1.3.4 Change on a daily basis: Day unit care
The importance of maintaining continuity of people and places is important in both cases. Many people attend day care services and find that the change is a stimulating experience, widening their daily contacts and allowing them to become part of another group. The issues of continuity of experience raised here will be familiar to day care workers.
Click below to hear an audio clip describing Redwood Day Unit.
Transcript: Redwood Day Unit
Activity 6: The Redwood Day Unit
Now listen to the audio clip. In the remaining part of the tape you will hear Brenda Masters and Ceinwen Conroy talking about the Redwood Day Unit. As you listen, think about how the environment of the unit and the way the staff work help to minimise the dislocation someone like Mr Bright might feel.
Make some notes about (a) the ways of working discussed here and (b) the environment.
Ways of working. The whole ethos of the Redwood Unit is one of maintaining a calm environment where people can be themselves. Pressure is not put upon people to take part in activities. There is even something rather calming about the way Brenda and Ceinwen speak. Brenda says ‘activities are spontaneous here’ and that ‘levels of ability vary from day to day’. The key to working here is flexibility. Enhancing ability rather than focusing on disability is important, and part of this comes from getting to know people and their past lives. This also involves those at the day unit in reaching out into the community and not seeing themselves as a separate service.
The environment. There are a number of things which are raised about the environment, especially orientation, use of space and safety. The unit was set up partly because another day centre used by older people was felt to be too big for people with dementia. Some settings can produce disorientation or make a condition even worse. Did you notice how Brenda says that there are two lounges and these are used by different groups of people – those who ‘can tolerate small groups’ and those who ‘need more space'?
The open plan nature of part of the unit allows some people to wander in safety. You will have also heard Ceinwen talk about the secure nature of the unit and the way in which they manage wandering. A tension exists here between the needs of people to wander – even to get back home – the needs of carers for respite and the needs of staff to be able to manage how they work in the unit with the resources they have available. How these various interests are balanced becomes crucial in many care settings.
The design of units for people with dementia has become a particular area of interest in recent years as designers and architects have been concerned to create environments which help people to maintain the abilities that they have, for example colour coding of floors or walls to assist orientation, and to help manage certain kinds of behaviour, for example a wanderer's garden or route layout (Marshall, 1993, 2001; Dunlop, 1994).
In this case we have been able to look at how shared care has implications in terms of time, space and place for all the people involved. Mr Bright's illness has led to decisions being made about the place of care. The aim is to enable him to retain his home base and this means supporting Mrs Bright by giving her some respite from caring. This has meant that Mr Bright has less control over where he spends part of his time and he has to adapt to relocation in time and space and to changes from individual to group settings.
Having home care has also meant allowing other people to have access to their home. For Mrs Bright this level of access has been accepted as it means that Mr Bright can continue to live at home. In this case the change of place has been daily and always involves a return to home, but for other people receiving care the change may be more long term and of greater permanency.
Receiving care can involve changes of place for different periods of time from daily changes to long-term changes.
Sharing care between informal and formal carers can mean that those on the receiving end of care have to accept changes in time, space and place. This can be disorienting for some people and stimulating for others.