Vol.5, No.8, 1227-1235 (2013) Health
http://dx.doi.org/10.4236/health.2013.58166
Relatives’ experiences of everyday life when
receiving day care services for persons with
dementia living at home
—“It’s good for her and its good for us”
Gunn Eva Solum Myren1,2,3*, Ingela Enmarker1,2, Ellen Saur4, Ove Hellzen1,2,3
1Centre for Care Research, Mid-Norway, Steinkjer, Norway; *Corresponding Author:
2Faculty of Health Sciences, Nord-Trøndelag University College, Namsos, Norway
3Department of Health Science, Mid-Sweden University, Sundsvall, Sweden
4Department of Educa t io n , Norwegian University of Science and Technology, Trondheim, Norway
Received 27 May 2013; revised 27 June 2013; accepted 15 July 2013
Copyright © 2013 Gunn Eva Solum Myren et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Relatives often become involved in the care of
people with dementia who are living at home.
The caregivers’ burdens are extensively de-
scribed in several studies, and one of the most
common, unmet needs of the caregivers is the
opportunity for da ytime activities. The aim in th is
qualitative study is therefore to explore the eve-
ryday lives of eight relatives of people with de-
mentia who are receiving day care services. A
content analysis is used, and three major the-
mes emerge and are discussed: 1) when life
becomes chaotic; 2) rebuilding a new, everyday
life; and 3) the agonies of choice. The findings
indicate that day care ser vi ce offers respi te c a r e ,
and, at the same time, it gives both the relatives
and those with dementia a meaningful day. These
findings can also be described as relatives trav-
eling a route from a situation characterized by
chaos and suffering to a new life situation that
has meaning through day care services. It is im-
portant to note that despite this new meaning in
the relatives’ lives, the relatives continue to strug-
gle with decisions about the futures of their
loves ones in regard to the dilemma of placing
them in an institution versus aging in place.
Keywords: Relatives; Caregiver; Dementia; Day
Care; Qualitative Content Analysis
1. INTRODUCTION
The term “dementia” is an umbrella term that is used
to describe a large class of disorders characterized by
progressive decline in cognitive functions. This decline
typically includes loss of memory and judgment as well
as changes in mood and behavior, communication and
functional ability in everyday life. There is no cure for
dementia, which remains the leading cause of depend-
ency and disability among st olde r people [1].
The worldwide prevalence of people living with de-
mentia was estimated by WHO to be 35.6 million in
2010, and is expected to double by 2030 and more than
triple by 2050 [2]. There are approximately 70,000 per-
sons with dementia in Norway today. About 35,000 of
them are living at home, and this number will increase to
approximately 40,000 in 2020 [3]. The Norwegian gov-
ernment has set the focus on the growing number o f peo-
ple with dementia the last decade. In the national plan for
dementia, one focus area is day care services for people
with dementia, and the aim of this care is to help them to
stay at home for as long as possible [4]. This is also in
line with the wishes of the majority of people with de-
mentia [5]. Dementia not only affects the person who has
the condition but also his or her relatives and family
members [2]. Most people with dementia have at least
one caregiver, usually a spouse or relative. Chumbler et
al. (2003) found no difference in caregiver burden be-
tween adult children and spouses [6]. In general, closer
kinship ties are associated with increased caregiving du-
ties [7]. Caregivers’ experiences of the stresses and bur-
dens of care are we ll known. Depression, anx iety, fatigue,
sleep disturbances and lack of time for pleasurable ac-
tivities have been well documented as effects of the
caregiving burden [8-10]. The stressors can briefly be
described as physical, emotional and economic burdens

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1228
[11]. Van den Wijngaart et al. (2007: p. 634) claim that
“a caregiver becomes burdened when there is a misbal-
ance between the care load (stressors) and the capacity to
function in daily life (functional health status)” [12]. One
of the most common unmet needs of the caregivers is
time for daytime activities [1 3]. There are different kinds
of daytime activities. Respite care in the form of day care
services is one of several respite services that aim to pro-
vide temporary relief to caregivers from their responsi-
bilities of caring for a loved one with dementia. Regular
day care facilities have traditionally been care-oriented,
while nursing home environments have a more or less
medical orientation [14]. In the last decade, there is a
trend toward increased attention to day care facilities as
an important area of community services [15]. The facili-
ties that lie beyond institutions are more socially orien ted
[14], such as Green care farms (GCFs). These farms
combine agricultural production with care services for
people with care needs, e.g., persons with dementia.
