Mohammed T. Abou-Saleh

DAY CARE 683Within busy day care settings, it is often difficult to ensurecontinuity of care for those attending. This potential problem canbe ameliorated by the appointment for each client of a ‘‘keyworker’’, whose role is to coordinate the programme for thatindividual. This process can be facilitated by a ‘‘problem list’’, witha corresponding list of proposed action for each problem area. Thekey worker can also play a crucial role in helping to coordinateother community services: Peach and Pathy 34 have shown that dayhospital attendance can be coupled with a reduction in other socialsupports without deleterious effects upon the patient. The keyworker can also maintain links with other members of themultidisciplinary team who are involved in the patient’s care.Levin et al. 31 have highlighted the underprovision of day carefacilities, with a minority of demented individuals in thecommunity having access to such facilities. While selection ofdemented patients for day care seems somewhat arbitrary 28 ,itmight be considered reasonable to prioritize day hospital placesfor those with complex needs, where assessment, problemidentification and management may lead to improvement in thepatient or allow for easier caregiving. Day hospital assessmentmay be especially helpful in the assessment of patients who livealone, where adequate information cannot be gathered throughhome or outpatient assessment. In the absence of complex needsand where the main aims are stimulation for the patient andrespite for the caregiver, then lower-cost day centre care maysuffice. Linked to this issue is the question of how many days perweek a patient should attend. Research is required into whetherday care should seek to provide a lot of respite for a few selectedcarers or a little respite for many more carers.The vast majority of day care programmes operate duringnormal working hours. It is likely that supporters would be evenmore appreciative of time for themselves in the evenings and atweekends 31,35 .SUMMARY AND FUTURE DIRECTIONSFew mental health practitioners would dispute that ‘‘day care,whatever its source, is a key component of comprehensive servicesto elderly persons and their families’’ 31 . However, in thisincreasingly cost-conscious age, such an assertion will not ensurecontinuation and expansion of day care services without adequateevaluation of their efficacy and cost-effectiveness. Day careservices will probably become progressively aligned with othercommunity resources for the elderly and it will surely be helpful ifthere is increased integration of health service day hospitals andsocial services day centres. Unless benefit can be demonstratedfrom the intensive involvement of mental health professionals,particularly nursing staff, then it is likely that there will be aprogressive move toward staffing day care programmes predominantlywith (cheaper) untrained personnel. In addition to studiesof efficacy, there is a need to investigate further the selection ofpatients for day care, the most appropriate hours for programmesto operate and the optimal degree of respite that should be offeredto supporters of the demented elderly.REFERENCES1. Teresi JA, Holmes D, Koren MJ et al. Prevalence estimates ofcognitive impairment in medical model adult day health careprograms. Soc Psychiat Psychiat Epidemiol 1998; 33: 283–90.2. Wells YD, Jorm AF, Jordan F, Lefroy R. Effects on care-givers ofspecial day care programmes for dementia sufferers. Aust NZ JPsychiat 1990; 24: 82–90.3. Wimo A, Mattsson B, Krakau I et al. Cost-effectiveness analysis of daycare for patients with dementia disorders. 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