Is socially integrated community day care for people with dementia associated with higher user satisfaction and a higher job satisfaction of staff compared to nursing home-based day care?

Figures & data

Figure 1. Description of the Meetings Centres Support Programme (MCSP), nursing home-based day care (NH day care), and community day care with carer support (CO day care).

Table 1. Background characteristics of people with dementia participating in nursing home-based (NH) day care versus community-based (CO) day care with carer support.

	NH day care (n = 41)	CO day care (n = 28)	Test statistic, p
Gender, n (%)			χ^2 = 0.10
— Male	16 (39%)	12 (43%)	p = 0.75
— Female	25 (61%)	16 (57%)
Age, years (SD)	84.7 (5.8)	80.0 (7.4)	Z = −2.58
			p = 0.01
Marital status, n (%)			χ^2 = 3.54 p = 0.47
— Married/living together	22 (54%)	15 (54%)
— Divorced/widowed/ unmarried/single	19 (46%)	13 (46%)
Living situation, n (%)			χ^2 = 0.01
			p = 0.92
— Independent, alone	20 (49%)	14 (50%)
— Independent, with others	21 (51%)	14 (50%)
Diagnosis, n (%)			χ^2 = 1.94
			p = 0.59
— Alzheimer	17 (43%)	13 (48%)
— Vascular dementia	4 (10%)	5 (19%)
— Alzheimer and vascular	8 (20%)	3 (11%)
— Other	11 (27%)	6 (22%)

Legend: SD = standard deviation, χ² = chi-square, significant differences between groups with p-value < 0.05 are presented in bold.

Table 2. User satisfaction of people with dementia participating in nursing home-based (NH) day care (n = 41) versus community-based (CO) day care with carer support (n = 28).

	NH day care			CO day care
Outcome measure (range^1) (response options)	Median	Range	Mean Rank	Median	Range	Mean Rank	Test statistic, p	Effect size
Aspects of the day care centre
Atmosphere (1–4) (totally not nice – very nice)	3.0	2–4	27.9	3.0	2–4	43.1	Z = −3.74 p = 0.00	r = −0.46
Location (1–4) (totally not nice – very nice)	3.0	2–4	27.7	3.0	2–4	34.0	Z = −2.07 p = 0.04	r = −0.27
Staff
Contact (1–4) (very unfriendly – very friendly)	3.0	2–4	30.2	4.0	2–4	39.4	Z = −2.40 p = 0.03	r = −.29
Attention (1–3) (insufficient – good)	2.0	1–3	30.5	3.0	1–3	35.5	Z = −1.18 p = 0.24	r = −0.15
Help of staff (1–3) (insufficient-good)	3.0	2–5	30.8	3.0	1–5	34.8	Z = −0.88 p = 0.38	r = −0.11
Staff listening (1–3) (insufficient-good)	2.0	1–3	29.1	2.0	1–3	37.4	Z = −2.12 p = 0.03	r = −0.27
Ambience and activities
Ambience afternoon meal (1–4) (totally not nice – very nice)	3.0	2–4	26.2	3.5	2–4	33.2	Z = −1.91 p = 0.06	r = −0.25
Can participants do what they like? Yes, n (%)	21 (65%)			18 (86%)			χ^2 = 2.63 p = 0.11	Phi = 0.22
Overall evaluation activities (1–4) (totally not nice – very nice)	3.0	2–4	26.4	3.0	1–4	34.5	Z = −2.13 p = 0.03	r = −0.28
Does staff ask which activity to do? (1–4) (never – always)	1.0	1–4	29.0	2.0	1–4	38.6	Z = −2.24 p = 0.03	r = −0.28
Is that acted upon? (1–4) (never-always)	3.0	1–4	13.9	3.0	1–4	16.6	Z = −0.87 p = 0.39	r = −0.16
General evaluation
General evaluation (1–4) (totally not nice – very nice)	3.0	1–4	29.6	3.0	2–4	39.5	Z = −2.25 p = 0.02	r = −0.28
	Mean	SD		Mean	SD
Grade (1–10)	7.6	1.3		8.1	1.1		t = −1.71 p = 0.09	r = −0.22

¹Underlined scores are more favourable.

