Formal Day Care Research Articles

“I Never Thought I’d See the Day That I Would Be Doing Things on Zoom”: Reimagining Day Care for Older People and Unpaid Carers in the Context of COVID‐19

This paper considers the role of collective forms of day care for older people and their carers during the enforced closure of services in 2020 due to COVID‐19. The study provides a unique opportunity to examine how the sector adapted to these unprecedented times. The paper draws on qualitative data collected from 8 case studies conducted in England, during which 120 interviews were held with older people, their carers, staff, and managers of services and local stakeholders. The findings demonstrate how day centres reimagined their services to meet the needs of older people and their carers in new and imaginative ways. They offer insights into the potential role day care centres could play in the new place‐based partnerships envisaged in recent legislation. The study provides an opportunity to consider the importance of day care services in the light of their enforced closure, providing a more nuanced understanding of day care provision. The impact of COVID‐19 on the social care sector meant that many day care centres were not fully operational and consequently the samples may not reflect the experiences of all centres.

Reimagined day care for older people - supporting older people and caregivers to age in place.

There is a widespread view amongst policy makers, as well as some senior managers and commissioners in local authorities, that collective forms of day care for older people are outdated and not aligned with wider policy ambitions. However, there is also growing recognition, amongst advocacy organisations such as Carers UK and Age UK, that many older people and their caregivers would welcome the opportunity to attend collective day care services, as well as growing interest amongst providers of services and older people themselves about the need to transform provision. 
 As health and social care commissioners in England develop Integrated Care Systems, there is potential for reimagined day care for older people to play an important role in delivering person-centred, preventative and place-based care for older people and their caregivers, including enabling older people to live at home for longer as well as addressing wellbeing, loneliness and social isolation. 
 The presentation will outline findings from case studies visited as part of a National Institute for Health Research, School for Social Care Research study exploring the experiences of and aspirations for collective day care in England, from the perspectives of older people, their carers, those who work in or manage services, as well as local stakeholders from the health and care system. For this research, day care is defined as community building-based services that provide care and/or health related services and/or clubs and activities specifically for older people (65+) with care and support needs. 
 Case studies visited included a range of models of day care for older people including day centres for people living with dementia, small-scale day care based in a hosts home, to large-scale preventative provision for older people. The study explored: peoples experiences of attending; impact on wellbeing and health of older people and their caregivers; what an ideal model of day care would look like; experiences of day care through the COVID-19 pandemic; and relationships with local health and community partners. 
 Our findings highlight the role day care can play in providing opportunities for connection and friendship for older people who attend, supporting caregivers to sustain their caring role, and supporting physical and mental wellbeing and health of older people and their caregivers. Highlighting the importance of personal connections, joy and purposeful activity, design of the physical space and connections with local place, the presentation will discuss innovations in practice that may support a ‘reimagining of day care’, ensuring it meets the aspirations of older people and their caregivers, as well as supporting wider policy ambitions including how social care services can contribute to the wider preventative health agenda. 

Sociodemographic and Biomedical Correlates of Developmental Delay in 2- and 4-Year-Olds with Sickle Cell Disease.

Developmental delay occurs frequently in sickle cell disease (SCD). Psychosocial and biomedical factors contribute to delays, but most studies have not examined the timing of risk factors and developmental delay. We examined sociodemographic and biomedical factors to evaluate whether risks of developmental delay differed across 2 developmental periods. We examined Ages and Stages Questionnaire, second edition (ASQ-2), outcomes in 2-year-olds (n = 100) and 4-year-olds (n = 101) with SCD. ASQ-2 data were obtained from routine developmental screenings administered as part of health care between 2009 and 2016 at a single hematology clinic. Medical record reviews were used to identify sociodemographic and biomedical factors associated with positive screenings for developmental delay. Two-year-olds with positive ASQ-2 screenings (n = 32; 32%) were less likely to have private health insurance or to have been in formal daycare and more likely to have a severe SCD genotype. Four-year-olds with positive screenings (n = 40; 40%) were more likely to have a severe SCD genotype or an abnormal transcranial Doppler ultrasound (TCD) examination indicating high stroke risk. The strength of the association between positive screenings and insurance status, severe genotypes, and TCD examinations differed across the 2 age groups. Domain-level outcomes on the ASQ-2 also differed across the 2 age groups. The cross-sectional data indicate biomedical and psychosocial risks are related to developmental delay, but the association with specific risk factors differs across age.

