Transforming nursing home-based day care for people with dementia into socially integrated community day care: Process analysis of the transition of six day care centres

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Abstract

Background

The community-based Meeting Centres Support Programme for people with dementia and their carers has been proven more effective in influencing behaviour and mood problems of people with dementia and improving sense of competence of carers compared to nursing home-based day care centres for people with dementia. Six Dutch nursing home-based day care centres were transformed into Community-based day care centres with carer support, according to this Meeting Centres model.

Objectives

To determine which factors facilitate or impede the transition to Community-based day care.

Design

A process evaluation was conducted with a qualitative study design.

Settings

Six nursing home-based day care centres transformed into Community-based day care centres for people with dementia and their carers.

Study participants

Stakeholders (n = 40) that were involved during the transition.

Methods

Factors that facilitated or impeded the transition were traced by means of (audiotaped and transcribed) interviews with stakeholders and document analysis. All data were coded by two independent researchers and analyzed using thematic analysis based on the Theoretical framework of adaptive implementation.

Results

Six nursing home-based day care centres successfully made the transition to Community-based day care with carer support. Success factors for the start of the project were: the innovation being in line with the current trend towards more outpatient care and having motivated pioneers responsible for the execution of the transition. Barriers were difficulties reaching/recruiting the target group (people with dementia and carers), inflexible staff and little or no experience with collaboration with community-based care and welfare organizations. Facilitating factors during the implementation phase were: finding a suitable location in the community, positive changes in staff attitude and adoption of the new vision, and good cooperation with care and welfare organizations. Barriers were insufficient involvement of, and support from the managers of the responsible organizations, and communication problems with referrers of other organizations, including the GPs and case managers.

Conclusions

The transition from nursing home-based psychogeriatric day care support to a community-based combined support programme for people with dementia and their informal carer is shown to be feasible. Successful implementation of this community-based combined support programme requires – besides motivated pioneers, a change in staff attitude and working style, a suitable pleasant location and collaboration with other care and welfare organizations – special attention for effective communication with the target user group and the referrers, and also how the management of the pioneer organizations can facilitate the staff during the transition process.

Section snippets

Background

For over 20 years the Meeting Centres Support Programme (MCSP) for people with dementia and their informal carers has offered effective combined support for community-dwelling people with dementia and their informal carers in the Netherlands (Dröes et al., 2000, Dröes et al., 2004). The added value of combined support for community-dwelling people with dementia and their carers has been demonstrated in earlier studies (Brodaty et al., 2003, Olazaran et al., 2010, Smits et al., 2007, Van’t Leven

Setting

This process evaluation was performed alongside an effect study with a pretest–posttest control group design. This process evaluation focused on facilitators and barriers to the transformation of nursing home-based day care into CO day care. The effect study aims to evaluate the added value of CO day care as compared to nursing home-based day care with regard to needs, behaviour and mood problems and quality of life of people with dementia and burden and feelings of competence of their carers.

Interviews with stakeholders and documentary analysis

Table 1 shows an overview of the interviewed 40 stakeholders, of whom 80% (n = 32) were female.

For an overview of the collected documents for the documentary analysis, see Table 2.

How did the day care centres adaptively implement the MCSP-model?

The original plan allowed for a year for the preparations for the transition and moving of the day care centres, but some day care centres found a suitable location soon after the start and were forced to make the move earlier. One day care centre had difficulty finding a location and moved 1.5 year after the start of

Discussion

This study provides insight into facilitators and barriers to the transition of nursing home-based day care centres to Community-based day care centres for people with dementia with carer support (CO day care) that implemented the MCSP-model.

The implementation of the six CO day cares resulted in important changes compared to the nursing home-based day care setting, such as the location, improved carer support and cooperation with care and welfare organizations, and a stronger focus on the

Acknowledgements

This study was conducted in cooperation with the participating care and welfare organizations in six regions and funded by Anna Elizabeth Foundation, Foundation Sint Bavo, Foundation Vita Valley and the Dutch National Elderly Care Programme (project nr 314080401). The funders were not involved in the design, execution or writing phase of the study.

Conflicts of interest: None.

Ethical approval: The Medical Ethics Committee and the Science Committee of the VU University Medical Centre Amsterdam

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