Safeguarding care gains: a grounded theory study of organizational change

The orientation towards a community focus of care challenges the need for National Health Service day hospital provision for people with dementia, thus forcing day hospitals to reorganize, relocate or close. Day hospitals were originally opened in the mid-1970s as cost-effective alternatives to the traditional in-patient care for the dementia sufferer. Ironically, day hospitals are now under threat because they are considered an expensive luxury. Advances in dementia care have included the move away from the mechanistic model of care (routines and tasks), to the development of the social psychological model of dementia care. This paper examines the process of changes experienced by a group of staff working in a day hospital for people with dementia. Where the staff experienced a period of prolonged change and loss, their perception of support differed from that of the organization. When threats to the future and low support were encountered, defensiveness and risk containment allowed the mechanistic model of care to predominate. The concept of 'safeguarding care gains' was contained in the actions the staff took to prevent further perceived erosion of their care practice.