Benefits of Early-Stage Day Care Centers
Day Care Centers (DCCs) can help caregivers find support and relief in early-stage dementia. Four benefits of the use of DCCs were identified in a 2017 descriptive study of previous research (Tretteteig et al, 2017) and the result of their own qualitative study of a small group of family caregivers. Interviews were conducted with 17 family caregivers of a person with dementia attending a DCC designed for dementia clients. The caregivers had face-to-face contact with the client at least once a week. (It might be interjected here with the question about how much caregiving were they actually providing?) The study did not limit inclusion based on the caregiver’s relationship to the client, gender, or age, and only two of the 17 caregivers were employed. The DCC was attended 2-5 days a week for a duration of 2 -18 months. (One perceived bias, however, concerned the DCC’s leadership recruiting the participants for the interviews.)
The benefits of DCC are paraphrased below for simplification.
The first benefit is separation time. The time spent apart while the IWD is in day care allows the caregiver to complete tasks in addition to time away from the situation to regroup. The caregivers interviewed in this study considered the time apart as respite and felt relieved their loved one could be cared for, involved, and provided with nutritional meals while they performed other tasks or spent time with family or friends. A drawback to this benefit was the fact that the DCC hours are restricted and limited; many are not open on weekends, holidays, and evenings, and have short opening hours during the day. Some caregivers reported negative feelings about having to trick or “dupe” the client into attending the first few sessions until a routine and positive experience at the DCC was established and expected.
The second benefit identified is reduced behavioral problems and a decreased need for assistance with ADL, although these effects remain tentative and not well-documented. Most caregivers in this study reported the DCC provided activities tailored to the functioning level of their loved one. Increased activity level, and interactive routine, and encouraged wakefulness during the day resulted in better sleep at night for both caregiver and client. Nutritional and social needs were met at mealtimes, which were described as one of the most important activities of the DCC from the caregiver’s viewpoint. In this qualitative study, the caregivers did not note a decreased need for ADL assistance, although some reported their loved one was more tolerant, sought more contact, and/or became more communicative and socially active because of DCC attendance. This alone could make the DCC worth a try for caregivers and clients alike.
The third benefit is “reduce(d) care demands, stress and depression as well as increase(d) wellbeing” for caregivers, which was demonstrated to be the case in this qualitative study but not in all previous studies. DCC attendance did decrease the number of conflicts and nagging between caregiver and client. This study postulates that “change led to increased wellbeing and a higher quality of relationship with the person with dementia” (Tretterteig et al, 2017 p.9). Other studies found a decrease in depressive symptoms of caregivers (Zarit et al 1998), while some did not (Zank et al, 2002).
The fourth benefit of DCC is an increase in motivation of the caregiver to provide care and postpone placement in nursing home settings. This is thought to be the result of reducing care-related stress and providing information and support on topics related to dementia (Balla et al, 2007). The caregiver was not anxious while the client was at the DCC and was given respite from the additional responsibility of caring for the client during that time.
A fifth benefit, while not mentioned in this study, involves the cost of adult day care. Day care typically costs half of what clients pay for home-based care, which is becoming increasingly expensive (Bryant, 2019). One of the reasons for this is the group structure of the facilities, and the ratio of several clients to one caregiver.
According to the study, some DCCs could improve by providing more direct feedback to the caregiver about the activities and schedule during the day. Individual meetings with the caregiver might provide invaluable information about the interests and capabilities of the client. This exchange of information would also help caregivers and clients in their daily conversation.
Sources:
Balla S, Simoncini M, Glacometti I, Magnano A, Leotta D, Pernigotti LM. The daily center care on impact of family burden. Arch Gerontol Geriatr. 2007;44:Suppl 1:55-9.
Bryant B. Senior Helpers’ Town Square model gaining steam as investors eye adult day care. Home Healthcare News, February 20, 2019. Retrieved on March 6, 2019 from https://homehealthcarenews.com.
Tretterteig S, Vatne S, Mork Rokstad A. The influence of day care centres designed for people with dementia on family caregivers – a qualitative study. BMC Geriatrics, 2017;17:5.
Zank S, Schacke C. Evaluation of geriatric day care units: effects on patients and caregivers. J Gerontol B Psychol Sci Soc Sci. 2002;57:P348-57.
Zarit S, Stephens M, Townsend A, Greene R. Stress reduction for family caregivers: effects of adult day care use. J Gerontol B Psychol Sci Soc Sci, 1998;53:S267-77.