Effects of an Integrated Palliative Care Pathway: More Proactive GPs, Well Timed, and Less Acute Care: A Clustered, Partially Controlled Before-After Study

ObjectivesThis study presents the design of an integrated, proactive palliative care pathway covering the full care cycle and evaluates its effects using 3 types of outcomes: (1) physician-reported outcomes, (2) outcomes reported by family, and (3) (utilization of) health care outcomes. DesignA clustered, partially controlled before-after study with a multidisciplinary integrated palliative care pathway as its main intervention. Setting and Participantsafter assessment in hospital departments of oncology, and geriatrics, and in 13 primary care facilities, terminally ill patients were proactively included into the pathway. Patients' relatives and patients’ general practitioners (GPs) participated in a before/after survey and in interviews and focus groups. InterventionA multidisciplinary, integrated palliative care pathway encompassing (among others) early identification of the palliative phase, multidisciplinary consultation and coordination, and continuous monitoring of outcomes. MeasuresMeasures included GP questionnaire: perceived quality of palliative care; questionnaires by family members: FAMCARE, QOD-LTC, EDIZ; and 3 types of health care outcomes: (1) utilization of primary care: consultations, intensive care, communication, palliative home visits, consultations and home visits during weekends and out-of-office-hours, ambulance, admission to hospital; (2) utilization of hospital care: outpatient ward consultations, day care, emergency room visits, inpatient care, (radio) diagnostics, surgical procedures, other therapeutic activities, intensive care unit activities; (3) pharmaceutical care utilization. ResultsGPs reported that palliative patients die more often at their preferred place of death, and that they now act more proactively toward palliative patients. Relatives of included, deceased patients reported clinically relevant improved quality of dying, and more timely palliative care. Patients in the pathway received more (intensive) primary care, less unexpected care during out-of-office hours, and more often received hospital care in the form of day care. Conclusions and ImplicationsAn integrated palliative care pathway improves a variety of clinical outcomes important to patients, their families, physicians, and the health care system. The integration of palliative care into multidisciplinary, proactive palliative care pathways, is therefore a desirable future development.

“Being Free Like a Bird”―The Meaning of Being an Informal Caregiver for Persons with Dementia Who Are Receiving Day Care Services

Respite care in the form of day care is one of the several respite services that aims to provide temporary relief to informal caregivers from their responsibilities of caring for a person with dementia. The purpose of this study was to illuminate the meaning of being an informal caregiver for a person with dementia living at home and receiving day care services. Narrative interviews were conducted, and data were analyzed using the phenomenological hermeneutic method. Two main themes emerged: “Living with limitations in everyday life” and “Having a life besides being a caregiver”. The comprehensive understanding suggested living with a person with dementia, changes and influences the informal caregiver’s life through a set of new roles and a new way of living and thinking. The result is discussed in light of Goffman’s analysis of the structures of social encounters from the perspective of the dramatic performance.

Gender-Equalizing Family Policies and Mothers' Entry into Paid Work: Recent Evidence From Norway

ABSTRACTUniversal parental leaves with job protection and earnings compensation increase women's labor market attachment, but very long leaves may have negative consequences at both individual and societal levels. Using panel data from the period 1996–2010, we study whether it is possible to offset the potential negative effects on women's labor supply of long parental leaves by policies targeted especially at fathers, and policies making formal daycare cheaper and more easily available. Norway is used as example, since all recent extensions in the parental leave scheme have been reserved for fathers and at the same time the daycare sector has expanded rapidly. We find that Norwegian mothers did enter work faster after childbirth in the late 2000s than a decade earlier. The latest initiatives may thus have contributed to a shortening of women's career interruptions and a more equal division of paid and unpaid work among parents.

A Social History of Ideas Pertaining to Childcare in France and in the United States

Childcare institutions have developed within social, cultural, and political con- texts. Their historical trajectories are linked with nation-specific societal and political discourses. Thus, prevailing ideas about childcare and child-rearing are underpinned by theories and beliefs about parenting, the role of women in raising children, and the duties and functions of families and the nation state. Although the developments of institutional childcare and ideas pertaining thereto in France and the United States show remarkable parallels, the two countries differ in respect to their childcare approaches. Today, different rates of enrollment in childcare facilities suggest that historically institutional childcare might have been embedded more deeply in the French than in the American society. Currently, 43 percent of children less than three years old are enrolled in France whereas 31 percent are enrolled in the United States. 1 Moreover, while parents in France cover 27 percent of the costs of institutional childcare for children up to three years, parents in the United States pay 60 percent of these costs on average. 2 In view of this discrepancy in the use and funding of institutional childcare, it is important to study both the societal conditions within which childcare facilities have developed and the evolution of theoreti- cal concepts underlying childcare in both countries. This study outlines relationships between societal contexts and major his- torical developments in two corresponding daycare facilities, the French creche and the American day nursery, summarizing paramount processes in the evolu- tion of these facilities and accompanying conceptual ideas that substantiated their existence. By highlighting discursive paradigms about childcare since the inception of the first formal daycare facilities, the study seeks to contribute to the understanding of current approaches in and societal attitudes toward institu- tional childcare in France and in the United States. The analysis draws on a comparative-historical approach. 3 It reviews primary sources of founders of childcare institutions, educational theorists, and administrative authorities as well as secondary sources from historical and social

