View report page

By and large, the centre has followed the course planned for it when it was opened.
There have been several minor difficulties and a major one. The minor difficulties
have been these:
The ambulance service tended to be erratic. Late arrival and early departure were
common, and meant a reduction in the time that the old people were at the centre.
This also had an unsettling effect on them, because they spent much of the day
waiting anxiously to be collected in the morning and taken home in the afternoon.
As the centre became established, the transport position improved and despite low
priority it has now been found possible to keep to fairly regular times.
Some patients appear to have misunderstood the purpose of the centre. Some,
despite previous explanation, expected to attend only for treatment and consequently
discharged themselves after a day or two. These were usually self-sufficient people
active enough to be able to get about by themselves, and therefore probably not
the type of patient we were intending to cater for. One or two patients have said
they were too ill to attend, and again were not really suitable patients for the centre
in the first place.
The main difficulty has been that of medical supervision. The original plan was
for practitioners to refer patients to the centre, and there to order and supervise
their treatment. Some practitioners have done just this. Others have preferred to
treat the centre as a kind of hospital to which patients could be sent for treatment
and not seen again until shortly after discharge. This has created difficulties for
the physiotherapist and occupational therapist, who have lacked detailed
instructions. Nor have practitioners always had the time to give to the slow
and painstaking rehabilitation of the old. This was particularly noticeable
during the very busy period in general practice during the latter half of January
and in February when referrals dropped sharply. There seems, therefore, a place
for a part-time visiting geriatrician at the centre, and this possibility is being
explored. The practitioner could thus have expert advice if he desired it, and, through
contact with the hospital services, facilities for investigation and treatment could
be extended. The practitioner who wished to handle his patient's case himself would
remain free to do so.
Despite these difficulties the centre is a going concern. It serves as a focal point
for the ascertainment of the aged handicapped, and for the provision to them of
the many other services that the borough can offer to old people. It has stimulated
lively discussion and exchange of ideas with many visitors to the centre from all
parts of the country. This report is of the first year's working of a five-year experiment.
The final pattern that day-treatment centres for old people should take may not yet
be clear, but this centre represents one authority's attempt to deal with its ailing and
lonely old people. The care of the elderly disabled is so largely a matter of social
rehabilitation rather than medical treatment that such centres seem inevitably to
be the direct concern of the local authorities. It would therefore be helpful if legislation
could be introduced to enable local authorities to provide treatment facilities
for the aged, and thus avoid the subterfuge of raising funds for a charitable object.
SUMMARY
A day-treatment centre for the elderly, established and managed by a voluntary
body and set up by a local authority at the instigation of its medical officer of health,
has been organised. A wide range of medical and ancillary services is provided.
All patients are referred by their general practitioners, in whose care they remain
throughout.
45