Combining medical and dementia day care units: Problems and solutions

Abstract

The effect of the establishment of a day dementia unit within an existing medical day care program for the elderly was evaluated. The psychosocial effect of the new unit on the day care clients, their families and the staff was considerable. Strategies were devised to deal with the problems which arose regarding the interpersonal relationships, programming and administration. In retrospect, it appeared that with appropriate planning and flexibility, a combined day program of elderly with medical problems and those with dementia could operate successfully, with certain advantages. 2, 3

The growing number of elderly with dementia and their increasing longevity ^1,2,3 has created a significant burden on care-giving families and nursing facilities. It is estimated that less than 4000 of the more than one million non-institutionalized demented persons in this country are served by day care centers.⁴ Individuals with dementia constitute only 20 percent of the clientele of most day care programs for the elderly. Therefore, it is evident that the needs of the majority of demented persons and their families are not being met. Day care programs specifically for the demented are being developed to assist families in the management of the demented at home.

In a previous paper, the authors expressed the view that from a psychosocial standpoint the advantages of a mixed program of frail elderly and those with dementia outweighed the disadvantages.⁶ In this review of a day care program that included some dementia clients, it was noted that although some were able to remain in the program for extended periods of time, others had to be discharged because of advancing dementia and inability to participate in social or activity programs.

In April 1987 the Daughters of Miriam Center for the Aged established an Alzheimer's Disease and Related Disorders (ADRD) Unit integrated with the existing medical day care program. The addition of this dementia-specific unit to an existing medical day care program made it possible to retain clients with more severe dementia in a day program. The two units, operating side-by-side, provided opportunities for mainstreaming, whereby the dementia clients could join the well-aged for some activities. Equally important, this concept of two units also appeared to have advantages in regard to financing, administration, staffing and transportation.

As the ADRD unit enlarged, the staff noted distinct changes in the attitude and behavior of the day care clients despite preparation for this expansion. Administrative, logistical and programming problems arose as well, requiring frequent modification of the management and operational plans of both programs. The purpose of this review is to document these observations from administrative, medical, nursing, psychosocial and programmatic standpoints and to propose recommendations which can facilitate the addition of a dementia unit to an existing day care program.