Daycare@Home, a mixture of an Integrated virtual/in-person model with direct support services.

Description

Introduction
Drogheda Community Services (DCS)has been providing social services in Drogheda since 1970 , with the objective of identifying social needs and attempting to tackle them.
Covid greatly increased social isolation, particularly in Older People. Daycare@Home was an initiative of DCS to combat this. As the crisis persisted, it became clear that ad hoc adaptations were not sufficient: the majority of those served by the Centre were categorised as among the most vulnerable. DCS had to make fundamental changes to services. To ensure we were meeting real-world needs especially of older people, research was needed before introducing sustainable digital interventions.

History.
As 2020 progressed, and the pandemic forced the closure of many services to reduce the spread of the coronavirus, DCS remained open to provide a range of new services. (meals, shopping delivery). However, members reported missing the daycare activities, in particular, the company of others. In response, the service decided to explore the idea of using Zoom to deliver social activities as well as to connect people to each other and to the service. There were also hopes, that if this form of delivering social activities was successful, it could offer a long-term solution for those unable to come into the centre even after the pandemic.
From this idea, and with support from NetwellCASALA research centre (DKIT), the Daycare@Home project was born. In June 2020, DCS began to provide some activities remotely, to those who could access them, delivered by DCS staff supported by a LMETB Tutor.

Starting Daycare@Home
In September, DCS launched Daycare@Home a pilot project, with funding from RTE Comic Relief one afternoon per week. By September 2021 activities being delivered by Zoom included crafts, art, chair exercises, quizzes and more. By December 2021, Daycare@Home was running four days per week with participants online joining those present in the day centre via a large screen. From three people in the first sessions, it grew to twenty-four regular attendees by the end of 2021.
“there is a bit of craic in it and a bit of, what would you say, down to earth people, just talking normal amongst themselves and talking about their gardens…”

Research Project
To ensure our Daycare@Home Project was evidence based NetwellCASALA Research Centre on Ageing at DKIT carried out analysis of a pre-pilot survey and an Advisory Committee of service stakeholders was set up and the research was funded by the Irish Research Council. This is the first research conducted in Ireland on the experiences of older adults engaging in social Daycare services.
In September 2020, a survey 81 Daycare members was conducted, to find out what members wanted and if they would participate in a pilot project. The pilot project was then established and members were invited to participate in the online activities from January 2021 as part of our outreach service. Interviews were conducted including focus groups with family members and with those providing the service. We wanted to know what worked and what did not, if there were any challenges, and what impact Daycare@Home was having on each of these groups. The project ran from September 2020 to June 2022.

The Ideal Daycare@Home
Part of the research was to consider what a Daycare@Home service should be like.
The findings highlighted the most important aspects of an online service that would meet the needs of day centre members, their families and the staff. This included, helping people to stay in touch with each other, providing support to help members to use it, provide a variety of activities and enjoyable things to do and be easy to use and have a reliable routine to join in real time – not recorded.

Findings
As the pilot was being implemented, day centre staff and family members highlighted a range of challenges. However, findings from all groups indicated that Daycare@Home was both enjoyable and beneficial. Daycare@Home feels normal and helps to build friendships in a similar way to attending daycare. As government restrictions were lifted, and members returned it was decided that Daycare@Home would continue.

Present
DCS provides the following outreach services as part of Daycare@Home.
• A phone call or email in the morning about that day’s activities.
• Hot cooked meals, either through the local MOW Service or supplementing this service i.e. on days MOW not available.
• Home delivery of shopping. Many other people to not have access to shopping online.
• Zoom activities such as art and craft , quizzes, Exercises, meditation, etc.
The service helps people remain in their own home, enhance their life experience and provides additional social inclusion that the usual home help supports may not provide.
“I look forward to it after dinner. Rush up the dinner and tidy up, get ready to sit down and see who’s in and who’s not in”

