Collaboration, facilities and communities in day care services for older people

Collaborative working in care for older people is often seen as a desirable goal. However, there can be problems with this approach. This paper report s on a single blind randomized controlled trial which was carried out to co mpare outcomes of rehabilitation in two settings: a day hospital and social services day centres augmented by visiting therapists. The subjects were 1 05 older patients. Principal outcome measures were the Barthel Index, Phila delphia Geriatric Centre Morale Scale and the Caregiver Strain Index. Two a spects of the trial are examined here. Firstly, we investigated whether tri al patients were more disabled than regular day centre attendees. Levels of health and well being amongst trial patients were compared with those of a random sample of 20 regular attendees from both of the participating day c entres and an additional voluntary sector day centre. Secondly, key staff f rom the different settings were interviewed to assess how well the day cent re model had worked in practice. Trial patients were significantly more dis abled than regular day centre attendees according to the Barthel Index (P < 0.001), but this difference was no longer significant after three months o f treatment. The day centre model had several problems, principally dischar ge policy, acceptability, facilities and attitudes of staff and regular att endees. Positive aspects of the day centre model, as well as successful reh abilitation, included shared skills, knowledge and resources. This paper su ggests that collaborative working in day centres requires multipurpose faci lities. If health staff maintain a permanent presence, benefits can include improved joint working, easier access to health care and the use of rehabi litative therapy as a preventative strategy. Day care settings can be analy zed as representing different types of communities. Allowing older users a greater degree of choice in facilities may increase the acceptability of ca re.