Day Services for Adults

Somewhere to Go

Jan Carter

• Publisher: Routledge
• Year: 2021
• ISBN:
  9781000437843
• Edition: 1
• Topic: Medicine
• Subtopic: Health Care Delivery

Originally published in 1981, this book describes day services for adults, a relatively recent development in health and social services at the time. Most people assume immediately that day care is only provided for young children: Day Services for Adults will make it clear that a growing number of services exist by day for adults, and in a diversity and variety which have enormous potential both for those who use them and for those who work in them.

Day Services for Adults reports the results of a five-year national survey. The broad terms of reference of the research were to review the present provision of day centres for adults. To consider the policy questions of staffing and accommodation and to suggest which groups in the community might benefit most from day centres and to advise on how these centres might contribute to the integration and development of local services for those in need.

The result was the first comprehensive investigation of day services in the world. Jan Carter analyses services for the elderly, the mentally handicapped, the mentally ill, the physically handicapped, offenders, drug addicts and those in family care centres sponsored by health, social services, probation and voluntary agencies. By a full coverage of all these groups and their sponsors, unique comparisons between services for the various groups can be made.

Day Services for Adults was intended for those who made decisions about day units and particularly for local authority policy-makers and executive civil servants in local authority health authorities and central government. It was also addressed to those senior professionals practising inside and outside day services: psychiatrists, geriatricians, those practising rehabilitation medicine, senior nursing officers, psychologists, senior social workers and social work administrators.

PART ONE

Chapter 1 INTRODUCING ADULT DAY SERVICES

Some may feel that when Ecclesiastes declared that there was nothing new under the sun, that he had not thought of day units in the mid twentieth century. The day centre, the day hospital and those other forms of day units which constitute contemporary day services offer a different kind of personal service. Day units neither confine people to the four walls of an institution, nor do they operate on a domiciliary basis, from people’s homes. Literalists might argue, in support of Ecclesiastes, that day services are nothing more but variants of each of these types of care: for example, that day services are part of a ‘community care’ movement, which far from being an invention of the modern age has been with us for centuries. Others will claim that day services have grown out of institutions such as hospitals, as a specific attempt to ‘open up’ institutional care.

But although different kinds of community care and institutional care have existed for centuries, services provided by the day in a day unit have not. We are entitled, therefore, to regard day services as ‘something new under the sun’. At the same time, although day services are, sui generis, of their own kind, they owe parts of their current format to the practices of workers in the institution and in the community.

This book, then, is about day services for adults. Day units for adults appear to have developed after the Second World War, although a few existed beforehand, mostly as occupation centres for the mentally handicapped and sheltered workshops for the disabled. But in recent years, day services have not only expanded, but boomed. In 1959 our estimates indicate that there were just over 200 day units in England and Wales. By 1969 this number had increased fourfold, but by 1976 we estimate that there were about 2,600 day units open each weekday up and down the country. A similar growth had taken place in Scotland (Tombs and Munro, 1980).

The numbers of people attending day units seem to have increased too. In 1959 our estimates indicate that the numbers of attenders at day units represented the population of a large village, whereas by 1969 the attenders on any given weekday at day units might fill the equivalent of a market town with a population of 70,000, such as Bury St Edmunds. But by 1976 the estimated number of attenders had swollen to the dimensions of a city the size of Blackpool or Brighton, with about 138,000 people setting off on any weekday to attend a day unit. Over 17,500 paid staff members worked to these attenders and there were large numbers of unpaid volunteers.

What are day units for adults? They are organisations offering a form of personal service during the day, organised by statutory or voluntary agencies. All that these organisations have in common is that attenders and staff are present at a day unit by the day: at night they go home or elsewhere to sleep and in the morning, normally on a weekday, some or all of them reassemble. Nearly all day units are open for five days a week but a minority open for a more limited period, perhaps two or three days each week.

However, this does not distinguish a day unit from other organisations where people meet by the day. Can a pub, or a gambling club be a day unit? How does a day unit differ from an adult education centre, a community arts centre or even a university? What marks it off from the House of Lords? Further research by the broad-minded may find elements of day services in each of those settings. For the purposes of this book, however, approaches more pragmatic and pedantic have guided the definition. First, a day unit has been regarded as a day unit if its staff say it is. When in doubt a definition was applied: ‘A day unit is a non-profit making personal service which offers communal care and which has care givers present in a non-domiciliary and non-residential setting for at least three days a week and which is open at least four to five hours each day.’

This definition excludes luncheon clubs and evening clubs as being open for an insufficient period of time. It also excludes pubs or cinemas, gambling clubs and betting shops as profit-making ventures. It would exclude the House of Lords because it lacks care givers offering communal care. A more serious problem is posed by adult education centres and community arts centres. The lack of inclusion of these facilities in the survey can be explained by an element in the definition which is implicit rather than explicit. This is that attenders at day services must fall into a defined administrative category, by reason of being in a certain age group, or because they suffer from a disorder. This disorder is usually a mental or physical disability and restricts, in theory, attendance at the day unit to those who share this disability. The ‘care giver’ works with those within a defined category of disorder or age.