SD = standard deviation, χ² = chi-square. Pearson Chi-square test was used to test for yes/no answers; independent samples t-test for grade score, Mann–Whitney U test for others. Text printed in bold is significant at p > 0.05. Effect size Pearson's r and phi: small = 0.10; medium = 0.30; large = 0.50.

Table 3. Background characteristics of informal carers of people with dementia participating in nursing home-based (NH) day care versus community-based (CO) day care.

	NH day care (n = 39)	CO day care (n = 36)	Test statistic and p-value
Gender, n (%)			χ^2 = 0.05
– Male	11 (28%)	11 (31%)	p = 0.82
– Female	28 (72%)	25 (69%)
Age, years			Z = −2.2
(median, range)	70.5 (42–87)	63.0 (24–81)	p = 0.03
Other (paid or voluntary)			χ^2 = 0.51
work besides caring? n (%)			p = 0.47
– Yes	17 (44%)	12 (33%)
– No	21 (54%)	21 (58%)
– Unknown	1 (2%)	3 (8%)
Relationship with PwD* n (%)			χ^2 = 2.56
			p = 0.47
– Partner	21 (54%)	16 (44%)
– Son/daughter	17 (44%)	17 (47%)
– Other	1 (2%)	3 (8%)
Living with the PwD? n (%)			χ^2 = 0.61
			p = 0.44
– Yes	23 (59%)	18 (50%)
– No	16 (41%)	18 (50%)

*PwD = person with dementia.

Table 4. User satisfaction of informal carers of people with dementia participating in nursing home-based (NH) day care (n = 39) versus community-based (CO) day care (n = 36).

	NH day care			CO day care
Outcome measure (range^1)	Median	Range	Mean Rank	median	Range	Mean Rank	Test statistic, p	Effect size r
Staff and support programme day care centre
Staff discusses progress sufficiently (1–4)	3.0	1–4	32.6	3.0	2–4	43.9	Z = −2.6 p = 0.01	−0.30
Staff listens sufficiently (1–4)	3.0	1–4	32.2	3.0	1–4	41.6	Z = −2.2 p = 0.03	−0.26
I am sufficiently involved in support (1–4)	3.0	1–4	31.1	3.0	2–4	41.6	Z = −2.4 p = 0.02	−0.28
I am actively informed of daily (1–4)	3.0	1–4	31.8	3.0	2–4	40.9	Z = −2.0 p = 0.05	−0.26
Staff accepts me as I am (1–4)	3.0	3–4	36.4	3.0	1–4	37.6	Z = −0.3 p = 0.78	−0.03
Staff is always friendly to the clients (1–4)	3.5	2–4	35.1	4.0	1–4	37.9	Z = −0.7 p = 0.50	−0.08
Staff genuinely has attention for you (1–4)	3.0	2–4	33.1	4.0	2–4	41.3	Z = −1.9 p = 0.06	−0.22
Satisfied about with expertise (1–4)	3.0	2–4	31.4	3.0	3–4	40.8	Z = −2.3 p = 0.02	−0.27
Day care nicely furnished (‘gezellig’) (1–4)	3.0	2–4	33.5	3.0	2–4	39.5	Z = −1.4 p = 0.16	−0.16
Staff needs to know more about my loved one's background (1–4)	3.0	1–4	38.6	3.0	1–4	33.3	Z = −1.2 p = 0.24	−0.14
Staff makes me feel I am a burden (1–4)	3.0	1–4	31.6	4.0	1–4	42.5	Z = −2.5 p = 0.01	−0.29
Thanks to day care I feel less burdened (1–4)	3.0	1–4	38.1	3.0	2–4	35.8	Z = −0.5 p = 0.60	−0.06
Sufficient activities are offered that are suitable for my loved one (1–4)	3.0	2–4	31.1	3.0	1–4	36.8	Z = −1.4 p = 0.18	−0.17
I made new acquaintances among other informal carers (1–4)	2.0	1–4	32.0	2.0	1–4	41.2	Z = −2.1 p = 0.04	−0.17
Experienced support
Sufficient emotional support (1–4)	3.0	1–4	29.1	3.0	2–4	39.1	Z = −2.4 p = 0.01	−0.29
Sufficient social contacts (1–4)	3.0	1–4	25.6	3.0	1–4	34.0	Z = −2.1 p = 0.04	−0.27
Sufficient information (1–4)	3.0	2–4	30.7	3.0	3–4	37.2	Z = −1.9 p = 0.06	−0.23
Sufficient practical support (1–4)	3.0	2–4	25.5	3.0	2–4	36.5	Z = −2.8 p = 0.01	−0.36
General evaluation
	Mean	SD		Mean	SD		Test statistic, p	Effect size r
Grade (1–10)	7.7	1.05		7.9	1.04		t = −0.9 p = 0.38	r = −0.10