GCFs provide day care services in a non-institutio nal an d
outdoor environment, which gives the person with de-
mentia opportunities to participate in a purposeful activ-
ity in addition to leisure and recreational activities do-
mestic activities, and farm-related and outdoor activi-
ties. These activities stimulate the older people with de-
mentia to be physically active and to interact with nature,
animals and other people [16]. The aim of this study is to
explore the everyday lives of relatives of people with
dementia who are receiving day care services.
2. METHOD
A qualitative ap proach with semi-structured interviews
and open-ended questions was used for this study. Ac-
cording to Kvale (2007: p.11), semi-structured interviews
“... seek to obtain descriptions of the life-world of the
interviewee with respect to interpreting the meaning of
the described phenomenon” and allow follow-up ques-
tions [17]. The relatives were asked about how they ex-
perienced everyday life before and after receiving day
care services for their loved ones with dementia, and
they were also asked to talk about th e future in relation to
their loved ones. The interv iews were co nducted be tween
February and May 2012. The length of the interviews
was between 45 and 90 minutes, and they were con-
ducted in-person and face-to-face. The first author tape
recorded and transcribed the interviews as well as de-
scribed the context where the interviews were conducted .
Those observation notes were later used in the analysis to
help the researches to understand the interview setting
and the context.
2.1. Participants and Context
During qualitative research, variation should be con-
sidered when choosing participants for a study [17]. The
number of informants depends on the need to obtain as
great a variation of data as possible [18]. In this study,
eight relatives were interviewed.
Ta b l e 1 shows an overview of what characterizes the
informants. The informants were recruited by the project
leaders in four different day care projects. The day care
projects were GCFs in four municipalities in the middle
of Norway. The two inclusion criteria were that the loved
ones lived in their own homes and that the relatives were
receiving day care services from one of these four GCFs
projects.
The GCFs varied both in size and in number of day
care services delivered per week. The size varied from
five to eight participants with dementia, and the number
of daycare visits per week ranged from one day every
other week to two days p er week. All of the activities on
the GCFs were related to farming, the domestic setting
home-like, or outdoor environments. The four different
day care projects” (GCFs) in this study have equally
good hardware (e.g. environment) and software (e.g. day
care services workers) and provide similar functions of
small group social life to the persons with dementia. In
addition, three of the persons with dementia received day
care services in regular day care facilities once a week.
We are not comparing the day care services in this study,
but see them both (i.e., the regular day care services and
GCFs) as day care services with the purpose of reducing
caregiver burden.
Table 1. Informants characteristics.
Gender
(relatives) Age (relatives) Relationship Gender person with dementia) Distance between each other Day care services per month
Female 61 Daughter Male 6,0 km 8
Female 60 Daughter Female 300 m 8
Male 82 Husband Male 0 2
Female 34 Grandchild Female 4,0 km 4
Female 57 Daughter Female 14,0 km 8
Male 58 Son Female 400 m 8
Female 55 Niece Female 600 km 8
Female 42 Daughter Male 2,0 km 4

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2.2. Analysis
A content analysis was performed to analyze the tran-
scribed material [18-20]. The interviews were read
through several times to get a sense of the whole. The
first author organ ized the data in a timeline to reduce the
data by eliminating text that was not relevant to the aim
and purpose of the study. The other reason for creating
the timeline was that the relatives talked about the time
before and after receiving respite care [21]. Further on,
the data were organized into meaning units with codes
before they were extracted to a more latent level with
sub-themes and themes. During the analysis, the data and
the process of labeling and creating categories and
themes were discussed with the second and third au thors.
Three main themes emerged from the analysis. Table 2
provides examples of this analysis.
