Dementia Day Care Endings: The Uncertain Limits of Care

Abstract

The purpose of this study was to gain an understanding of the endings of day care for people with dementia. Staff members from a statewide random sample of dementia day care facilities were asked to think back over their practices and describe especially satisfying and dissatisfying experiences. The day care endings—either by death or by termination for other reasons—were governed by the uncertain limits of care. Dimensions of uncertainty included the capacities of the family, client, and staff, the ethical dilemmas embedded in the care; and the working relationship between staff and family. The staff experiences were shaped by Western ideologies about the "good" of community care and the "bad" of institutional care. Findings suggest the need for increased staff awareness of the uncertainty that dominates the endings of day care and for better contextualization of the endings into each client's ongoing life story.