Non-use of day care services for dementia in Singapore - a dilemma for caregivers

Background: Day care services for patients with dementia (PWD) are generally under-utilized worldwide despite evidence of positive outcomes, such as improved behavioral, psychological, and cognitive functioning for patients, and reduced caregiver burden. This study sought to gain an in-depth understanding of the reasons for non-utilization of day care services in Singapore using qualitative methodology. Methods: A purposive sample of 16 caregivers of PWD who had never attended day care services participated in semi-structured interviews. Interviews were audio-recorded and transcribed verbatim. Data analysis was based on an Interpretative Phenomenological Analysis framework. Findings: Caregivers recognized the importance of engagement for PWD, yet were constrained by patients' refusal to attend day care, which caregivers attributed to the patients' negative beliefs about day care and fear of abandonment by their families. Caregivers also raised concerns about service delivery issues, the suitability of activities at day care, and their perceptions of the patients' ability to integrate into the setting. Non-utilization was also related to caregivers' low perceived need due to the availability of alternative care arrangements (e.g. having a domestic helper and adequate family support). Conclusions: Caregivers generally understand the value of day care but several factors tip the balance in favor of non-use. These include culturally bound caregiving values and perceptions, and inadequacies in service delivery. Negative perceptions about services highlight the need to enhance the image and standards of day care and increase awareness of the benefits of day care for PWD beyond its custodial role.