2.3. Ethics
Ethical approval fro m the Norwegian Regional Ethical
Committee North was obtained before the start of the
study. Written, informed consent was obtained initially;
however, at each interview, the information was repeated,
and consent was obtained orally. During all of the inter-
views, the interviewer sought to establish a safe and gen-
tle atmosphere by speaking to the respondents in a
friendly and reassuring manner [22]. According to the
informants’ wishes, six interviews were conducted at the
homes of the primary caregivers, and two interviews
took place at other locations. The project leaders from
the four day care projects also served as emotional back-
up for the relatives if they needed somebody to talk to
after the interviews.
3. RESULTS
Three main themes were identified an d named, “When
life becomes chaotic,” “Rebuilding a new, everyday life,”
and “The agonies of choice.” The results of the analysis
show that the first two of these three main themes have
two sub-themes. The first sub-theme represented the di-
rect experiences of the relatives themselves, and the sec-
ond sub-theme represented indirect experiences through
their loved ones. The third and last main theme includes
one sub-theme.
3.1. When Life Becomes Chaotic
The first theme is about the time before the day care
services began. The relatives described their everyday
lives during this period as very stressful and unpredict-
able, and it was a time marked by a feeling of chaos,
both for the person with dementia and the relatives. One
of the relatives said, “It is complete chaos. And I’m be-
ginning to think of how this is going to turn out.”
3.2. The Duty and the Burden
Every relative described how he or she experienced
his or her own feelings, such as “I’m so exhausted” or “I
have such a bad conscience about her.” This first sub-
theme explores the relatives’ feelings of grief, their guilty
consciences, their reversal of roles, the conflict between
siblings, and the organizational and practical work that
they had to handle in their everyday lives.
All of the relatives talked about the feeling of loss;
they explained that they were losing their loved ones,
and described the situation as having to get to know them
again from scratch. One daughter described it this way:
“It’s a grief over losing her . .. ov er the p erson sh e used to
be.”
The experience of reversing roles was also very com-
mon amongst the relatives. From childhood, their parents
or loved ones had been taking care of them; now the
situation was completely turned around. One son said,
“Seriously, am I really going to talk to my mother about
her personal hygiene?” Or, as a daughter said, “... and
that was such a fight then to get h im to change clothes ...
because I was very particular then when I got there too
so I’m like, knew that it smelled a little to o and could see
that he had spilled on himself so he had to change. And it
was ... almost like getting a child to do that because he
refused.” The relatives also talked about how difficult it
was to be put in a position where they had to make sev-
eral different decisions on behalf of the person with de-
mentia.
Having a guilty conscien ce made the everyd ay lives of
the relatives very exhausting and difficult to handle.
There was no difference between relatives who were
living nearby or in the same house and relatives living a
long distance fro m their loved ones. One of the relatives,
Table 2. From meaning unit to theme 2.
Meaning unit Condenced meaning unitInterpretation of the
underlying meaning Sub-theme Theme 2
I was very pleased when she got the daycare
because then I could rest a while. It’s just like
that. And I know that they took care of her.
Somebody else are taking
care of the loved ones Less stress and burdenFeeling secure
I don’t thi n k s h e have had such a social
and rich life after the retirement as now. Social and rich life after retirement Everybody have a social need Having a meaningful everyday life
Rebuilding
an new
everyday life

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1230
a niece, said, “I haven’t been there since January ... and
now ... it’s too long ... but it is so busy and ... I have con-
stantly a bad conscience about her because I’m thinking
that she is sitting alone.” The feeling of not doing enough
or visiting enough was a common experience for the re-
latives.