¹ Underlined score is more favourable.

Mann–Whitney U used for testing group differences, independent samples t-test used for grade. Text printed in bold is significant at p > 0.05. Effect size Pearson's r: small = 0.10; medium = 0.30; large = 0.50.

Table 5. Background characteristics of care staff (n = 24) with measurements before and after the transition to CO day care.

Characteristic	Value
Female, n (%)	24 (100%)
Age, years (SD)	52.3 (6.1)
Marital status, n (%)
– Married/living together	17 (71%)
– Divorced	1 (4%)
– Widowed	1 (4%)
– Unmarried	3 (12%)
– Unknown	2 (9%)
Education, n (%)
– Primary school	0 (0%)
– Low	4 (17%)
– Intermediate	18 (75%)
– High	2 (8%)
– Other	0 (0%)
Position, n (%)
– Nursing assistant	11 (46%)
– Activity therapist	5 (20%)
– Other	8 (34%)
N years employed in elderly care
– Less than 5 years	0 (0%)
– More than 5 years	24 (100%)

Table 6. Work experience and job satisfaction of care staff working in the six nursing home-based (NH) day care centres that transformed to community (CO) day care with carer support. Data are shown of staff involved both before and after the transition (n = 24).

Outcome measure (range^1)	Before transition Median (range)	After transition Median (range)	Z	p	Effect size r
LAKS^2
Work demands (1–4)	2.6 (1.8–3.0)	2.8 (2.0–3.4)	−1.2	0.22	−0.26
Autonomy (1–4)	3.0 (2.3–4.0)	3.0 (2.5–3.5)	−0.2	0.86	−0.04
Support of manager (1–4)	3.0 (2.0–4.0)	3.0 (2.5–4.0)	−0.7	0.50	−0.15
Support of colleagues (1–4)	3.3 (2.8–4.0)	3.6 (2.5–4.0)	−0.2	0.82	−0.05
Job satisfaction (1–4)	3.0 (2.2–3.5)	3.0 (2.2–3.7)	−0.8	0.43	−0.16
VBBA/QEEW^3
Work pace (0–33)	11.0 (7.0–21.0)	10.0 (4.0–20.0)	−2.6	0.01	−0.54
Variation in work (0–18)	5.0 (0.0–10.0)	5.0 (2.0–10.0)	−1.1	0.29	−0.22
Learning opportunities (0–12)	4.0 (0.0–8.0)	5.0 (1.0–8.0)	−2.1	0.03	−0.45
Independence (0–33)	12.0 (0.0–22.0)	14.5 (2.0–22.0)	−0.7	0.48	−0.15
Problems with task (0–18)	4.0 (0.0–7.0)	3.5 (0.0–10.0)	−0.7	0.50	−0.14

¹ Underlined score is more favourable in the questionnaire. ²LAKS: Leiden Quality of Work Questionnaire. ³VBBA/QEEW: Questionnaire Experience Evaluation of Work. Wilcoxon Signed Rank Test used for testing group differences. Text printed in bold is significant at p > 0.05. Effect size Pearson's r: small = 0.10; medium = 0.30; large = 0.50.