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use of skilled medical and nursing care, but without links with the Day Hospital, the
types of patient who could be supported by non-medical workers in day centres would be
more limited. The work of these two day centres has been a major contribution to the
care of the elderly in the community.
The Day Hospital plays a valuable role in the assessment of patients. Townsend and
Wedderburn have drawn attention to the importance of social factors in precipitating
admissions to hospital, and also to the large numbers of severely incapacitated old
persons .being cared for by their relatives at home. Often, requests for admission are
associated with developments of tension within the family, who do not want to "put Mum
away" but can see no alternative. The Day Hospital is often a satisfactory solution,
for some time at least.
Occasionally it is difficult to know whether relatives are exaggerating the behavioural
difficulties of a patient, when they demand admission to hospital. Often, it
is difficult to discharge patients so admitted. It may be impossible to evaluate the
situation adequately in an out-patient clinic. Admission to a day hospital allows assessment
in a cooler atmosphere, and enables the doctor to offer something concrete to
relatives, short of in-patient admission. Further information about home conditions and
family relationships is often obtained by the nurse who regularly travels in the ambulance
on its daily round to collect patients.
We have been very fortunate in our ambulance service. Transport is one of the
essential factors necessary for success of any day hospital for old people, and we greatly
value the hard work of our ambulance driver. Another key figure is the senior nurse
on duty. We lost an excellent sister during the year but she has been replaced by an
equally excellent charge nurse.
Much responsibility for the smooth running of the Day Hospital rests with the nurse
in charge. He has to organise lists of names and addresses of the patients for the
ambulance on the appropriate days and co-ordinate medical treatment, physiotherapy,
occupational therapy and social events. He is often the first person contacted by relatives
in distress, or by the day centre staffs in the area. He is daily in touch with
the patients and therefore likely to be one of the first to observe that a patient is
not well and needs medical attention.
It is our policy to limit the attendance at the Day Hospital to the over 65 age
group, though on occasions exceptions are made. It seems reasonable to admit patients
who would obviously benefit from day hospital attendance, when they live very near to
St. Clement's and particularly if they do not require an ambulance to bring them. I
have tried to limit day hospital attendance to patients who could not adequately be
treated in the out-patient clinic with additional attendance at an old persons' club.
Patients are assessed for suitability before admission to the day hospital, usually in
the out-patient clinic. Many of the patients are severely incapacitated and would
51.