This book will report on the current state of day services from the perspective of the national survey which took place between 1974 and 1978. The information collected during this time is the basis of statements made about day services and their practices. This survey discovered that most day units are called day centres or day hospitals, but there are less common names, too. Adult training centres, day training centres, workcentres, sheltered workshops, drop-in centres, family and community centres are examples. Attempts to introduce common names for day units need to be informed by common usage and professional sensitivities. For example, the term ‘day care’ is controversial in many day hospitals in the health service, where, for some, ‘care’ and ‘treatment’ are antipathetic concepts. For others however the overlap is a fait accompli. Likewise in many work centres and sheltered workshops sponsored by voluntary and statutory agencies, the term ‘day care’ is unwelcome: ‘care’ and ‘work’ are considered to have nothing in common. A variety of sponsorship by both statutory and voluntary organisations provide day services for a range of user groups, from old people to the families of the very young on the one hand, or to those with a particular disability or disorder on the other.

Day units for adults are the preserve neither of a rural arcadia nor of the madding crowd. While few day units are to be found in the countryside, equally few coexist in inner cities. Most day services are to be found in areas more prosaically twentieth century: in suburbia. About four out of every ten day units are to be found in those locations where the Englishman maintains his castle, that is, in concentrations of public and private housing. About the same proportion are located in areas which are ‘mixed’: that is to say, they contain a mix of housing alongside commercial premises and light industry. Thus unlike many residential institutions such as asylums which during the last century were placed purposefully out of cities, or prisons which were built on their perimeter, day units are placed in dormitory areas: ‘in the suburb that’s thought to be commonplace’ as that poet of the suburbs, John Betjeman, put it. ‘Home of the gnome and the average citizen, Sketchly and Unigate, Dolcis and Walpamur’.

About four out of every ten day units are in the grounds of residential institutions. These are usually hospitals, but are sometimes residential homes or hostels. The rest are to be found outside the parameters of institutions; freestanding within the ‘community’ although some are alongside churches or community centres. A number occupy eccentric sites: a double-decker bus, a former police lock up, a country house, and so on.

Most day units insist that prospective attenders live within a defined area or district. They must be one of very few contemporary organisations where adults congregate regularly and routinely on a day-long basis outside a work place. Several aspects of this need comment. Although day units, like schools and hospitals, are part of larger bureaucracies, day units are relatively small when compared with other modern organisations. An average-sized day unit has forty-three places and the average ratio of staff member to users clusters at about the one to eight mark. Day units might be said to be unfashionably small. It is true that extra-large hospitals (of 2,000 beds or more) are no longer favoured, but neither are very small ones: those with fewer than fifty beds are being phased out. In contrast, the hospital which provides between 500 and 999 beds has steadily grown in the past ten years. And a decade ago, the average-sized secondary school catered for just over 400 students, but by 1974-5 the population of an average school had doubled.

Another unusual aspect of day units which cannot be disconnected from their small size is an almost unique emphasis on regular meeting and day by day assembly.¹ Given that they offer a relatively small, artificially constructed society to certain people living within the same district, they may have a certain contemporary significance. It is beyond the scope of this book to examine this, but perhaps day units, along with community centres, offer a rare but quite specific suburban alternative for some, to the ‘fellowship’ of church or chapel accepted by earlier generations. Day units are not separated by theological differences, but as we shall see, they are constructed by forms of twentieth-century secularism, in the shape of professional ideologies which carry some of the normative functions formerly the prerogative of church and chapel.

Who attends day services? The first point to be made about attenders (who are called the users in this book) is simple but not obvious. Users of day units are, in many respects, like other people. Most of this book will concentrate on the ways in which users of day units differ from the average man or woman, so it is legitimate to start by emphasising their commonality. Attenders at day units watch television, read newspapers and listen to the radio as regularly as anybody else. Like the general population, they are enthusiastic pet owners and occasional visitors to museums and exhibitions. There are as many users of day units who do their garden and indulge in ‘do it yourself’ decorating as there are addicts of these pursuits in the population at large. Users of day units are, however, slightly more frequent visitors at the cinema or theatre than the general population.²

Day services have slightly more women users than might be expected from the proportion in the general population and slightly more persons who live alone. The percentage of the middle-aged groups, those aged 30 to 64, who use day services is similar to those in this age group in the general population, but young people aged from 16 to 29 and those past retirement age are over-represented. Only 13 per cent of the population is aged 65 or more, but this age group represents nearly a third of those attending day units.

The most striking difference between day unit users and the general population is that all users of day services are outside the open labour market for one reason or another. All, except those few in sheltered work, are, to use the technical phrase, ‘economically inactive’. This is striking once it is understood that one in every two day units see 90 per cent more of their users as ‘long term’ and never likely to leave the unit. By comparison, in only one out of every twenty day units are 90 per cent or more of the users thought to be likely to leave within six months of enrolling.

Most users of day services are at the unskilled, unqualified end of the scale. Half, excluding the elderly, left school at the age of 14 or before; 76 per cent have no qualifications or any type of job qualification. Only 4 per cent have a job they can return to after they leave the day unit. Users of day services start at the bottom of the skill pile. Given that most have an additional disability, by reason of labelled mental disorder or extant bodily infirmity, the combination of lack of skills plus disability leave many day unit users as diffic...