As data are complementary, outcomes gained are presented thematically, with verbatim
quotations illustrating commonly-expressed or contrasting perspectives (underlining
indicates participants’ own emphasis), together with ASCOT scores where relevant.
Ten outcome areas arising, and experiences contributing to these, were reported: 1)
social participation and companionship, 2) the way time was spent, 3) getting out
of the house, 4) improved mental wellbeing and health, 5) practical support, information
and access to other services, 6) physical wellbeing and safety, 7) having a meal,
8) accommodation cleanliness and comfort and 9) personal cleanliness and comfort. Certain aspects of attenders’ experiences and outcomes contributed to a tenth theme
of process outcomes which were identified from both qualitative and quantitative data.
In qualitative interviews, attenders reported benefiting from attending their day
centres. Attendance had added something unique to the lives of all but one attender
who later added that the cost was worth it for the change of environment. For one,
it had not just ‘added’ something to her life, it had changed it. Qualitative outcomes
themes (1-7) and process outcomes were reported across socio-demographic and health
characteristics, social network types and day centres and across both self-funding
and publicly-funded source sub-groups.
Completion of ASCOT INT4, by 22 attenders, also indicated that quality of life improvements
were directly attributable to day centre attendance, covering themes 1, 2, 4, 6 and
7-9. Figure 1 shows average ASCOT current and expected SCRQoL score in each domain as a percentage
of the total possible score (unweighted), gain in each domain and numbers of attenders
saying that centres made a difference to their lives in each domain).
Figure 1: Average unweighted current/expected scores, gain scores and attenders centres made
a difference to.
Overall average preference-weighted SCRQoL scores were 0.88 (current) and 0.70 (expected),
with a resulting overall quality of life gain of 0.18 resulting from day centre attendance.
Average gain varied between centres (0.13, 0.15, 0.16, 0.24) and between individuals
(individual gain score range 0.00-0.62). Gain scores may have undervalued attendance’s actual impact on some participants’
quality of life. For instance, a small number of attenders’ answers did not always
correspond with their qualitative interviews, and clarification of questions’ meaning
was needed in some cases. Notwithstanding socio-demographic and health variations between centres, in three
centres, overall expected SCRQoL, in the absence of day centre attendance, was 0.69
and 0.75 in the fourth. Average gain was higher for publicly-funded attenders (0.24)
than for those self-funding (0.15). The 2016-17 Adult Social Care Outcomes Framework (ASCOF) in England reports an average
current SCRQoL score of 18.9 across England (18.95 across the four day centre areas)
among ASCOF service-using respondents aged 65 and older[46]. Study participants’ average
score of 19.4 compares favourably when converted to be comparable.[37]
Theme 1: Day centre attendance provided access to social participation and companionship
Centre attendance was said to address the problem of not meeting people when physically
unable to get out of one’s home. ‘Social participation and involvement’ was one of
two ASCOT domains in which centre attendance made a significant impact (p-value <0.001,
99% CI) on participants as a group. There were different facets to this most talked-about
outcome which was one of the unique contributions that participants reported centre
attendance made to their lives.
Many valued having social contact which contrasted with usually being alone:
‘It's like, if somebody is married and they are not happy in their marriage, they
look for a way out. Well I am not happy being at home on my own and so that's my way
out.’ (Tina)
‘I get conversation instead of talking to myself… And I’m mixing with human beings.’
(Nellie)
Attenders enjoyed doing things in company:
‘We sit together and play together, like cards or any other games or … the memory
class, and of course, the exercise.’ (Mariana)
The group environment enabled the opportunity for laughter or fun. There was a good
deal of banter in some centres, sometimes group-based, or one-to-one between attenders
or one-to-one with staff or volunteers:
’I think that's one of the things that I like about it. You have heard [female attender]
and I roar with laughter before now, haven't you? …I can make her laugh so easily. I love it.
I know when she laughed her head off one day when one of the questions was what did
Richard II lose in the bushes and I called out, “his virginity.” She said, “for God's
sake.” I don't know. I just like laughing anyhow.’ (Kaye)
Participants highlighted how they looked forward to regular contact with day centre
friends, which was interesting as there was mostly no contact between attenders outside
centres on non-attendance days; some considered it unnecessary as they saw each other
regularly at centres:
‘You look forward to seeing friends again, you know.’ (Elizabeth)
However, around half of the participants mentioned that increasing proportions of
cognitively impaired attenders, either due to dementia or a learning disability, impacted
negatively on levels and quality of connection possible. A small number also commented
upon ‘annoying’ or disruptive behaviours and conversational faux pas sometimes made.
