Day Hospitals

Geriatric day hospitals have been part of the health care of older adults for many years. The global increase in the number of older adults has combined with fiscal pressures to decrease lengths of stay in acute care facilities and resulted in shortages of long-term care space in most developed countries. Day hospitals are intended to serve as a midpoint between acute care and out-patient rehabilitation, and to not only delay institutionalization but also to improve quality of life and independence in the patients who attend.

First introduced in the United Kingdom in the early 1960s, when long-term care beds were even more limited than at present, day hospitals were designed to provide interdisciplinary assessment and management of chronic health problems for older persons. They were initially developed in association with geriatric inpatient services to allow access to diagnostic facilities, but many are now sited with ease of access for older persons in mind. There are day hospitals in community centers and in shopping malls in some parts of the world. Day hospitals are even known as community rehabilitation centers in some parts of Australia. Several programs in the United States use centralized day programs to provide integrated assessment and therapy for frail older persons (Program for the All-Inclusive Care of Elders, or PACE ). The key feature is the interdisciplinary assessment and management provided. Staffing usually consists of a geriatrician or physician with special training in the care of the elderly, nurses, nurse practitioners, physiotherapists, occupational therapists, social workers, and sometimes a speech pathologist or nutritionist. Often there is a recreational therapist. Case management models are usually used and day hospitals work in liaison with other community caregivers, such as home care services.

Patients who attend day hospitals benefit from both the therapy and the company of other peers. Most have individual therapy with specific treatment but will also participate in group activities such as exercise and usually some recreation. Some day hospitals provide more acute assessment and management. Persons usually attend for two days per week, although more often in some cases (PACE), and usually for about four hours each day. The geriatric program often arranges transportation.

Day hospitals should be distinguished from day centers, which do not provide specific therapy. Day centers are designed to maintain function and to provide not only activity and socialization but also respite for caregivers. They do not have the rich staffing of the geriatric day hospitals.