Some of the relatives, especially sons and daughters,
talked about the conflict between siblings. The conflict
was usually about who should do what and when. Often,
the siblings living closest to their mom or dad felt this
extra burden. One daughter said, living 300 m from her
mother; “I have one sister, but she doesn’t live around
here. She lives in another municipality. So I felt when
she came visiting our mom that she was visiting her, but
I couldn’t do that. I had to do some work for mom. Do
you understand?” The adaptations or organizing for the
persons with dementia in their own homes were other
burdens or duties that the relatives experienced. They
had to help their loved ones with practical chores like the
installation of a stove guard to prevent dangers such as a
kettle boiling dry, filling out different forms, taking over
financial concerns, and doing laundry or other household
chores, such as cleaning the floors or shopping. These
activities demand time and attention from the relatives
and their own families, and a lot of them did these chores
after they came from work. The time spent on these ac-
tivities led to the feeling of “missing quality time” with
their loved ones. It was more often described as a duty
than as a desire to help. The distance living from their
loved ones, does not seems to matter or affect the ex-
perience of having a responsibility for the person with
dementia.
3.3. Time Out from a Social Life
The second sub-theme refers to what the relatives de-
scribed as a passivity and social withdrawal that they
could see in the person with dementia. This withdrawal
also contributes to the relatives’ bad feelings, because
their loved ones do not seem to have the kind of social
life that they used to have. One daughter put it this way:
“We felt that she became very passive and she was very
anxious ... she had always been such a social person, but
now it’s like nothing ... she says she is neither able to or
willing to do anything.” Other relatives describe the per-
son with dementia as sleeping a lot, staying inside the
house, not visiting old friends, and not participating in
their usual activities, such as café visits, going for a walk,
or participating in other leisure-time activities with their
friends.
3.4. Rebuilding a New, Everyday Life
Theme two describes relatives’ experiences after re-
ceiving day care. The relatives described how things
were falling into place after a period of chaos. They
mentioned that they are starting to establish a new plat-
form with new routines for the everyday lives of them-
selves and their loved ones. The relatives’ experiences
are represented by two sub-themes. On the one hand,
they talked about th e feeling of security, and, on the other
hand, they talked about the person with dementia need-
ing to have a mean i ng ful day.
3.5. Feeling Secure
The relatives said that they do feel safe and secure
when they know that their loved ones are being cared for.
One daughter said, “Knowing that somebody is taking
care of her. That is a security.” The niece living far away
from her aunt expressed it like this: “It is perhaps, that
she will be taken care of (...) Thus I do not know how it
would have gone without? I do not because, I would
have been sitting here and she is there and no it (...) But
we know that it fills her time and I think it does very well
for her and it does very well for us.” This security also
leads to the relatives’ being able to pursu e their interests,
and they could cope with the needs of everyday life more
easily. A husband said, “It should expand day care. I
should like to have one day every week ... then I could
take my time when I have to go to the city for some er-
rands. Yes, and yesterday I even went outside for a
walk ...” Other relatives pointed out clearly that day care
gives them an opportunity to rest when their loved ones
are receiving the assistance. As one daughter said, “But
she could not do anything in the end. So it was a year
that was a little awkward. Therefore, I was very happy
when she go t day care for two d ays, then I could r est and
do different stuff for myself (...) and I knew that she was
being looked after.”
3.6. Having a Meaningful Everyday Life
Knowing that day care was offering the persons with
dementia meaningful activities and thereby meaningful
days was important to the relatives. Und er this sub-theme,
the relatives showed the importance of their own well-
being in knowing that their loved ones were having a
meaningful day. The relatives were speaking of social
life in terms of the person with dementia having some-
body to talk to, having fellowship, and thus flourishing.
One daughter expressed it like this: “It sounds like she
does not want to live if she cannot go there (at the day
care services). It is top of everything. And about the day
care, they told me really, really fast the staff that worked
there that mom just got better and better. She flourished
during the days she was there. I felt it also ...” A grand-
child said about her grandmother, “I don’t think she has
ha d su ch a social and rich lif e after retire ment as [she has]
now.” The relatives also appreciated the physical activi-

G. E. S. Myren et al. / Health 5 (2013) 1227-1235 1231
ties at the day care. They talked about how their loved
ones were walking on a forest path or in the forest, pick-
ing berries, or feeding the horses and the sheep in the
fields. They also mentioned the importance of other
types of activities related to handicraft, music, or house-
work, such as preparing dinner or doing the dishes. Ac-
tivities that give their loved ones a meaningful day and
thereby help to maintain their skills are of great value to
the relatives.