Two of the five male participants expressed a preference for higher numbers of men
since they maintained that men and women chat about different things.
Theme 2: Day centres provided something (different) to do
The second ASCOT domain in which centre attendance made a significant impact (p-value
<0.001, 99% CI) on participants as a group was that of ‘occupation’, or meaningful
activity. This was also a unique contribution centre attendance made to participants’
lives. Attendance was an activity which meant doing something instead of doing nothing
at home:
‘…just quite different to what you are doing at home’ (Kaye).
‘I just sit here from when I get up to the time I go to bed.’ (Ruby).
Having regular day centre days gave some attenders purpose within their week:
‘…something to wake up in the morning to do’ (Nellie).
It also gave them something to think about, something also benefiting family relationships:
‘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)
Attenders enjoyed being occupied or they enjoyed specific activities they did at their
centres. In most centres, activities were varied although not all attenders’ (mainly
sensory impairment) needs were always catered for. Joining in these was said to be
enjoyable, stimulating, and, in some cases, satisfying:
‘I like to be doing something.’ (Lenny)
‘I enjoy the art. I enjoy the singing. I love to sing. I don't mind whether there is one or two singing.’ (Wilma’ emphasis added in bold).
Activities cited as particularly enjoyable were art, craft, cooking, computer classes,
charades, discussion groups, memory exercises, raffle/tombola, singing and music sessions,
sweet shop, trips out, poetry reading, food tasting, table games, listening to background
music, reading the paper, sitting in the garden, visiting speakers, therapy dog visits
and performances by folk and belly dancers. Quizzes, bingo, card games, and exercise
provoked mixed reactions.
Theme 3: Day centres provided the opportunity to go out and have a change of environment
A qualitative theme, being enabled to ‘get out of’ their home, another of centre attendance’s
unique contributions to their attenders’ lives, was framed in two ways.
Firstly, it was tantamount to escaping from their home in which they felt they were ‘stuck’,
or even imprisoned:
‘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)
Others did not feel imprisoned and were more concerned with having a change of scene:
‘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)
Secondly, the day centre was somewhere to go when you had ‘nowhere else to go’ (Nellie). It was also a place to go and gather; saying hello to an acquaintance
in passing was ‘not the same as actually going to a function with the people’ (Bob).
There was much stoicism and acceptance of current situations in which some attenders
said they would never have imagined themselves. For some, centres appeared to be a
good substitute for what they may have preferred to do had their abilities been different:
‘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.’ (Dorothy)
Theme 4: Improved mental wellbeing and health
Participants reported improved mental wellbeing and health as a further unique contribution
of attending their centres. Not only did participants enjoy certain aspects of what
was provided by centres, but many enjoyed the whole experience. They gained a sense
of purpose, felt like they belonged, felt in control or more independent and ‘felt
better’ generally. They had something to look forward to that they enjoyed – and some
found fun. Attendance also counteracted boredom and life’s monotony, helped participants
gain a better perspective of their own situations and feel more relaxed, less lonely
or depressed or more confident, mentally stimulated or energised. Centres were also
referred to as a ‘lifeline’. Furthermore, participants felt valued and respected as
individuals which reflected centre staff’s and volunteers’ character, behaviour and
their delivery of the service. ASCOT domains of dignity and control, the second and
third highest scoring, fall within this theme.
Theme 5: Practical support, information and access to other services
A qualitative theme, practical support, information and access to other services were
either provided as part of the day centre service, via occasional or regular visiting
professionals, speakers or other centre visitors, or were other services offered by
the day centre providers. Most mentioned were the supply of hearing aid batteries
or maintenance, and useful talks. Other examples provided were lunch clubs, holidays,
shopping trips, hairdressing, fingernail filing and painting, help with arranging
health or other appointments, referrals to, for example, occupational therapy to get
a shower installed at home, or to the local authority to get a personal falls alarm
installed, help to claim taxi vouchers (discounted taxi fares) and visiting chiropodists
or massage therapists or clothes-sellers. Benefits gained included, for instance,
saving or having more money, feeling safer or having peace of mind, enjoying trips
out or feeling more settled after a group holiday:
‘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 [pharmacist]. 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 made myself 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)
Co-located facilities were a bonus. At one centre, the short, midweek religious service
was attended by some participants. At another, the library was appreciated by a keen
reader who also enjoyed occasional contact with babies at the mother and baby group,
as was an advice service.
Theme 6: Physical wellbeing, health and safety
This theme comprised three parts.
