Ensuring continuity of care in response to the Covid19 crisis was the theme of the recent webinar organised by the European Social Network (ESN) with social services leaders from Italy, Denmark, the UK, Spain and the United States. The aim of this webinar was to try to understand how this crisis is impacting social services, what have their responses been so far, and the measures they have put in place to support frontline workers in Europe and the United States.
Who have been the most affected populations?
Social services have been recently reaping a bitter harvest of years of failure to invest adequately in public health and social care systems across Europe. In the UK, the picture was that of a fragmented market with over 22,000 providers of domiciliary care, residential care and supported living for older people and people with disabilities, where care homes have been under pressure due to the lack of protective equipment. The issue of providing food, medication, and social support for those who are either self-isolating or cannot leave their homes has also been a source of concern.
Panellists stressed their fear of a potential rise in domestic abuse, specifically violence against women and children. “There has been an 80% drop in calls to the helpline and the situation of many vulnerable children is becoming dramatically invisible”, highlighted Tobias Voltan, from the national social workers association in Italy (CNOAS). Along the same lines, Tracey Wareing, from the American Public Human Services Association (APHSA), expressed her concerns in relation to those who are not seen. There has been a decrease in the number of calls to helplines where people raise concerns about children’s safety in many states, which has led social services to try to understand how they can be supportive to ensure that children, who are in isolated families with increasing levels of stress, are safe.
Concerns were also raised in relation to people who are in residential facilities; for instance, those providing mental health support, substance abuse support, or residential care for people with learning disabilities, and older people. Lise Willer, social services director in Esbjerg (Denmark), explained that personal group therapies and meetings for people with mental health problems had been cancelled and replaced with phone or Skype calls. “We fear an increase in the number of psycho-social related admissions to hospitals in the coming months”, predicted Ms Willer.
Another especially vulnerable group has been the homeless and people living in illegal settlements, in particular in urban areas where there is a lack of housing and social distancing is implemented to ensure their safety. Finally, social services have seen a rise in families in need of income support due to the sharp increase in unemployment over the past weeks.
Measures put in place to assure continuity of services
There have been three main types of measures implemented across countries to assure the continuity of care services in this crisis including legislation and policies to support provision, the development of local partnerships for service delivery, and reinforcing services for the most vulnerable.
Legislation and policy supporting provision
In Italy, essential social services were guaranteed by law and there has been a focus on ensuring continuity of home care for people with disabilities and older people linked with street operations such as goods and food delivery for those with reduced mobility. Also in the UK and Spain, legislation has been used so that social services can prioritise the most vulnerable. The Spanish government declared social services ‘essential’, which meant that professionals must have access to personal protective equipment (PPE) and be able to undertake their duties such as travel to a home where there is suspicion of domestic violence, supporting a child who may be in foster care or provide support to families. According to Carlos Santos Guerrero, deputy director in the regional ministry of social policy in Galicia (Spain), designating social services as ‘essential’ has made it easier to allocate workers to where they are needed the most, has provided flexibility for public authorities to set up longer shifts if needed or reorganising work to respond to the emergency.
In Denmark, emergency response teams were set up in residential services for people with disabilities at the beginning of the crisis to ensure that the necessary staff were available. So far, this has ensured an adequate flow of workers. In the US, disaster preparedness plans have been put in place for leaders on the ground to respond to the situation. However, it has been a real challenge to have call centres operated from homes in terms of securing lines, dealing with broadband issues, ensuring the safety of the service provided. In Italy, social services have also moved to be organised remotely through IT tools; visits and face to face conversations have now been replaced with videoconferencing raising concerns that the most vulnerable, who are unable to use these tools, are being left behind.
Partnership for service delivery
In Spain, the national government has issued measures and recommendations covering all regions, in relation to emergency accommodation distinguishing between the responsibilities of local and regional authorities, home care, and nursing homes for older people. A protocol was issued to support health services in the discharge of older people; in each region, buildings are being adapted to accommodate old people who are discharged after having been at hospital with Covid 19. In the UK, the focus on partnership has also revolved around discharge hubs that aim at discharging people who do not need to be in hospital in 2 hours.
Local communities have come forward to deliver food and support to people locally. In urban areas, resilience hubs have been set up to take phone calls from people in the community who are struggling to get supermarkets to deliver their online shopping. “We are deploying volunteers and council staff into ensuring that food and medication reach those who need them the most. In a small city like Swindon we delivered 150 food parcels last week and over 120 calls per day” -said Sue Wald, corporate director for adult social services in Swindon Council (UK).
Reinforcing services for the most vulnerable
Investments have been made in childcare, nutrition, support for the homeless, older people and people with disabilities. In the US, a package of 2.2 trillion dollars was approved for state and local authorities to provide social services support for children and economic relief for low income people.
In Italy, emergency programmes for the homeless have been set up with centres operating and open 24/7 as well as anti-poverty schemes with 6 billion € in emergency income for 10 million workers. In Denmark, municipalities like Esbjerg have opened a combined service of shelter and health care for homeless people who may have become infected with Covid19.
Other measures implemented across the five countries assessed included reinforcing telecare and phone calls with people who regularly use social services and additional monitoring measures for those at risk of violence at home.
Psychologists are trying to support social services and social care staff to help people with disabilities understand the situation as it is now. “People with autism and intellectual disabilities have difficulties in understanding why they cannot be given a hug or why they cannot visit their day care centre”, explained Carlos Santos Guerrero, deputy director at the regional government of social policies in Galicia, Spain. In the UK, local councils’ leisure and wellbeing staff are taking them out for a walk as long as social distancing rules are respected.
Measures to support frontline workers
Panellists highlighted that the focus has been on mitigating the risk of exposure to the virus for frontline workers; e.g. for professionals working in a facility or those who go to a home if they work on child protection. Efforts have focused on designating those workers as essential and getting them access to PPE.
“What kind of assessments can you put in place ahead of home visits? How telehealth and other IT tools can be used for youth and foster care? As legislation requires that they are regularly supported, how can this be done if workers cannot visit them at home?” asked Tracy Wareing, CEO and president of APHSA in the US.
CNOAS in Italy has focussed efforts on informing workers promptly about the decisions taken, e.g. safety measures and how rules change on a daily basis. Also, in Italy there is a civil protection taskforce that coordinate all professionals, including social workers, and volunteers working for emergency services.
In Denmark, job portals have been set up by the municipalities to look for additional staff to replace those who may become sick as well as volunteers, and agreements with the unions have been reached to make it possible for public employees to be transferred between social services.
While the focus has mostly been on securing PPE for community social services practitioners, panellists emphasised the need to assure psychological and professional support specifically designed for those working in health and social services.
CNOAS has recently prepared a questionnaire for 44,000 social workers to come up with a national overview of the working and safety conditions of social workers. The results of this survey should serve to analyse how investments in the wellbeing of frontline workers pay off, report critical issues to policy-makers, and start developing a strategy as we get out of this crisis to support social care professionals in the long run.
With thanks to the webinar panellists:
- Tobias Voltan, Board Member, National Council of Social Workers, Italy
- Lise Willer, Social Services Director, Municipality of Esbjerg, Denmark
- Sue Wald, Corporate Director Adult Social Services, Housing and Health, Swidon, International Lead, Association of Directors of Adult Social Services, England, UK
- Carlos Santos Guerrero, Deputy Director, Ministry of Social Policies, Regional Government of Galicia, Spain
- Tracy Wareing, President and CEO, American Public Human Services Association, USA
Alfonso Lara Montero, Chief Executive Officer at European Social Network