Aim of Initiative

As a community service, Drogheda Community Services (DCS) was established 1970to identify and address the needs of the local community and especially older people in Drogheda and its environs.
Our Daycare@Home pilot project has the dual purpose of maintaining immediate social connections with our service users while developing and evaluating a sustainable online outreach daycare service delivery model. As the commencement of the Pandamic, the main aim was to make fundamental changes in the modalities, protocols, premises, equipment and skills to continue to effectively deliver support for the long term , to ensure we are meeting real-world needs, introducing sustainable digital interventions, to ensure that the Daycare@home model we create is fit for purpose. Therefore it was the aim to make sure the development of Daycare@Home is evidence-based, NetwellCASALA at DkIT is leading research on our pilot project.
This was also seen as an opportunity to develop a new service delivery model, intended to enable expansion of services to those unable to visit the centre after the pandemic. At the time, it was unclear how long the pandemic restrictions would last. The decision to robustly consider this online model so early in the pandemic response may have been fortuitous as DCST embarked on an evidence-based approach to inform the development of the proposed Daycare@Home project.

Who is it aimed at

The pilot project DCS Daycare@Home was aimed initially at existing key stakeholders including service members, staff, and families of members attending our Daycare Centre , Scarlet Crescent, Drogheda. The research aspect examined the feasibility of delivering social activities to older adults through the use of Zoom, and outreach services during the Covid-19 pandemic. Albeit a small study, conducted under specific (pandemic) circumstances, the findings provided evidence of the value of Daycare@Home to all of the key stakeholders including service members, staff, and families. Daycare@Home has been found to be a potentially successful and novel way of providing support to service members and their families and a new resource for community referrals.
In addition the experience gained by DCS in researching and co ordinating the different aspects of developing and running the new service , has also laid the foundation for potential transferability of the Daycare@Home model For example, Irish Men’s Sheds Association (IMSA), in conjunction with Drogheda Community Services and NetwellCASALA are embarking on a project to transfer Daycare@Home, to the Drogheda Men’s Sheds. This initiative, Sheds@Home, will facilitate engagement with shed activities via Zoom for men who have a variety of barriers preventing their return in-person to the Shed.

3 Steps critical to success

1. The increased availability of digital devises through funding from RTE does Comic Relief, Louth Age Friendly, LMETB, among others and new strategies to address improving the digital skills of those working, volunteering, or on educational placement in a social care capacity. By expanding the range of technology we use both in the Centre ( such as whiteboard, video and microphone Kit) and in the homes of members (tablets and E-Readers) this has allowed us to integrate members of the Daycare with other members in the Community , e.g. people on the waiting list for Daycare , or not able to avail of Daycare due to medical reasons. Our Daycare@Home Pilot project distributed tablet devices and developed an increased range of activities for online engagement with Centre and outreach members. This has deepened our in-person interactions and outreach capabilities and enhanced the quality of life of members as well as staff and volunteers.
2. To make sure the development of Daycare@Home was evidence-based, NetwellCASALA at DKIT led the research on the pilot project, guided by an Advisory Committee of service stakeholders, supported by colleagues from DCU and funded by the Irish Research Council. This collaborative approach worked on finding solutions that worked for everyone. The research project was specific to the outreach service operated by Drogheda Community Services and independently the identified the benefits and challenges of DCS Daycare@Home service
3. Successful delivery of Daycare@Home required members and the service providers to work together, often with help from family members. Ensuring the diverse needs and preferences of service members were met, presented both a challenge and an opportunity for service providers. For example, 30% in this research study, are not interested in receiving services or joining activities online. Over half (52%) of members were also over 85 years of age and, therefore, often less likely to use online services. Others will be happy to join online activities passively, observing rather than interacting, while some are eager to see the continuation and expansion of the Daycare@Home offering because it meets their need for social connection and stimulation in a way that suits them.”‘…he won’t participate in anything but he’s in the background all the time with his pen and paper and he’s answering all the [quiz] questions. So, he is a non-partaking participant”
   Our pilot project, was guided by an Advisory Committee of service stakeholders, with interviews with service users and focus groups with family members and service facilitators. It is imperative that the voices of services users, staff and volunteers who deliver services are heard. Initial findings showed a strong desire and willingness of members to follow DCST in this direction , with 69% expressing willingness to engage with the services remotely given the support to do so. Important to remember that even the small steps, encouraging one new person on a digital devise is a great achievement.

