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Community lifeline: Re-opening day care services

The loss of, or reduction in, day care services during the COVID-19 crisis has been hugely challenging for people. In this article, Kathryn Smith of the Social Care Institute for Excellence (SCIE) shares advice on re-opening and Becky Hamilton, Manager at Windward Day Care Services, reflects on its response to the pandemic.

During a webinar we held in March 2021, we heard about all of the challenges thrown at day service providers during the pandemic.

At SCIE, we have developed a guide that supports day care managers, social workers, commissioners and providers to restart or continue activities. It’s focused on community-based day services and day centres (with and without personal care), including specialised day centre environments and those with outdoor spaces. The SCIE Guide was developed in conjunction with Public Health England, the Department for Health and Social Care, the Local Government Association and King’s College London. It has been recently updated to reflect the changing COVID-19 landscape and policies.

Considerations for providers

Some services might have been able to provide very limited, or no, day care support during the pandemic. It is highly likely that things can’t just revert to the way they were pre-COVID. During lockdown, there may have been changes to contracts, re-deployment of staff and/or an increase in the use of technology and home-based one-to-one support.

Communication and engagement are key. For example, a communication plan can be agreed on, to ensure all people using services and their families are informed of what will be happening in the weeks and months ahead. It is important to make sure that staff and volunteers feel safe and supported when services resume and that their concerns and needs are considered when re-opening or expanding face-to-face support. Managers will need a plan to respond to the trauma of COVID-19 experienced by people who draw on services, staff, volunteers and others.

From the Guide: How to approach re-opening day care services: Where to start and planning for the future.

Get creative

One county council has been identifying people most in need of face-to-face day care using a red, amber and green system. ‘Red’ means there is an immediate risk for the person or carer. This could be that a safeguarding concern has been raised. ‘Amber’ suggests the person or carer is experiencing difficulties but is not at immediate risk. One indicator here is that the existing care arrangements could be at risk. ‘Green’ suggests there are minimal concerns regarding a person’s or carer’s wellbeing; for instance, the carer isn’t expressing concerns and there were no welfare concerns prior to isolation in March 2020.

From the Guide: Practice examples of delivering safe adult day care.

New ways of working

Despite the vaccination programme being much further on compared to March 2021 when we held the webinar, infection and control measures in the workplace should be robustly implemented and adhered to. This includes limiting close contact, optimising ventilation, PPE and hand and respiratory hygiene.

Staff (including kitchen staff, cleaning staff and transport staff) and volunteer training is needed to embrace new ways of working, along with how to cover COVID-19 etiquette. It is important that staff understand why new systems and protocols are in place and how they can help to minimise risk. This includes infection prevention and control, safe systems of working, limiting close contact, correct use of PPE and local training on measures to be taken in different environments or service locations.

Legal factors

Depending on the service, a range of agencies and contractors may need to be involved in the safe re-opening or expansion of face-to-face services. This includes insurance providers, facilities that are open to the public and transport providers. When it comes to building landlords and management groups, providers must ensure relevant health and safety checks have been undertaken for buildings that have been closed or, indeed, new spaces. It’s best to be clear about who has responsibility for deep cleaning and regular cleaning. It is important to be aware of other users of the building and know who is responsible for handing over and cleaning between user groups.

From the Guide: Considering agencies and contractors.

The SCIE Guide was developed in conjunction with Public Health England, the Department for Health and Social Care, the Local Government Association and King’s College London. It has been recently updated to reflect the changing COVID landscape and policies. The guide has been significantly updated since the 19th July and these updates will be available in September. SCIE: Delivering safe, face-to-face adult day care.

Essential service

Day care offers an essential service and improves the quality of life for participants and their carers. It is a central component of social citizenship for many. It is essential that participants and carers continue to receive the support they need. There is also clearly the need for day services to be as safe as possible.

Becky Hamilton, Manager at Windward Day Care Services, reflects on how her team responded to the pandemic and outlines some of the biggest challenges they had to overcome, so they could continue to support people.

