Day centre, or a day carer at home?

Centres vary enormously and the only way to judge one is to go and stand in it on a normal day. Look at whether people are talking to each other or sitting round the edge of the room, whether staff know names, and whether the people there are at a similar stage to your parent. A sharp 78-year-old in a room of people with advanced dementia will not go twice, and neither will someone with dementia in a room where everyone else is running the quiz.

Ask specifically what the centre can and cannot do: whether they can give medication, whether they take people who need two staff to transfer, whether there is a nurse, what happens if your parent is unwell at 11am, and whether they run in school holidays and over Christmas. Many centres are closed for two weeks in December, which is exactly when a family carer most needs the day.

The other question worth asking is who else goes. Plenty of areas have centres or groups aimed at particular people: a dementia-specific day service with a calmer room and staff trained for it, a stroke club, a group for men who will not go to anything called a coffee morning, a lunch club run by a church that is really a day centre with a different name. A general centre is fine for most people, but if your parent has a specific condition it is worth asking whether something more targeted runs nearby, because the difference in whether they settle can be large.

Be prepared for the first day not to go well. Most people say they do not want to go, most say afterwards that it was all right, and a good number are asking about next week by the third visit. Three tries is the usual advice from centre staff. If your parent is still refusing after three, that is an answer and it is worth respecting rather than arguing with, and the hours simply move to a carer at home instead.

The other difference is the shape of the week. A centre sells you a fixed day, usually the same one every week. A carer is booked by the hour, so you can have four hours on a Tuesday, two on a Thursday and a longer block on the Saturday your brother normally comes and this month cannot. If the days keep changing, or if you need help most days rather than one or two, visits at home are the only thing that bends that far. Our guide to how many visits a week your parent needs works the hours out from the tasks.

Day carers are also the answer when leaving the house is the problem rather than the solution. After a fall, during a chest infection, in the weeks after a hospital stay, or when someone is anxious and unsettled, taking them out for six hours makes the day worse. If that is where you are, read hourly care after a hospital stay, and if the person lives alone, care for someone who lives alone.

It helps to ask what your parent would miss most if you took it away. If the answer is other people, then a centre is what does that work. If the answer is being clean, fed and safe in their own house, then a carer at home is the one who does it.

The highlighted row is the pattern most families settle on: one centre day and one longer visit at home, for roughly £112 to £180 a week. That gives you two days of cover in the week, and two different kinds of help, with somebody other than the family keeping an eye on your parent.

There is one thing to watch on the centre side. If your parent needs help to get washed and dressed before the minibus arrives at half past nine, you have not avoided paying for care, you have moved it to eight in the morning. Plenty of families book an hour of morning care on centre days for exactly this. Our hourly cost guide has the full picture on rates, and the cost of care guide puts home care next to the other options.

Council-run and council-commissioned day centres are often heavily subsidised, so the price on the leaflet is not always the price your parent pays. Ask for a care needs assessment and a carer's assessment at the same time. If your parent has savings below the threshold the council may pay towards either option, and if they are self-funding, a direct payment is still worth asking about because it gives you the choice of carer.

Do not assume the council will only fund the centre. A personal budget can usually be spent on home care instead, and many families use it that way because the hours land where they are needed. Our guide to help with paying for care sets out every route, and council funding explains the thresholds.

When you ring a centre, ask what the day rate includes. Some quote a price that covers lunch, transport and everything else; others charge for the minibus, for lunch, and for the hairdresser separately, and a day that sounded like £40 comes to nearer £80. Ask what happens to the charge if your parent is ill and cannot go, because many centres bill for the place rather than the attendance, and ask whether a place is held for them if they are in hospital for a fortnight. None of that is a reason not to use a centre, but it is a reason to know the real number before you build a budget around it.

1. 1

   Ask the council what runs locally, and ask for an assessment

   Free, start today

   Ring adult social care and ask for a list of day centres and day opportunities, plus a care needs assessment. Ask the GP surgery too; many have a social prescriber who knows the local groups better than anyone.
2. 2

   Go and look at two, on a normal day

   Week 1

   Go on an ordinary day rather than an open day. Watch whether people are talking, whether staff use names, and whether the other people there are at a similar stage. Ask about medication, transport, wheelchairs, holidays and what happens if someone is unwell.
3. 3

   Book one centre day and go with them the first time

   Week 2

   Start with one day rather than three. Someone your parent knows should stay for the first hour. A lot of first days fail because nobody stayed, not because the centre was wrong.
4. 4

   Put a carer in on the other days

   Week 2 to 3

   Start with the day you are least able to cover. A longer block works better than two short calls: a wash, a meal, the washing on, and a walk. You choose the carer, and you can keep the same one.
5. 5

   Review after a month, and be willing to drop one

   Week 6

   Ask your parent, ask the carer, and look at whether they are eating and sleeping better. Some people take to a centre and want a second day. Others never settle, and the right answer is to stop and put the money into hours at home.

If the reason you are reading this is that you are worn out rather than that your parent is struggling, look at respite care and at sitting services as well. A sitting service is often free or very cheap and exists specifically so a family carer can go out. And if your parent is lonely rather than unable to manage, companionship care and the local groups in our guide to helping a lonely older person may do more than either option here.