Activities under INNOMEC have mainly been implemented in the Austrian City of Graz but also in surrounding districts. 21.53% of the inhabitants of Graz are older than 60 (31st March 2015), which totals to nearly 60,000 people. Since 1996 the Municipal Senior`s Office (SeniorInnenbüro Graz), the first of its kind in Austria, caters to elderly people in Graz, who still live independently. Nearly 20,000 elderly people in Graz are older than 75, and likely to live in or visit one of the (day) care centres in Graz, which offer a total of 1,930 places (05/2015). Above that, ambulatory social services support citizens who opt to live in their own homes.
A team of two trainers, Andrea Gaal and Elisabeth Schrattner, worked together in workshops with residents of day care centres and other social facilities to find out about topics of large interest to the elderly. They used creative methods to engage elderly people. An important role is played by the method of transcultural biographical work (TBW). It was used in common talks to exchange memories, record them, and make them available in the form of interviews. Afterwards those interviews were recorded as video or audio-tapes and uploaded to the international database MEMORO (www.memoro.org/at-at) too, a new branch of Memoro in Austria, still missing among the countries’ collection of the Bank of Memory, widening its availability at an international level.
The workshop aimed at revitalizing and re-evaluating elderly participants´ memories, which should be transferred to the present. The individual biographies served as a basis for the process of lifelong learning and the development of future perspectives. Biography based workshops have been offered since February 2015. The modules were held in small groups directly within the premises of the care centres or other places of activities. The first module (lasting about 1.5 hrs) served as preparation for the group. The second module was mostly held individually and lasted about 1 hour per person. Within this module using the method of half-structured interviews the residents were interviewed for an anamnesis. These interviews were taped as videos.
Activities took place in six different settings: seniors café, district office, day care centre, shared flat and assisted living, nursing home, and at home. Altogether 61 individual elderly people took part in 5 pilot group activities (12 modules) and individual activities at home, 37 of them participated twice, 29 of them consented to individual interviews being captured either on video or audio recording. The youngest participant was born in 1949, the oldest in 1919.
Inspire`s two trainers were supported by young people, practitioners and/or people in training and the staff of the visited settings.
Settings:
Our pilot was mostly focused on the French speaking part of Belgium and in particular on the city of Brussels and the city of Liège, located in Wallonia (French speaking region). This contextualization heeds the fact that the country is a federation of 3 regions: Brussels Capital, Flanders and Wallonia. The language issue (2 principal languages: French, Dutch plus a German speaking minority) is of paramount importance in this constitutional context and determines a great number of political and administrative differences between the 3 Regions.
Initially our research was orientated along 2 complementary lines:
Through research via the Web we obtained interesting information that we used in the continuation of the project:
Public Institutions cooperate on a multilevel scale with the associative groups in order to provide adequate services to the elderly. During the second phase of the project, we contacted the public authorities to preview the management policies and practices of Elderly Care Centres.
The city of Brussels is a microcosm, including 19 municipalities, each with a CPAS (Public Centre for Social Action), managed by a president elected within the municipal council. Every CPAS gives impetus to the social structures they want to promote and in accordance with the needs of their territory. In this context, our first contact was with the CPAS of the Municipality of Forest (one of the 19 municipalities) and this led us to the Centre Val des Roses. During a period of 6 months, a number of experts working in this institution, as well as the managing team were interviewed. The “Maison Val des Roses” mostly hosts seniors suffering from dementia. There are of course cases which are less serious than others and this requires an important differentiation of the services provided. Moreover, the institution is currently going through a reconstruction process of the buildings. It was impossible to organize a group activity in this context. However, during the European Mutual Learning session held in Brussels in June 2014, participants were invited to visit the care home and to share experiences and practices among social workers.
We then contacted the Administration of the Municipality of Schaerbeek, the City Council and the College of Aldermen. Our activities took place in the “Maison des Femmes” of Schaerbeek, an open institution, where all generations are welcome for various emancipatory activities (art exhibitions, movie sessions, workshops…). This is the place where we recorded the video of the workshop to train for listening skills, an example of a didactic training session around Audio-Psycho-Phonology [link to the video on YouTube].
We also presented our programme at the “Centre d’Animation de Quartier Biloba” where intergenerational activities take place, at the “Centre Résidentiel poor Seniors Albert de la Tour”, both in Schaerbeek and at the Orpéa Residence “Le Sagittaire” located in the Municipality of Uccle.
We contacted the centre “Le Monde des Possibles” in Liège, an institution for lifelong learning, located in the Wallonia-Brussels federation, an institution with which we already had been collaborating. We presented the APP method in their multicultural and intergenerational context of language acquisition. We have started a collaboration with them in this field.
Thanks to the support of the deputy responsible for the department of Education, Culture and Equal Opportunities of the Municipality of Schaerbeek, a bilingual community, who assured us of her appreciation, to pursue our activities for Dutch speaking citizens, we also presented the APP in the Dutch Region, in Antwerp, where the institutions manifested a lively interest.
On the whole, our activities mostly took place in open institutions, for intergenerational groups of valid seniors and younger participants of various cultural backgrounds.
According to the observations of the “Bureau Fédéral du plan – Région de Bruxelles-Capitale” the seniors (from 65 up to 80 and more) represented 14.3 percent of the population in 2010, the perspective being that this percentage would stay practically the same until 2030, to increase up to 19.7 percent in 2060.
At the moment, the residential housing in this region, providing equipment and services specially adapted to seniors are:
The Region of Bruxelles-Capitale has 204 structures and services, providing residential services for seniors, 28% of them for French-speaking seniors, 5% for Dutch-speaking ones and 67% for the bi-lingual elderly. These statistics are based on the over 60 population, since 60 is the age of admission for these institutions. On average, the region counts one structure or service for residential housing per 1,000 senior citizens.
