Programs that address the needs of the elderly are especially important in Canada today as it experiences population aging. There are currently no pretest-posttest studies evaluating functional independence of patients attending the Geriatric Day Hospital at Bruyère Continuing Care in Ottawa, Ontario using the set of indicators and outcome measurement instruments in this study. Evaluation of older patients (age over 65) in this program using various outcome measures was carried out using a single group pretest-post test design. Results showed that there was statistically significant improvement between pretest and post-test scores measuring fear of falling, balance, and functional exercise capacity. However, no significant difference was found between pre- and post-scores for caregiver stress, for which various hypothesized reasons are proposed. There were similar findings for the subgroups analyzed (patients with a history of: stroke or TIA; previous falls; or osteoarthritis) with the exception of fear of falling, which did not show a significant decrease in the stroke subgroup. Some caregivers suggested that “burden” was not an appropriate word for describing their experience, as care-giving was often seen as a moral obligation or an act of love. Future evaluation research using a mixed methods approach and repeated measures design is recommended for a more comprehensive understanding of the effects of this Day Hospital. It may also be of value to compare the different geriatric day hospital programs at the local and regional levels.

This ethnographic nursing home study explores the meaning which residents make of being old and in care. Its primary focus is on the role of social and communicative interactions in maintaining residents’ sense of self. Throughout the thesis I argue that the self is socially constructed, narratively communicated and is continuous throughout the life span. This narrative, relational self is diminished in old age by bereavement and the loss of social networks, and threatened by the loneliness and isolation of the institutional environment. Nonetheless, despite the stripping of relational layers entailed in the loss of the people with whom the younger self was constructed, there is a continuing core of self which, while bending, does not break. I argue that the nursing home can be a site of recovery for this vulnerable, diminished self, offering support and the opportunity to take on new roles and form new relationships, and through these relationships, new layers of self. / Staff are key players in the healing process, and staff-resident relationships important new sources of meaning for the relational self. The ageing, marginalised self is strengthened through empathetic communication which recognises the individual person and the importance of that individual’s life, acknowledges residents’ adult status, and enhances self-esteem by enhancing personal control. For residents, telling their stories and remembering their past lives provides a means of making sense of where and who they are in the present, and of envisaging a future. Consequently, it is vital that residents have opportunities to speak and be heard, and to be recognised and spoken to. These opportunities are sometimes adequately provided by families, friends, church and other visitors and volunteers, but frequently they are not. Staff then become the main source of resident support. / The capacity of individual staff to meet residents’ communication needs is dependent on many factors including the legislative framework and funding of the aged care system, the philosophy of the individual provider organisation (translated into work routines, staffing practices, and the training, mentoring and support available to staff) and the individual personalities and communication skills of staff themselves. Continuity of staffing is a vital factor, with “Know your resident” identified by staff in this study as the most important element in understanding and recognising the needs of residents withcognitive and communicative impairment, and in building relationships which support residents and enhance their autonomy.

5 Abstract This thesis is focused on the research of adult day care centers. Its aim is to answer the question how the the day care centers define the care from the point of view of different stakeholders; how are the centers specific to other social services and what are the possible problems and obstacles. Theoretical part describes the current situation of elderly care and deals with topics such as the demographic development of the Czech Republic, the media image of the elderly, new trends in the area of care, active aging, social services etc. Empirical research deals with two day care centers from the points of view of different stakeholders. The research, which results in two case studies and their comparisons, is carried out using qualitative methods - semi-structured interviews, analysis of documents and survey. Data analysis shows that the main function of day care centers is "relief service" for families who provide care to the frail seniors. The distinctive feature of day care centers is emphasizing differnces with other social services for elderly, especially the residential ones. This is why the great emphasis is placed on individual care in a small environment and on intergenerational encounters. The analysis also shows the day care centers as a female environment. Women prevail among...