ESN Members in practice
How can local public social services achieve this? How can they help people to continue living their ordinary life as far as possible while meeting their needs?
Primary or acute health care is often the first point of contact for older people. Let’s take the example of a short hospital stay as the result of a fall: it is very important that the hospital social worker builds a relationship and assesses the person’s needs for care and social contact,” remarks Elisabeth Mejersjö, social director in Jönköping, Sweden. Teresa Spaliviero, Head of Older People’s Services in the Veneto Region, Italy, agrees, adding: “it matters too that we try to understand a person’s past social and family relationships in order to build a support network of friends and family.’ This would be the beginning of providing a package of care and support to help them continue to live an unexceptional life in spite of their care needs.
“In home-care in Flanders, we are starting to use vouchers to help people to pay for what we call ‘comfort services’ (i.e. laundry, house-work, shopping or gardening). The idea is to provide an affordable way for older people to manage their household,” explains Luc Kupers. The OCMW (local social services agency) offers financial support to those who cannot afford to co-fund the vouchers. Also these visits to help them with laundry and house-work, Luc explains, are in a way a preventive measure because they allow the OCMW informally to keep up with how people are getting on.
Indeed, the most 'unexceptional' life can be lived in your own home, though this is not the preference for all. It can be distressing and disorienting to move home and move away from the neighbourhood, where you have lived for decades. Social directors are responsible for ensuring capacity across different care settings (home-care, nursing care, residential care, sheltered housing). In this way, local, regional and national strategic choices shape the options that older people have about where they are cared for.
Achieving the right balance of care is a challenge everywhere, but general under-capacity is creating particular problems in Romania: “One of the problems we have now is that some older people are left without any formal care. Their only option may be to get someone to come and live with them and look after them in their own home” explains Dia Gheorghita, Head of Older People’s Services in Oradea. Dia goes on to explain that some home-care services subsist on short-term project funding, not on the basis of sustainable long-term investment backed by political commitments.
An important development in the debate on residential versus care at home raised by the ESN long-term care group is the development of a range of supported housing options. As the group continued to debate, it became clear that the choice elsewhere in Europe is no longer between home-care or residential care. There can be a third way, as Stella Vidisdóttir, Director of Social Services in Reyjkavík, Iceland, explains: “People are prepared to sacrifice their independence for a sense of security and companionship by moving to service and safety apartments. We are expanding the building of this type of accommodation over the coming years in response to demand.”
This shows that social services need to remain flexible and adapt services to meet people’s needs for care. To do so, the group members agree, social services need to create a relationship with people.