Små barns livsverdener: Klassespesifikke erfaringsrom?

Title: Young children’s life worlds: Class specific spaces of experienceAbstract: The significance of class for children’s everyday life has received limited attention in Norway. In recent years a number of studies from the UK and the US have explored this topic. This paper presents analysis from a research project inspired by this growing body of research. It explores classed patterns in parents’ interactions with the institution of formal day-care. The paper also discusses how parenting practices of different sorts contribute to the reproduction of classed ways of being in the world. Special attention is given to the life worlds of middle-class and working-class children, and what is perceived as parallels between these life worlds and parents' class experiences.

Selective Identification, Quiet Distancing: Understanding the Working-Class Response to the Nordic Daycare Model

In Norway, our empirical case, enrolment of children under three years old in formal daycare has increased rapidly during the last 5–6 years, especially among the working class. This has happened despite working-class parents' traditional reluctance to use such childcare services for the youngest children. As a pedagogical project, formal daycare mirrors middle-class cultural traits that seem to clash with traditional working-class notions about young children's needs. Drawing on a longitudinal qualitative study, this paper explores this new element in working-class parenting. The analysis suggests that working-class parents' response to daycare unfolds as a dual process; it involves participation and identification as well as distancing and separation. This pattern of selective identification and distancing is interpreted as a type of boundary management that structures working-class childhoods in particular ways. To facilitate a discussion of the wider cultural context that working-class parents' response both reflects and potentially reproduces, we contrast it to middle-class parents' ways of relating to daycare. Koselleck's (2004) analytical concepts of ‘space of experience’ and ‘horizon of expectation’ are used to explore such linkages.

The epidemiology of chickenpox in UK 5-year olds: An analysis to inform vaccine policy

Varicella vaccine is not routinely administered to children in many countries including the UK. Longitudinal data are lacking to inform optimal schedules. We report the prevalence of VZV infection at 5 years of age, cumulative incidence between 3 and 5 years and socio-demographic associations with risk of infection using longitudinal data on 12,509 children from the UK Millennium Cohort Study. VZV prevalence by 5 years was 76.9% [95% CI: 75.9%, 78.0%]. The cumulative incidence between 3 and 5 years was 32.2% [95% CI: 31.1%, 33.3%]. Risk of infection by 5 years was associated with higher maternal socio-economic status, larger household size and formal day-care attendance at 9 months and 3 years. If universal varicella immunisation were introduced in the UK, where 40% children have attended some formal day-care by 3 years, a schedule commencing early in the second year of life would be indicated.

The political economy of childcare in OECD countries: Explaining cross‐national variation in spending and coverage rates

AbstractIf childcare policy has become topical in most OECD countries over the last ten years or so, actual developments display huge cross‐national variations. Countries like Sweden and Denmark spend around 2 per cent of GDP on this service, and provide affordable childcare places to most children below school age. At the other extreme, in Southern Europe, only around 10 per cent of this age group has access to formal daycare. Against this background, this article aims to account for cross‐national variations in childcare services. It distinguishes two dependent variables: the coverage rate and the proportion of GDP spent subsidising childcare services. Using a mix of cross‐sectional and pooled times‐series methods, it tests a series of hypotheses concerning the determinants of the development of this policy. Its main conclusion for the coverage rate is that key factors are public spending and wage dispersion (both positive). For spending, key factors are the proportion of women in parliaments (positive) and spending on age‐related policies (negative).

Maquiladoras and market mamas: Women's work and childcare in Guatemala City and Accra

This paper analyses work, childcare, and earnings of mothers in the slums of Guatemala City and Accra. Similar factors affect decisions to work and to use formal daycare, but the importance of childcare varies with the role of the formal labour sector. In Guatemala, where formal sector work is important, higher prices for informal care increase formal daycare use. However, daycare prices and proximity to daycare centers do not significantly affect earnings in Guatemala City and Accra, respectively. Providing formal daycare may be more important to mothers' decision to work in cities where formal sector work dominates.

