory room and a day centre for adults with learning disabilities that operated in the room used by DCV2 on its non-operational days. The hub also hosted sessional activities (e.g. blood donation sessions, health and wellbeing drop-ins run by charities, NHS Health Trainer support with healthy eating, stress, wellbeing and managing smoking and alcohol intake, and an outreach sexual health clinic), a young carers’ group, an active retired group and classes (e.g. pilates, yoga, dancing, singing and children’s activities). At times, local authority advisors assisted with, for example, financial and benefits advice, disability equipment information, and death registration.
DCV2’s entrance led off the library, beside the centre’s reception/library desk staffed by two local authority employees. It was a large, bright room overlooking the garden. Furniture was arranged by day centre staff each morning. At the far end, brightly coloured, fabric-upholstered armchairs and two two-seater sofas were arranged in a small circle (with entrance/exit gaps) with small, folding wooden tables beside them. A wall-mounted television screen was next to glass fire doors leading to the garden and car park. Nearer the entrance were sofas, the tombola and sweet shop tables, and two six-seater lunch tables. Off the room was a cloakroom, two accessible toilets (one with an adult changing table, a shower and screen), a kitchen with a hatch through to the main area, a small meeting room, a therapy room, equipment cupboards and double doors to a sensory room.
Being part of a busy building brought challenges to cohesiveness and security. People constantly came in and out to use the kitchen and fetch items from the small meeting room. A learning disability centre attender often visited to take magazines and needed guiding back to another room. During fieldwork, the manager introduced provider-branded t-shirts to improve security. In the mornings, background noise came from children using the sensory room and the baby and toddler groups in the library. An additional staff member had been employed when the centre moved to this location because of its numerous access points. Despite the accessible toilet and therapy room having two points of entry/departure, no attenders had got lost, although staff needed to keep an eye on the only attender with more advanced dementia. The provider’s manager indicated the problematic nature of shared facilities, for example, some of the two-seater sofas were too low, and fabric chairs were not suited to a group with occasional continence ‘accidents’.
Formal and informal care and support
Using Lunt’s (2018) categorisation, there was a mix of frontline personnel in centres. DCLA had one part-time volunteer in addition to its paid staff. DCHA was fully operated by paid staff. DCV2 was managed by a paid staff member who ran the service with two paid staff and one volunteer. DCV1’s manager was also the manager of the provider organisation; volunteers provided the service, supported by the manager and assistant manager.
Centres with paid staff provided more personal care (help with continence/toilet, eating); this was formally undertaken in two centres accepting only local authority referrals, but all staff roles were varied, described by one as a 50/50 care and social role. Work involved personal care; planning, running and supporting activities, playing games with attenders, organising occasional events; providing emotional support; monitoring attenders’ wellbeing and health, often by chatting on arrival or during the day, and acting where necessary; making/serving refreshments; practical support; attending to logistical requirements and acting as a key worker for named attenders and maintaining paperwork.
With reference to domestic work, staff and volunteers at all centres set and cleared tables and served meals; at DCV2, they also washed up and loaded the dishwasher. Dedicated kitchen staff at DCLA and kitchen volunteers at DCV1 prepared meals (see Table 2 for further lunch details).
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All staff had received a range of training (see Table 3).
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Volunteers’ roles involved taking initiative in supporting attenders to enjoy themselves, thinking of stimulating activities, supporting attenders during activities, reassuring anxious attenders, making and serving refreshments, serving lunch, helping people walk to the toilet, moving furniture, chatting with attenders, collecting money and ‘troubleshooting’ (e.g. sewing on buttons, buying birthday cards locally). Volunteer and staff outcomes are reported elsewhere (Orellana, Manthorpe and Tinker 2021b). Volunteers specifically mentioned having received training in moving and handling people, first aid, food hygiene, falls prevention, dementia awareness, and in the Mental Capacity Act 2005.
What is in a ‘day’
Opening hours ranged from 4.5 to 6 hours. All centres differed, but all built in informal time at the start for arrival, refreshments and chatting, lunch, mid-afternoon refreshments and optional organised group activities, with programmes influenced by facilities available. Tables 4-7 outline the research day at each centre and models of provision. DCHA and DCLA ran regular, timetabled activities whereas programmes at DCV1 and DCV2 varied, and DCV1 had an informal, semi-structured session. Activities included some with a therapeutic or rehabilitative nature, although this was not always explicit. Not all attenders participated in all activities. Additional services were available at some centres on request or through links with social care and health services or local community and voluntary organisations; these are summarised below and set out in the next section. Supplementary Online File 1 provides a narrative description of a ‘typical day’ and fuller details of the variety of activities taking place at each centre, as observed and recorded in fieldnotes.
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Charges to attenders
Full finance details, including individual payment methods, were not made available. Centres charging systems, attendance, meal and transport charges varied (see Table 8). Voluntary sector centre charges were lower as they were subsidised by grants, contracts and fundraising.
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