Who are the clients? goal displacement in an adult day care center for elders with dementia

This ethnographic study of "goal displacement" in an adult day care center explains how and why certain goals come to surpass others in the organizational practices of elder day care settings. Adult day care is often oriented towards providing family caregivers with respite rather than attempting to directly improve the lives of the elders themselves. Although the adult day care center studied (CADC) was ostensibly founded to care for and improve the lives of elders with dementia, the center instead focused on providing respite for family caregivers who depended on the center for relief from care-giving. I show how the goals that CADC could realistically pursue, and the population it ultimately came to serve, were limited by the larger structural setting in which the organization operated. CADC's dependence on a limited pool of external resources of questionable quality converged with the organizational demands of a difficult population in such a way that simply providing a safe and orderly environment strained the organization to the limit. Providing care that aimed to directly improve elders' lives was seen as unreasonable, because this would have required unavailable resources, personnel, and training. In contrast, helping family caregivers by adopting a "respite focus" was seen as reasonable and worthwhile. Thus, family caregivers came to supplant elders as the de facto clients of CADC. The goal of improving elders' lives remained, but only in brochures and ideology, not organizational practice. Still, this goal remained an important part of the organizational discourse of CADC, since widely shared cultural understandings of the type of care elders deserve, constrained the way the organization could present itself.