3.7. The Agonies of Choice: What about the
Future?
In this last theme, the relatives expressed their uncer-
tainty about how to handle or to think about the future.
The relatives struggle with the decision of whether to
move their loved one to a nursing home. They felt a
commitment toward keep ing the person with dementia in
his or her home for as long as possible, and the relatives
also offered some reflections about the dignity and self-
determination of persons with dementia. One relative
said, “She is not declared to be without legal capacity
and she does decide about her own life. Of course she
does that, but at the same time, she does not know what
she is deciding about ...”
3.8. Going to an Institution vs. Aging in
Place
On one hand, the relatives wish for a place for their
loved ones so they can better cope with everyday life and,
in one way, to get some relief from the burden of daily
caregiving. On the other hand, they also think about their
loved ones’ dignity and self-determination. One daughter
said, “I do wish for a place at the special care unit for her,
because then I feel I could have avoided the bad con-
scious. It’s a sort of egoism in it. ... It is very, very diffi-
cult. Because ... I also want her to feel that she can con-
tribute with her skills and resources. I do believe that that
is important ... and that is what makes me so uncertain. ...
She can take good care of herself, you know, and if she ...
if we take away things that she can handle very well ...
it’s about human decency...”
There are also relatives who are very clear that they do
not want the person with dementia to go to an institu tion,
because they “don’t belong there,” or because the loved
ones are bonded to their homes; as another daughter said,
“I do hope we can have this arrangement as long as pos-
sible, so dad can stay at home as long as possible, be-
cause I can see that he can manage to take care of him-
self very good. ... Daddy wants to stay at home. He
said ... he is also very attached to his home.”
4. DISCUSSION
In this study, the aim was to explore the everyday lives
of relatives of people with dementia receiving day care
services. When a person is diagnosed with cognitive im-
pairment, the relatives are affected one way or another.
In this study, the relatives give us insights into how th eir
lives change as they care for their loved ones before and
after the person with dementia began to receive day care
services as well as insights into their struggles to make
decisions about the futures of their loved ones.
To be a relative of a person with dementia is a chal-
lenging situation that puts him or her in a vulnerable po-
sition. Golden (2012) identified different metaphors that
were used to describe the caregivers’ burden and what it
was like to be a caregiver. “Pathway” was one of those
metaphors. When the person with dementia receives the
diagnosis, there is no turning back, so a new life as a
caregiver can perhaps be described as being in a jungle
where the “pathways” are broken [23]. In this particular
study, the relatives characterized their new life situations
as chaotic, that is, a situation of confusion and uncer-
tainness.
Grief over their loved one’s illness, guilty con sciences,
and the complex situation of changing roles affect the
relatives in different ways [24]. Several relatives talked
about how they had to handle the practical aspects of
everyday life, such as grocery shopping and cleaning.
Making time to help the person with dementia was ex-
perienced as a duty, which led to emotions such as grief,
a bad conscience, and the experience of loss. According
to Adams (2008), each stage of dementia has its particu-
lar emotional tasks, and the feeling of loss will influence
the quality of the relationship with the loved one [25].
Therefore, the feeling of loss will be a constant emotion
during the illness that the relatives must handle adap-
tively. Relatives’ experiences of burden and stress are
described in several studies [7,9,12], and the results of
this study are in line with those findings.
Family conflicts or conflicts among sib ling s also led to
greater strain and stress when it came to coping with
caring for the person with dementia [26]. For the sibling
who lives closest to the loved one, the burd en of carrying
the responsibility can be a difficult struggle [27].
Social isolation and loneliness is also a topic to which
the relatives refer as another challenge. The relatives
experienced that the persons with dementia withdrew
from social life, and thus became lonely. In our study, the
result can suggest that persons with dementia increased
their social life when they began to receive day care ser-
vices. This increase may be because of different factors,
such as the feeling of fellowship. Moreover, they still
regained the feeling of having a meaningful day through
day care services [28]. Nevertheless, one study from
Australia shows that placing persons with dementia into
new environments or with unfamiliar people does not
necessarily dec rease fee li ngs of loneliness [29].

