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

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.