Mohammed T. Abou-Saleh

DEVELOPMENT OF DAY HOSPITALS AND DAY CARE 679Panella et al. 24 found that only 69 of 314 elderly dementedpatients likely to benefit from day hospital programmes in Burke,USA, took advantage of them. For these, the costs were estimatedto be considerably lower than nursing home care and theprogramme was acceptable to patients and carers. Zeeli andIsaacs 25 , despite describing a geriatric day hospital where 75% ofattenders’ time was spent in active therapy and transportproblems were non-existent, still showed only half the patientscompleting planned treatment. Only one-third achieved staffdeterminedobjectives or felt improved by 3 months.Transport problems, along with changes in health or socialcircumstances, were often associated with costly lost days of carein the comprehensive review performed by Eagle et al. 26 , but thework confirmed the positive effects of day hospital care on thephysical and emotional health of elderly attenders.The Audit Commission 27 has confirmed the expense of day carewhen linked to domiciliary support services to the moderatelydisabled—it can exceed the cost of residential care, and the cost ofinformal care is all but impossible to calculate. This does notmean it is not preferable to other forms of care.Donaldson, Wright and Maynard 28 emphasized the need toconsider several measures when assessing day hospital care. Theseincluded the costs of all services used over a designated period,with clinical, social and psychological measures at set intervalsrelated to treatment and follow-up, and carer and patientsatisfaction scores. As yet, few if any studies have examined allthese aspects of care, although a work in progress by Read andher colleagues in a joint day care/day hospital project inWolverhampton is designed along very similar lines to thosesuggested by Donaldson’s team 29 . This evaluation is alsoattempting to place such care in context with other care andservices available. More comprehensive assessments of the efficacyof all available complementary facilities individually and withinsystems are necessary to tease out the particular effects of dayhospitals. These would include measures of the morale and selfimageof professional carers in the sectors and their views andattitudes towards other complementary services, patients andtheir carers. These considerations reflect the complexities of theprocesses of care delivery to the elderly mentally ill, and therelationships between ‘‘consumers’’ and ‘‘providers’’.CONCLUSIONDay hospitals for the elderly mentally ill have become establishedservices, especially within the UK. There is little reason to doubtthat they fulfil a useful and acceptable function. Providingsomething of this nature has both energized and encourageddevelopments in many areas. Refinements of practice occur overtime as individual day hospitals modify what they do in thecontext of a changing awareness of their own potentials andweaknesses, and in relation to changes in other services availableto the potential client or patient group. Formal researchevaluations continue and may better inform such evolutionarydevelopments and future planning. It remains important to beaware of the limitations of such evaluative research and it wouldbe quite wrong to stop good ideas being put into practice on the‘‘quasi-scientific’’ basis that ‘‘its cost-effectiveness cannot bedemonstrated’’.REFERENCES1. Farndale J. The Day Hospital Movement in Great Britain. Oxford:Pergamon, 1961.2. Hodgson SP. Day hospital for dementia: a safety net for a high-wireact? In Reed J, Lomas S, eds, Psychiatric Services in the Community:Developments and Innovations. London: Croom Helm, 1984; 191–6.3. Currie A, McAllister-Williams RH, Jaques A. A comparison study ofday hospital and day centre attenders. Health Bull 1995; 53(6): 365–72.4. Carse J, Panton N, Watt A. A district mental health service: theWorthing experiment. Lancet 1958; i: 39–42.5. Jolley D. Hospital in-patient provision for patients with dementia. BrMed J 1977; 1335–6.6. Department of Health and Social Security. Services for MentalDisorder Related to Old Age. Circular HM(72)71. London: HMSO.7. 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The Blakenhall Model: evaluating theeffectiveness of a new approach to day care for the older people withmental health needs (work in progress).