Choice, control and person-centredness in day centres for older people.

Katharine Orellana,Jill Manthorpe,Anthea Tinker

doi:10.1177/1468017320952255

Katharine Orellana, Jill Manthorpe + Show 1 more

Open Access

https://doi.org/10.1177/1468017320952255

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Abstract

BackgroundDay centres are a substantial element of community-based support for older people in many countries. However, assumptions that they are an outdated or costly service model have resulted in many centre closures in England. The perspectives of 42 people attending, providing, making referrals to or purchasing places at four diverse day centres for older people were collected in interviews. Using these data, we explore day centres’ relevance to social workers’ efforts to promote person-centred support for older people enabling them to maintain or improve their well-being. These are explored from the perspectives of choice, control and person-centredness and local authority responsibilities for shaping the care market under the Care Act 2014.FindingsAttenders highly valued centres’ congregate nature and the continuity they offered which contributed to the development of person-centred relationships. Attenders exercised choice in attending day centres. Social work staff were more positive about day centres’ relevance to personalisation than those responsible for making decisions about the shape of local care services.ApplicationsWith social isolation recognised as a serious risk of old age, the value of togetherness in group environments may need highlighting. Enactment of personalisation policies need not necessarily lead to individualisation; day centres may be community-based assets for some. Those shaping the care market may be encouraged to acknowledge wider outcomes, and frontline social workers may benefit from hearing positive experiences that may help in the development of effective care plans for older people who would like to benefit from day centre participation.

Highlights

Day centres for older people are community building-based services that provide care and/or health-related services and activities for older people who are disabled or in need of support
While some criticisms and negative depictions of day centres relate to their congregate nature, our recent scoping review of the international evidence (Orellana et al, 2020b) identified several indications that their congregate nature may contribute to positive outcomes
Three points for discussion emerge from this empirical study: the operationalisation of choice and control in later life, factors relating to market shaping, and day centres’ congregate nature in the context of preventing social isolation and loneliness

Summary

Introduction

Day centres for older people are community building-based services that provide care and/or health-related services and activities for older people who are disabled or in need of support. The perspectives of 42 people attending, providing, making referrals to or purchasing places at four diverse day centres for older people were collected in interviews Using these data, we explore day centres’ relevance to social workers’ efforts to promote personcentred support for older people enabling them to maintain or improve their well-being. Just as residential institutions were stigmatised as undermining people’s self-identity (Goffman, 1961) and for operating structures that created and reinforce dependency (Townsend, 1981), day centres have sometimes been characterised by similar organisational structures and labelled as institutions, albeit ‘partial’ institutions as they only operate during the day (Salari, 2002; Townsend, 1981) They have been described as perpetuating social isolation in a different setting ‘out of normal community life’ In Singapore, they are considered key enablers of ageing in place (Liu et al, 2015); in the Czech Republic, they are a place in which to meet people and engage in activities (Marhankova, 2014); in Norway, they support the prevention of loneliness and isolation (Boen et al, 2010; Lund & Englesrud, 2008); and in Israel, they are part of a package of community services covered by long-term care insurance as services which support the well-being of socially isolated, frail people who are ageing in place (Iecovich & Biderman, 2013; Ron, 2007)

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