Windward Day Care Services

The impact of COVID-19 has affected every part of Windward Day Services. We are a team of 70 people, who support 170 adults with a learning disability and who may also be autistic. We have been offering day opportunities for 20 years in small community-based buildings in Hampshire and Dorset. We support our clients to have a good day undertaking activities, including physical activity in the community such as using gyms, outdoor gyms, swimming pools, sailing and golf. We also offer more focused sessions like dance, drama, cooking, self-care, singing, Makaton and recycling. We are developing a shop and showroom where people can gain employment skills.

When we closed in March 2020, we were thrown into shock. Fortunately, we quickly adopted zoom to communicate within our managers’ group. We then started to meet throughout the day and developed new systems to support people. Windward is an outward-looking organisation and we maintain links with other similar providers to enable us to share knowledge.

The biggest game changer was when we threw everything into our new breakout digital service called Click. Click offers a full timetable of meaningful activities throughout the day, evening and weekends. We fostered a culture of staff creativity and co-production. Click is accessed by existing people who use our service and also new members.

We were in weekly contact with everyone linked to our service, which helped us to keep up to date with how people were coping. After we had to close, we quickly began to offer hands-on critical support for people who were struggling and we were supported by the councils to do this. Following a request by one council, we released our staff to work in local Supported Living provisions. The staff involved felt they were really helping out and good links were formed.

Windward opened in July 2020 on a trial basis and then fully opened on 1st August for people in need. The local authority and Windward assessed those people most in need (60% of the community became eligible). We didn’t close fully again throughout all following lockdowns. To ensure safety, we performed full risk assessments and then communicated our measures to our clients and their circles of care through easy-read docs, on Facebook and via email. We produced videos of walk throughs of the new services, which were available on YouTube.

Reading between the lines

The Government released good information for residential homes, Supported Living, domiciliary care providers and education. However, those of us involved in day opportunities had to read between the lines of all this information to find a way forward. Day services are not regulated by CQC and so are often misunderstood by Governments.

Our biggest challenges throughout the whole period were to:

  • Understand constant changes in guidance and regulation.
  • Help support people with anxiety.
  • Advocate on behalf of people whose voices are seldom heard by decision makers.

At times, we have been disappointed by the speed with which paternalistic attitudes have returned towards people who have care and support needs. People we support have been unable to make their own decisions about many aspects of their life. Others have decided how, when and what services they can access. We are driven by the desire to provide a safe service but it has often been forgotten that we are working with adults who are used to having some agency in their own lives.

A helping hand

One of our clients, Steve*, is autistic and lives with his mum in a flat near to one of our centres. He really struggled from the beginning of lockdown one. He has considerable support needs with processing and communication and was becoming increasingly frustrated. When his lack of routine became so hard that his mum was being physically harmed, we opened part of one centre just for him and a small team of key people. This support enabled him to stay living at home and avoid moving to emergency respite, which would have been difficult for both of them.

What has helped us to flourish through the pandemic is being open to others – we have received support from other services and offered support in return. In preparation for another pandemic, we would always want to be keeping up to date with technology and to not be afraid of thinking of new ways to approach challenges.

Day service provision has been seen by some people as unfashionable in the last few years, with the focus coming away from buildings-based support. What we have clearly seen throughout this period is that a day service is a place where people know and are known. It’s a place where friendships form and sustain. It is a hub for many types of support. Without services like ours, many people would struggle with deep isolation and a loss of friendship, fun and support.


Kathryn Smith is the Chief Executive of the Social Care Institute for Excellence (SCIE). Email: media@scie.org.uk  Twitter: @SCIE_socialcare  Becky Hamilton is Manager at Windward Day Care Services. Email: becky@windward-dayservices.co.uk 

How did you adapt and respond to day care service closure during the pandemic? Have you devised creative ways to re-open services? Comment below.  

 

 

 

 

 

 

About Kathryn Smith

Kathryn Smith has thirty years’ experience working in health and social care. She is Chief Executive of Social Care Institute for Excellence (SCIE). Prior to this, her roles included Chief Operating Officer at Alzheimer’s Society, and Director of Services at Scope.

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