3 Challenges in Planning / Delivery

1. Initially as expected, access to the internet/broadband, tablets, was a challenge for service members. While a small number of members were already computer users, others had access through family members who provided tablets or computer access and provided help to join the activities. We found it difficult to decide on the right equipment/software to use There were a number of issues to be considered such as security, access, training, tablet ownership set up and decisions around what equipment/software to use. As many family members were working from home due to the pandemic, for some this meant family was close to hand to help if a problem arose, but for others, it meant they could not always join the activities because their family member was using the laptop for work. However, not all family members were comfortable using technology or Zoom and some found it difficult to help the service user to join Daycare@Home. This required significant time from staff to help these members take part in Daycare@Home.
2. The research highlighted the lack of technical ability in the majority of staff, which contributed to hesitancy and reluctance to offer digital support to older service users. It is challenging for staff to juggle managing both online and on-site groups simultaneously depending on the activities being carried out. Some activities work better than others. In addition, DCS underestimated the time it would take to set up the project and found it difficult to find the necessary expertise to advise us, as the roles were not just IT, but involved training, mentoring and social care.
3. For some participants, physical challenges such as arthritis, eyesight or hearing difficulties limited their ability to use a tablet or participate fully in some activities. However, these limitations did not either dampen the enthusiasm or prevent participation among Daycare@Home users. Indeed, it was noted in the research that the range of social activities offered meant there was always something to join in with, and this is considered a positive aspect of the project. ‘You need…how will I put it?… I think you need challenges. Little challenges. Not big ones, now, but little challenges’ ” “‘I know that in a while, if I can stick at it, I will be alright”

3 Outcomes / Benefits

1. For Daycare members , staff and management, a primary outcome of the Daycare@Home project was that it helped them to stay in touch with through the pandemic. More specifically, the project meant they could stay connected while recreating the enjoyable and social aspect of the centre’s mission even while the doors of the centre remained closed.
   It was clear from the research that Daycare@Home feels normal and can help to build friendships in a similar way to attending the Daycare service in person. Service members reported a sense of personal achievement from participating in Daycare@Home and at having mastered the digital skills required to participate, as well as learning other skills through the activities. This was linked to an attitude of lifelong learning. Members were committed to continuing participation in the online activities and to becoming more comfortable and adapt at engaging over time
   The enhanced accessibility of services benefits not only current service users but new members into the future.
2. Being introduced to tablets and Zoom during Daycare@Home also resulted in the service being able to identify digital skills required for staff and service users and to provide training to support this learning. Many of the staff working in a social care setting had little digital experience before Daycare@Home. For staff who were technically capable it affirmed the work they already do with the members. It also raised the awareness of staff to the possibilities of caring for and connecting with older people in ways that are different to the standard care that they were used to. It also showed the staff the benefit and advantages of using technology with clients who are off-site The outcome of “Building Digital Bridges” a series of workshops included a training manual for those using tablets to join Daycare@Home, training videos were created for staff about the different tablets being distributed for Daycare@Home, a review of broadband providers was conducted to identify contract and pricing options and a ‘how-to’ manual was developed to help those new to being online. A paper format is available from Drogheda Community Services, and an online version is available, through NetwellCASALA at https://www.netwellcasala.org/pdf/tech-guide.pdf
3. One purpose of the research project was to consider if Daycare@Home could be part of the solution to a growing waiting list for day services. Prior to the pandemic closure, members were already limited to a specific number of days in the centre, in an effort to accommodate as many people as possible. By the time the research project ended in June 2022, Daycare@Home was providing a service four afternoons per week. The DCS Daycare@Home service is now operating along side DCS Daycare Centre. This expanded delivery means that members can join the Daycare@Home activities even on the days they are not scheduled to attend the centre This was reported as a significant benefit offering greater opportunities to be both active and socially connected. A further benefit identified,in the event a member being unable to attend the centre on their scheduled day, e.g. due to illness or recovering from surgery etc., Daycare@Home provides a welcome option to stay connected to friends and the centre while forced to be away.
   “‘Tuesday, Wednesday and Friday now, we have a zoom meeting and I am there [in the centre on]Thursday so you have the whole week [covered]….”
   “‘…say you’re after being sick. Isn’t it nice to come down and sit at your kitchen table, and have a chat with them before they start? And okay, if you can do it you’ll do it and if you can’t make the activities you’ll watch the others.”