Day centres for severe mental illness

The number of people with severe mental illness who receive treatment whilst living at home has increased greatly over the last 30 years. Day centres and day hospitals frequently supplement this treatment. To determine the effects of non-medical day centre care for people with severe mental illness. We updated our search in September 2005. All databases and searches are detailed in the body of the text. We would have included all randomised controlled trials where seriously mentally ill people were allocated to non-medical day centre care. We reliably selected studies, quality rated them and extracted data. For dichotomous data, it had been hoped to estimate the fixed effects Relative Risk (OR) with 95% confidence intervals (CI) and the number needed to treat statistic (NNT). Analysis was to have been by intention-to-treat. Normal continuous data were to have been summated using the weighted mean difference (WMD) and scale data presented only for those tools that had attained pre-specified levels of quality. Electronic searches identified over 300 citations but none were relevant to this review. We found no trials of non-medical day centres. We feel that the inclusion of any studies less rigorous than randomised trials would result in misleading findings and that it is not unreasonable to expect well designed, conducted and reported randomised controlled trials of day centre care. More precise nomenclature would greatly help identify relevant work. At present non-randomised comparative studies give conflicting messages about the roles provided by day centres and the clinical and social needs they are able to meet. It is therefore probably best that people with serious mental illness and their carers, if given the choice, take a pragmatic decision on which type of unit best meets their needs. There is a clear need for randomised controlled trials of day centre care compared to other forms of day care, and when resources are limited, day centre care within the context of a pragmatic randomised trial may be the only way of ensuring equity of provision.

Day Care for Demented Elderly in a Dairy Farm Setting: Positive First Impressions

Long-term care for demented patients in the Netherlands is changing. The focus is now more on quality of life and delaying institutionalization by offering substitutes to the traditional nursing home. In this article, we present a new type of day care, offered on a small dairy farm setting. A small observational study was performed to get a first impression of the effects of care farm day care on demented patients. Also, global comparisons were made between patients attending day care in the farm setting and patients attending regular day care in a nursing home. Demented patients attending day care on the farm showed fewer behavioral problems, used, on average, fewer drugs, including psychotropic drugs, and were more actively involved in normal daily activities. Moreover, family caregivers were more satisfied with this new type of day care. Currently, there is only a scant amount of information to support the therapeutic effects of day care in farm settings. This experience indicates a positive trend of this new form of day care. Well-designed longitudinal follow-up studies are needed to provide more substantial evidence of positive patient outcomes in this new care setting.

Children in the environment: Forest day-care centers: Modern day care with historical antecedents

Some features of early child care are more prominent in Norway than in other countries, such as emphasis on the outdoor environment. Of general relevance and interest is the form of day care provided by forest day-care centers. Three ideas form the development of these centers placed in wild areas. First, throughout history, Norwegians have had a close attachment to nature and some parents want to provide their children with outdoor experiences at an early age. Second, urging children to play outdoors characterizes the image many parents have of a happy, healthy childhood. Third, provision of day care for children has always been restricted in western countries, forcing parents to invent types of service that can become part of an ecological system that promotes healthy development. The forest day-care centers developed recently represent a supplement to the wide typology of child care in the 21st century. The article outlines the connections between these ideas in general European and western history and Norwegian history and presents debate and decisions about a question dating from the last half of the 1980s. It concludes that the forest day-care centers are perhaps only a modern form of the original kindergarten concept, which started in Europe and America as gardens for children not gardens of children.

Spheres of care in the UK: separate and unequal

This article analyses recent developments in Britain in the use of formal and informal day care following the introduction of a National Child Care Strategy in 1997. It is argued that the government's focus on only supporting formal care ignores the crucial contribution made by the informal sector. A small study of the daycare arrangements of mature student parents compares the informal and formal daycare `markets' and shows how the firm line which government policy draws between formal and informal care is based on an incomplete understanding of the meaning of `care' and of `work'. The use of cash payments in the informal sector can sustain, rather than damage, the willingness and ability of carers to care — a choice does not have to be made between love and money. Rather, policies that support both are needed.

Day centres for severe mental illness.