G. E. S. Myren et al. / Health 5 (2013) 1227-1235
1232
In this study, the relatives were of the opin ion that day
care services are both respite care and a place where the
persons with dementia could have a meaningful day.
Gústavsdóttir (2011) also concludes that a well-organ-
ized day care service not only provides respite care for
the relatives but also supports and enriches the loved
one’s life [30]. Surprisingly few relatives were talking of
or expressed a clear relief of having a break from their
loved ones, which may be because only the husband was
living in the same household as the person with dementia,
i.e., his wife. Nevertheless, having respite from caregiv-
ing gave some of the relatives opportunities to do things
that they had been doing before the diagnosis, and they
felt it was like a real break [31], or they used their
“break” to do different th ings [32]. Instead of expressing
clearly the need for a break in everyday life, the relatives
expressed their feelings of assuredness that their loved
ones were receiving good care in a safe and secure envi-
ronment. It seems that knowing their loved ones were
having a meaningful day and were receiving good care
may lead to a form of safety and a reduction of caregiver
burden amongst the relatives. The relatives could cope
better in their everyday lives and explore more of the
meaning of the life situation [8,33].
In addition, the fact that several of the relatives ex-
perienced that day care services was allowing the per-
sons with dementia to take walks outside in the forest or
to do other physical activities outdoors was of great im-
portance to the relatives. Spending time outdoors doing
different activities like walking, picking berries or flow-
ers, and so on increased the quality of life and offered
health benefits [16]. Several of the relatives were talking
about how their loved ones flourished after they started
the day care services. They claimed that this flourish
came from participation in activity or in the social com-
munity that allowed their loved ones to rely upon their
individual coping capabilities and to pursue personal
interest. It may therefore seem that day care service can
offer customized and personalized activities that engage
persons with dementia in small groups. In spite of all
these positive thoughts about the day care services, the
relatives still face challenges.
The relatives are in a position where they have to
make some choices for the person with dementia; they
are struggling to discern what the right choice is. Making
a decision about placing a loved one with dementia into a
nursing home is one of the most painful and difficult
processes of the relatives’ caregiving trajectory [34].
Making this choice leads to guilt and distress, which is
also described in other studies [35,36]. Some studies
placed special emphasis on the relatives’ decision-mak-
ing process concerning “going to an institution or aging
in place.” For example, Butcher et al. (2001) described
the relatives’ experiences with the transfer to an institu-
tion in four steps: moving toward the unavoidable deci-
sion, struggling with the decision, seeking reassurance,
and remaining connected [37]. The relatives expressed
different r eason s fo r star ting to th ink ab ou t the f utu re an d
the decision about a nursing home. For some of the rela-
tives in this study, the decision is about the progress of
the dementia and the increasing scope of the caregiving
burdens over time; for the other caregivers, the decision
is related to a more acute situation, such as a fall, or it
could be in response a proposal from the home care
nurses [34]. Although the relatives were concerned with
when and how they should ask for help to make such
decisions, they also had their own thoughts about the
loved one’s self-determination and dignity. In other
words, the relatives were facing a dilemma: their loved
one’s wishes and capabilities to make the right decision
did not align with their responsibility to make a choice
on behalf of the person with dementia. One study from
the United States found that the decision-making moved
from the use of autonomy to the use of beneficence as
the core principle in guiding decisions [38]. In that way,
it becomes easier to make the right choice for the loved
one. The broken pathways described by Golden (2012)
[23] may lead to a point where the relative experiences
suffering because of the new situation and the feelings of
chaos. According to Eriksson (2006), suffering is a part
of human life [39].