First, attenders reported benefiting from informal health and wellbeing monitoring
and follow-up undertaken by day centre personnel, such as being asked how they were
or if something was the matter, which they appreciated. Staff, and volunteers, listened
to attenders talk about continence or pain, for example, and spoke to named relatives
about health concerns:
‘They come around asking “Are you alright? What's the matter?”’ (Thomasina).
They also measured blood pressure, made GP appointments, reported safeguarding matters
(e.g. about possible elder abuse) to the local authority and replaced a screw in one
attender’s reading glasses.
Second, exercise was felt to help maintain mobility and alleviate depression:
Interviewer: ‘So what is it about being here that helps you feel less depressed?’
Denzel: ‘Well, I do exercise three times a week.’
Attenders felt they were more likely to exercise in a group than alone at home:
‘I think I quite enjoy it when there is people come and give us exercises and things,
you know, make us to do things. (…) I think it's good for us. (…) I can sit here all
day and not move. [Laughs] I could move, but I think it's good to make you do a few
exercises. If you’re all doing it, you do it.’ (Ruby)
Third, some attenders felt physically safer and less vulnerable at centres compared
with at home. ASCOT’s third highest scoring domain of gain, personal safety, although
broader in scope, falls within this sub-theme. One attender spoke about feeling vulnerable
at home after a doorstep incident with rogue traders, and another, suffering from
vertigo, said:
‘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)
Theme 7: Having a meal (food & drink)
Although a minor outcome theme arising from qualitative findings, almost half the
participants said that day centre attendance made a difference to them in the ASCOT domain of food and drink,
and most shared their, mainly positive, views of the meals provided. Reasons for reporting
having a meal as an outcome included being unable to stand for long periods when cooking,
closure of a lunch club, wanting ‘a meal put down in front of me without having to cook it myself’ (Isobel). The opportunity for conversation over lunch was welcomed. Negative comments,
concerning one centre only, included long waiting time, lukewarm food, feeling rushed,
poor variety and disliking the meals. Meals are categorised separately from physical
wellbeing and health since people would be eating lunch at home on non-day centre
days.
Theme 8: Accommodation cleanliness and comfort
A theme emerging from quantitative data only, centre attendance was reported to make
a difference to just under one-third of participants in this ASCOT domain, but the
average gain score was very small.
Theme 9: Personal cleanliness and comfort
Another theme emerging from quantitative data only, centre attendance was reported
to make a difference to just under one-third of participants’ quality of life in the
personal cleanliness and comfort ASCOT domain, but average gain was zero. However,
while responding to the tool’s questions, two participants implied that attendance
did impact positively on them: one commented that attendance affected how clean he
felt since he bathed and wore his best shirt on attendance days and the other said
she took care of her appearance as she knew men would be present.
Two of the day centres had bathing facilities (suitable for people with disabilities),
but managers reported attenders using these only in emergencies.
Theme 10: Process outcomes
While certain experiences contribute to the overall centre attending ‘experience’
(e.g. activities offered), others contribute towards ‘process outcomes’ which are
those pertaining to the way services are accessed and delivered; they may include
feeling valued and respected, being treated as an individual, having a degree of control
over the way a service is delivered, the extent to which a service fits with other
support received and value for money.[47] Some of these outcomes (emerging from both
datasets) have already been alluded to, particularly under Theme 4, Improved mental
wellbeing and health.
Overall, reported experiences and feelings about day centres indicated that attenders
experienced mainly positive process outcomes. All planned to continue attending and
would recommend their centre to friends, family or somebody in the same situation
as themselves. Many considered their centre offered good value for money. Although
a very small number of attenders reported mixed feelings on centre attendance mornings
and making themselves get ready as knew they would enjoy it once there, feelings of
positivity were widespread, with many enjoying the whole experience, looking forward
to or loving it.
‘I think it's the best thing they have done, [local authority], make this place (…). they do a wonderful
job here. I don't think I'd rather be anywhere else but here. I really do enjoy being here (…) I am glad I come.’ (Isobel)
‘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)
‘Oh, I love going. Oh yes. Yes.’ (Kenneth)
‘Well it’s my life. It’s all I’ve got. It literally is my life.’ (Nellie).
It is likely that less positive feelings, a judgement that attendance may not have
been such good value for money and, perhaps, fewer attenders planning to continue
attending may be been more apparent had attenders not found themselves feeling valued,
respected, treated as an individual or with a degree of control over service delivery.
Comments on centre personnel were overwhelmingly positive. The few criticisms related
to attenders exhibiting unpleasant or disruptive behaviour not being dealt with, certain
staff very occasionally being a bit domineering or lacking understanding of sight
loss. In once centre, three attenders but were less enthusiastic about one staff member
than others but did not ‘dislike’ her.