Article 24 of Law 39/2006, of 14 of December, Promotion of the Personal Autonomy and Attention to the People in Situation of Dependancy, speaks of the centers by day, and also at night, like a service of integral attention to the people in dependancy situation, whose objective is “to improve or to maintain the best level possible of personal autonomy and to support to the families or caretakers. In particular, it covers, from a biopsicosocial approach, the needs of advising, prevention, rehabilitation, direction for the promotion of the autonomy, qualification or welfare and personal attention�.

This resource favors the continuity of the people with moderate levels of dependancy in its address with the professional attention and cares, mainly if they have complementary familiar support. For that reason, it is important the impulse of the Public Administrations and deprived organizations to by day harness the incorporation of the centers to the development of programs of healthful aging, notwithstanding the aid of taken care of that corresponds to them, since this seems to be the tendency as far as the demand of the people majors and their families: the permanence in its habitual surroundings.

“The centers by day are a resource of diurnal attention in a protective and familiar atmosphere, where it facilitates to the people personal well-taken care of majors, medical aid, physical and mental rehabilitation and activities of leisure and free time, besides social and emotional support to the relatives. Therefore, this service offers an integral answer of public health and interdisciplinary character to those people majors that have difficulty to realize the activities of the daily life, well by physical and/or mental limitations�, explains the coordinator of the center Torreblanca Madrid by day, Noelia Ferrer.

In fact, the last aim is not other that to increase the quality of life of the major by means of specific programs including in the policies of social welfare, which they delay to the maximum possible time his institutionalization. Of this form, the centers by day could consider the intermediate link between the total independence of the major and the residential attention. In this point, it is fundamental the prevention and the rehabilitation. In the centers by day, the people majors can improve their health through the different activities that are realized according to their needs: group and individual gymnastics (physiotherapy), exercises of mental stimulation (occupational therapy) and precocious control of the processes that bring about the worsening at psychological-behavioral level (psychology).


Results

• They increase his self-esteem.
• More equipment feel.
• They improve his behavior.
• They increase his personal autonomy.
• Greater socialization.
• They maintain mobility.
• Its stress falls.

                                                                                                                                                           

In first person

A van every day waits for to Marcelina Slab Martin (77 years) in the door of its house, to the center by day Torreblanca Madrid. Nothing else to arrive, first that does is to have breakfast to activate body and mind, because as they say, the breakfast is the most important food of the day. Next, and with the loaded batteries, Marcelina one goes later to the factory of occupational therapy and to the class of gymnastics, to work the skills and attitudes necessary to develop the activities of the daily life (AVD) and to secure to the maximum of autonomy and integration, besides working the memory to stimulate the mental part. In the evening, days it attends manualidades and others to psicomotrocidad. Already in house, Marcelina reviews with its daughter everything what it has done in center, which serves to him to practice the retentive capacity.

                                                                                                                                                           

Intensity of the service

On the other hand, recently the Territorial Council of Dependancy has approved an agreement on the criteria to determine the intensities of protection of each one of the services anticipated in the Catalog and the compatibility and mutual incompatibility between the same, as well as the amount of the economic benefits for the people recognized in situation of dependancy in Degree I. Concretely, indicates the document: “The centers by day will be adapted to offer to the people in dependancy situation attention specialized according to their age and to the cares that they require�.

In this way, the intensity of the service of the centers by day will be based on the services of the center that needs the person with dependancy, in agreement with its Individual Program of Atención (PIA). In the case of the centers by day, the following intensity will be applied like minimum attention:


                               


What includes?

• Social attention as much to users of the center like a its relatives.
• Attention and psychological intervention.
• Physiotherapy.
• Occupational therapy.
• Taken care of and monitoring of the health.
• Attendance in the activities of the daily life (AVD).
• Maintenance.
• Transport.
• Others: hairdressing salon, podología.

