by Adelina Comas-Herrera
Despite very welcome increases in investment in research to find a cure for Alzheimer’s Disease and other the causes of dementia, it seems that a breakthrough is still some years away. In the meantime the numbers of people living will dementia are expected to continue to increase, and it seems that this will happen at a faster rate than the numbers of potential carers. The MODEM project (Modelling Outcomes and Cost Impacts of Interventions for Dementia), a large collaborative research project based at the LSE, will be modelling how we can better the meet the needs of people living with dementia and their carers by 2030, using the best available evidence.
A key question we need to address is whether the way we are caring for people today is fit for purpose, not just for the future, for the present too. While the policy focus on dementia seems to be resulting in welcome improvements in the diagnostic rates of people with dementia and access to memory clinics, their day-to-day longer term care needs are increasingly falling mostly on families, with access to home help and day care services becoming harder as local authorities budgets tighten. A recent report by Age UK shows that, between 2005/6 and 2012/13, the numbers of people supported by local authorities using home care declined by 21% and those using day care services declined by 49%.
The decline in day care services reflects in part that, at least in the UK, day care is not seen as a very attractive care option. However group care has the potential to play a much larger and positive role in the care of people with dementia, particularly for people in the moderate to severe stages who are not in care homes. Partly reflecting its lack of popularity, there has been little research about the role of day care for people with dementia, but, in contrast, the evidence that have shows that it is very cost-effective, as it delays admissions to care homes, and it reduces stress and burden on unpaid carers.
In practice, day care can enable working age family carers to continue to work, as was the case with my own grandfather, who lived with my parents in the last years of his life. He was picked up every morning and driven to a wonderful day care centre in Catalonia, where he spent the day while my parents worked. He was initially reluctant to go, but was quickly persuaded by the fact that the day care programme included exercise classes and singing, and by the warmth with which he was welcomed and cared for. Attending the day centre also meant that, like the rest of the family, he had been out for the day and had had experiences that, when his condition allowed it, he was able to share when he went back home in the evening.
An especially interesting aspect of group care is that, as well as meeting care needs, it also offers the opportunity to deliver many of the therapies for which we have increasing evidence that they can improve the mental and physical health of people with dementia and their the quality of life: from cognitive stimulation, exercise, falls prevention, to music, arts, dancing, films, reminiscence, gardening… even hen keeping.
And this is, perhaps, the key. Many of the activities listed above are recreational and very difficult to deliver in people’s own homes. Perhaps the group care of the future is one based on recreational activities that people enjoyed before developing dementia, provided in a setting that also meets their care needs, and that is appealing to people with dementia, their families and to health and social care commissioners. This is what some of the best day care services are already offering, often using different names that do not carry the negative connotations of “day care”.
I recently had the opportunity to visit Memory and Company, a fantastic “Alzheimer’s Health Club” in Ontario (Canada). It’s a private centre, yet priced at a level that compares very well with paying home help by the hour. At the time of visiting it had only been open for a few days, but it was attracting much attention from people with early-onset dementia and people whose main carers work. At Memory and Company Dementia-friendly design has been integrated into very thoughtful interior design, creating an open, fluid space, with plenty of rooms where activities happen: from a day spa with hydrotherapy (all completely wheelchair accessible, of course), to a potting shed, a library, a digital cinema, an office, a music room with instruments and wireless headphones, an open kitchen where everyone can take part in making food, a gym catering for all levels of physical ability, a dressing up room and a beauty salon. This is very much a place where you’d like to spend a day whether you have dementia or not, which is very much the point.
About the author
Adelina Comas-Herrera is Research Fellow within the Personal Social Services Research Unit at the LSE. She is Academic Project Manager of the MODEM project.