Taiwanese Experiences: Elders with Dementia in Two Different Adult Day Service (ADS) Environments

Abstract

Background: Researchers have demonstrated that adult day services (ADS) benefit elders with dementia and their caregivers, but they have also observed infantilization that diminishes personhood. Many ADS are socially constructed as places for incompetent elders, where clients are labeled as child-like dependents. Most ADS research has been performed in Western society; little is known about ADS in Asian countries. The Taiwanese Government seeks to expand ADS availability to meet the needs of an aging population; researchers must examine their ADS environments and practices to inform program development and expansion that supports respectful elder care.Objectives: Elders’ experiences of daily life were examined within the physical and social environments of one social and one medical model ADS in Taiwan. The ecological model and place rules informed our research framework.Methods: Ethnographic data were analyzed for themes reflecting our framework with attention to physical and social environment and staff–client interactions.Results: The social model center included unique environmental features, such as a temple, indicating the purpose of different areas. Staff treated clients like family, sometimes to clients’ detriment, providing limited privacy and demanding compulsory activity participation. The medical model center with nurse's station and institutional furniture reflected a hospital-like environment and fostered a patient–nurse relationship. Staff inattention actually created opportunities for autonomy among some clients.Conclusion and discussion: Physical features and social interactions within Taiwanese ADS reflected infantilization similar to that seen in the US and uniquely embedded within a traditional cultural background. Our findings reveal a tension between physical and social care features reflecting Eastern traditions of respect for elders and western traditions of institutional care.