                                                                                  

Hoffmann method

Catherine Hoffmann, delegated adviser and founding partner of Vitalia, the Hoffmann Method created in 2004 being based on its formation and professional experience working elbow elbow with the people majors. “The Hoffmann methodology arose by the necessity to by day offer specialized programs of therapeutic adaptation in the centers�, explains the founder of Vitalia. Since then, its philosophy is based on causing that the majors feel like in professional and warm house while they receive a especilizado treatment, adapting to the maximum to each particular case.

“It is a method of specialized rehabilitating treatment in the areas physical, mental and psycho-social. Not only it is an activity of mental stimulation proper. What the Hoffmann methodology does is to evaluate the person of global way. That is to say, we make an initial evaluation by full name, and not by pathology. Because there are not two equal people and, for example, two do not exist Alzheimer equal. Therefore, the rehabilitation completely must be different and the different treatment�, affirms Catherine.

For it, it counts on an ample team of professionals: doctor, infirmary, physiotherapist, occupational therapist, psychologist and neuropsicólogo and specialized aids of clinic in geriatrics, who value “what cerebral areas have affected, which stay and those that begin to deteriorate themselves; what pathologies present/display: if it has osteoporosis, some fracture; what muscular group interests to harness first; what studies have had, to what it has been dedicated, with whom lives, what character has, etc., to know the needs of the major and to elaborate a plan of totally customized treatment with objectives to short, half and long term�, counts the founder of the centers Vitalia by day.

One is an innovating form to work with that they come obtaining important profits and improvements in the health and quality of life of many majors that Alzheimer, Parkinson or hemiplejías suffer and that is registered as scientist builds. “That the Hoffmann methodology is scientist demonstrates that we worked of a way differential. For the professionals of Vitalia, the fundamental thing is the pharmacological therapy together with the nonpharmacological one�, assures Catherine. And to certify it, the equipment of the center monthly sends a report to the families so that they see how they are evolving the majors in each area, what does and they do how it, and they also develop so that it in house, but following the same you rule that in center.

Vitalia counts at present on 18 located centers at national level in Barcelona, capital Madrid and community, Granada, Oviedo, Badajoz, Salamanca, Valladolid and Leon.

                                                                                                                                                                 

The importance of the occupational therapy

The Law of Dependancy has supposed a new impulse for the occupational therapy in Spain that, in the last years, has happened to be simply an academic diplomatura to being recognized like sanitary profession. The World-wide Federation of Occupational Therapists defines the occupational therapy like “a public health profession that, through the valuation of the capacities and physical, psychic, sensorial and social problems of the individual, it tries, with a suitable treatment, to enable to him to reach the greater degree of possible independence in his daily life, contributing to the recovery of his disease and/or facilitating the adaptation to his surroundings�.

Therefore, the main objective of the occupational therapy is to promote the personal autonomy and to enable the people to realize the activities of the daily life. In this sense, the occupational therapists own an extensive formation that provides the abilities to them and the knowledge to work with those people that undergo the affectation of a corporal structure or function due to the age or to some type of disease, which causes that they undergo limitations in his participation.

The occupational therapy is exerted in a great variety of scopes of action, including residences and centers by day of people majors and/or in situation of dependancy. When a person arrives at a public health center, the occupational therapist evaluates his capacities and designs an individualized program. Of this form, the therapist helps the patients to acquire the knowledge, the skills and attitudes necessary to secure his maximum autonomy by means of different activities. The fundamental thing, in this case, is to act not only to improve the quality of life of the people in dependancy situation, but to prevent the same.

The inclusion of the occupational therapist in the multidisciplinary equipment is, according to the president of the Spanish Professional Association of Terapeutas Ocupacionales (APETO), Ana Vicente, fundamental and necessary “to prevent future pathologies, as well as to palliate the deterioration of which already they are restored. The people majors must occupy their time of an effective way and with interventions that persecute an intention�.

The majority of the independent communities forces in their norms to the residences and centers by day to have an occupational therapist. It is more, in the Scale of Valuation of Dependencia (BVD) takes shelter that there is to consider the physical and mental functional performance, as well as the surroundings in which is carried out the evaluated task and the state of health of the person, knowing to identify, in addition, the barriers in case of existing and the product use of support like facilitators of aid for the autonomy.