4.1. From Suffering to Meaning
When faced with the incurable illness of a loved one,
relatives also face potential suffering and will, at some
point, ask themselves the meaning of suffering. This
perspective is valid in all forms of caregiving, and it is
important for relatives coping with the burdens of care-
giving. If we look at suffering as a concept, we can
imagine it as a prism where different perspectives and
dimensions take part. There is a positive and a negative
dimension, where desire for happiness and enjoyment is
the opposite of suffering, according to Erik sso n [39 ]. The
suffering can imply that energy is lost and that the person
is filled with depression. The relatives have an implicit
and moral responsibility to care for the ill person, and
many also want to do this [40]. As caregivers for the
person with dementia, relatives can also be considered
victims of the illness, because the illness also puts them
in positions of suffering. Demanding caregiving respon-
sibilities and the doubt about making the right decisions
will always be a part of the relatives’ lives and thus cause
them to suffer. In a situation characterized by suffering, it
is important to find meaning in the suffering [39]. Frankl
(1969) describes three ways of finding meaning in life:
by doing works or deeds; by experiencing beauty, good-
ness, truth, and nature or encountering another person in

G. E. S. Myren et al. / Health 5 (2013) 1227-1235 1233
his/her uniqueness by loving him/her; and by choosing
an attitude toward unavoidable suffering and being chal-
lenged to change oneself. According to Quinn (2010), the
relatives’ ability to find meaning in caregiving, to derive
something positive out of it, could reinforce their desire
to provide care [28]. By accepting the changes in the
lives of their loved ones, the new caregiving situation,
and the new life situation for themselves, relatives may
rather cherish the joy they still have instead of focusing
on grief and loss [41]. In this study, the relatives point
toward finding meaning through day care services, where
several opportunities open up for happiness and enjoy-
ment for both the person with dementia and his or her
relatives. Frankl (1969) claimed that we discover mean-
ings; we do not invent them [42]. Reconciliatio n with the
new life situation may therefore contribute to the discov-
ery of meaning. On the other hand, Frankl (1969) says
that we have a choice and can find meaning by changing
our attitudes. If we look at day care as an intervention
that helps relatives to change their attitudes and to make
discoveries, then we may see that it gives the relatives an
opportunity to rebuild an everyday life with the person
with dementia based on the meaning that they build. At
the same time, the agony of making choices will always
be a part of the relatives’ lives as an ethical demand [43].
4.2. Conclusion
The findings support other studies indicating that day
care services can offer respite care and that day care ser-
vices give both the relatives and the person with demen-
tia a meaningful day. It is important for relatives to be-
come accustomed to their new life situations and dis-
cover the meaning of caring through the relationship
with their loved ones with the help of day care services.
This new life can be described as traveling a route from a
situation characterized by chaos and suffering to a new
life situation with meaning throug h day care services. By
allowing the persons with dementia to participate in ac-
tivities that are facilitated and personalized and thus en-
gaging, day care services seem to lead to a form of relief
for the relatives. Even if they do find meaning, relatives
must still face the agonies of making a choice about how
to care for their loved ones with dementia in the future.
The struggle to make a decision about the future of their
loved ones and the dilemma of going to an institution
versus aging in place will likely remain an ethical de-
mand for some time to come and may even intensify in
the future.
4.3. Methodological Considerations
This study focused on how relatives of persons with
dementia who lived at home experienced their everyday
lives when their loved ones were receiving day care ser-
vices. Qualitative research allows flexibility and insight
into complex phenomena and is therefore a strength in
this kind of study. On the other hand, the qualitative
method does not seek objectivity but instead seeks peo-
ple’s genuine experiences and must, therefore, act sub-
jectively. The main limitation of this study is its small
number of informants. The study includes only eight re-
latives as informants, bu t they do represent different gen-
ders, a wide range of relations, and a wide range in the
distances that they lived from their loved ones. This di-
versity may contribute to the strength of this study. An-
other limitation may be that the relatives received day
care services from two types of day care service, which
may affect the loved ones’ participation in activities in
one way or the other; however, they were all participat-
ing in day care services involving green care. In one of
the interviews, both the daughter and the wife who has
dementia participated in the interview, with the husband
acting as the primary informant. This could have both a
positive and a negative effect on the interview outcome.
On one hand, the husband could withhold information to
avoid hurting his wife. On the other hand, the presence
of the daughter and the wife contributed to a richer inter-
view, because they both provided useful input during the
interview. It is also important to no te that this is on ly one
of several possible interpretations.
5. ACKNOWLEDGEMENTS
The authors would like to thanks participants who made this study
possible.
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