The number of people with severe mental illness who receive treatment whilst living at home has increased greatly over the last 30 years. Day centres and day hospitals frequently supplement this treatment. To determine the effects of non-medical day centre care for people with severe mental illness. The Allied and Complementary Medicine Database (1985-1999), The British Nursing Index (1994-1998), The Cochrane Library (Issue 2, 1999), The Cochrane Schizophrenia Group's Register (May 1999), EMBASE (1980-1999), MEDLINE (1966-1999), PsycLIT (1887-1999), The Royal College of Nurses Database (1985-1996), and Sociological Abstracts (1963-1999) were searched. References of all identified studies were also inspected for more studies. All randomised controlled trials where seriously mentally ill people were allocated to non-medical day centre care. Studies were reliably selected, quality rated and data extracted. For dichotomous data, it had been hoped to estimate the Peto odds ratios (OR) with 95% confidence intervals (CI) and the number needed to treat statistic (NNT). Analysis was to have been by intention-to-treat. Normal continuous data were to have been summated using the weighted mean difference (WMD) and scale data presented only for those tools that had attained pre-specified levels of quality. Despite extensive searching, no trials were found of non-medical day centres. The electronic search identified over 300 citations but none was relevant to this review. The reviewers feel that the inclusion of any studies less rigorous than randomised trials would result in misleading findings and that it is not unreasonable to expect well designed, conducted and reported randomised controlled trials of day centre care. More precise nomenclature would greatly help identify relevant work. At present non-randomised comparative studies give conflicting messages about the roles provided by day centres and the clinical and social needs they are able to meet. It is therefore probably best that people with serious mental illness and their carers, if given the choice, take a pragmatic decision on which type of unit best meets their needs. There is a clear need for randomised controlled trials of day centre care compared to other forms of day care, such as day hospitals.

Day-care centers and diarrhea: A public health perspective

To assess the relation between morbidity from acute diarrhea and the form of day care. The design was a retrospective cohort study. The setting was the city of Espoo, an urban-suburban municipality in southern Finland with a population of 170,000. The study population comprised 2568 randomly selected children aged 1 to 7 years. The main outcome measure was the occurrence of diarrhea. Children in day-care centers (DCCs) had an increased risk for acute diarrhea compared with children in home care. In the whole group of children in DCCs, the relative risk was 1.20 (95% confidence interval [CI], 1.08 to 1.34). The risk was greatest in 1- and 2-year-old children, for whom the estimated relative risks were 1.76 (95% CI, 1.28 to 2.43) and 1.56 (95% CI, 1.16 to 2.09), respectively. The proportion of diarrhea episodes attributable to DCC care in 1-year-old children was 49% (95% CI, 18% to 91%), in 2-year-old children 37% (95% CI, 11% to 73%), and in the whole group 17% (95% CI, 7% to 29%). The infection risk did not differ between children in home and family care. The results provide quantitative evidence that the care in DCCs is a major determinant of acute diarrhea in children, whereas family day care does not increase the infection risk.

From Critique to Responsibility: The Ethical Turn in the Technology Debate

In recent years Dutch media have shown a rapid increase in interest in the ethical aspects of technological developments. The genetic manipulation of animals and plants and the cloning of animals caused heated arguments about the question whether technology can be allowed to intervene in the design of life itself. According to many the patenting of live organisms is fundamentally wrong. Mad cows and plagued pigs have been taken as signs that our bio-industry has lost all sense of moral direction. In the medical sphere, technological progress confronts people with hitherto unknown moral dilemmas: Is abortion defensible in the case of severely handicapped fetuses? Should everything that is technologically possible actually be done? Are we investing too much in spectacular medical high-tech and too little in relatively dull, but nonetheless essential, forms of daycare? And so on. Computers lead to their own moral questions, ranging from privacy-infringements to the shamelessly aggressive and sexist character of many computer games. And these are only a few of the many examples of the moral issues around technology which in recent years have become the topic of extensive public debate.

Form of day care and respiratory infections among Finnish children.

The relationship between respiratory infectious diseases and form of day care was assessed in a retrospective cohort study of 2568 randomly selected children aged 1 through 7 years in Espoo, Finland. Day-care center children had an increased risk for the common cold, acute otitis media, and pneumonia. The risk concentrated in 1-year-old children, for whom the adjusted relative risks (incidence density ratios) for the common cold, otitis media, and pneumonia were 1.69 (95% confidence interval [CI] = 1.43, 2.01), 1.99 (95% CI = 1.57, 2.52), and 9.69 (95% CI = 2.31, 40.55), respectively. Among 1-year-old children, the proportion of infections attributable to care at day-care centers were 41% (95% CI = 30, 50) for colds, 50% (95% CI = 36, 60) for otitis media, and 85% (95% CI = 57, 98) for pneumonia. The results provide evidence that care in day-care centers is a determinant of acute respiratory infections in children under 2, whereas family day care does not essentially increase risk.