The localization of the housing facilities is evenly spread over the territory, the day care centres are mostly situated in the central part of the region{3}.
The local culture, Bruxelles-Capitale being a highly urbanized place, explains that families are more inclined to choose residential housing for their seniors, rather than welcoming them into their homes (apartments are too small, expensive, all family members work, etc.).
Today, the population of Iceland is 329,100. It is a rather young nation as 67 years and older are about 33,000 or only 10% of the population. It is expected that the population of Iceland will increase about 33% by the year 2060 and will then be 430,000 people. In the year 2040 we expect that 67 years and older will have grown from about 10% of the total population up to 18%.
The project took place at the elderly centre Hrafnista, which is the largest elderly centre and nursing home in Iceland. About 600 residents live in Hrafnista nursing homes and Hrafnista has three day care and training centres. Hrafnista makes a priority of high-quality nursing and medical care, rehabilitation, physio- and occupational therapy and varied social activities. We chose the day training centre to have our workshops. Our clients in the day care centre have applied to our rehabilitation option in consultation with their doctor. The clients can come to the day training centre for about 4 weeks, where they get for example physiotherapy and occupational therapy. The clients can come during business hours which are usually between 9:00-15:00 weekdays. Many of our clients are socially isolated and have depression, Parkinson’s, dementia among other diseases and they all live in their homes.
In the day training centre we can reach out to the younger cliental of the elderly. Our focus was on empowerment and giving the elderly an opportunity to share their life story, using Transcultural Biography Work (TBW), Memoro interviews and Audio-Psycho-Phonology (APP).
We adapted the TBW to our own biographical work which we call Life history. We were already working with Life history at the nursing home especially for people with dementia. Participants were asked questions like: “Why should I do this?”
and “Who could benefit from it?”
. The day training centre gives every client a handout about how they can start to make their own Life history, what questions are good to have and the possibilities. Most of our clients were positive and wanted to start at home with their families, others thought it was good to know but not interested at that time.
Our goal is that when people move into a nursing home they have themselves written their story which can be introduced to the staff members. The person can benefit from it especially if the elderly person has memory loss.
The Memoro interviews were realised by Oddur Albertsson and took place in our day training centre. Oddur introduced the project for all of our day training centre clients at the auditorium. About 15 people listened to his lecture and there was a group discussion about memories and the old times. Later Oddur and two high school students interviewed three of our clients and made a video recording of the session. The clients were hesitant at first because they were afraid of the internet and who could see the video. Questions like: “Will I look dumb?”
or “I have nothing interesting to say!” asked.
All three clients wanted to see the interview before it was published. All of them were happy with the result.
The APP was introduced to all of our day training centre clients. We used an iPad with the APP application LIT and the clients could use it daily at resting time after lunch. There were about 4-5 people using it on a daily basis. Each one for 30 minutes about 2-4 times each week. The clients were positive and thought listening to music cleared their minds and helped with their concentration, it was uplifting and the 30 minutes was a pleasant resting time without falling asleep. After the testing time we continued using the APP app all through the summer.
From the early stage of the application, Speha Fresia involved as associate partner the Elderly Care Centre “Principe Ventimiglia e Conte Palagonia” (IPAB Principe di Palagonia) a little care home located in Palermo (Sicily region), that needed further training for its social workers and expressed its interest in piloting innovative practices also for improving the quality of life of the older guests. The Institute manages a nursing home for 32 clients, 13 of whom took part to INNOMEC pilot, and also an Elderly Daily Centre with 250 people enrolled, open to all the seniors of the neighbourhood. The Centre is based within the Institute and offers social and recreational activities. The elderly people are women/men of 65-100 years old (average age in the residential home is 90 years old, while in the Daily EC is around 70 years-old). It is a public institute of charity 70% funded by private funds (60% income from properties; 10% costs paid by clients); and 30% by public funds (regional funds for the staff costs and contribution paid by the Municipality of Palermo in support of the Elderly Community Centre). The staff involved in the nursing home is composed of 12 fixed staff: 3 nurses, 1 doctor, 1 health-care operator, 1 animator, 6 cleaning workers; But they can also count a Social Assistant trainee (internship from UMSA University); two volunteers, the chaplain, and a nun. The legal requirements in regard to the qualification of the main operators are: the Vocational Qualification for the Health-Social-Care operators; the bachelor in Nursing and the related licence for the nurses; the bachelor in social services for the Social Assistant. In Italy the health-care systems are regulated by Regional laws. According to the Sicily Region, for the establishment of ECCs it is necessary to be enrolled in a specific registry for obtaining the regional accreditation. Centres have to respect a series of common standards concerning the structure (Regional Law 22 of 1986 and DPR 29/06/1988 structural standards for the social care interventions foreseen by the Regional Law n°22/86) and concerning the staff (Decree of Republic Presidency of 4/6/1996 with the approval of the agreement template by the municipalities of the Region for the social-care services, as stated in the R.L. 22/86). Services offered by the organisation include elderly care assistance and social/cultural activities. As art.10 of the National Law n.328 of 2000 did not find yet application in the Region of Sicily, about the regulation of “IPAB” (Public Institution of care and charity), this institution still finds its funding law in the so called “Crispi Law” of 1890!
The age structure in Sicily in 2015 counts 19.9% {4} of the population over 65 years, while in Palermo and its province, it's a little bit lower (19.3%) confirming longevity in our country, but analysing the offer of care and cure services, consistently with the rest of Italy, elderly care is still almost completely in the hands of families and private care givers. Ageing and the transformation processes of families’ structure make these care efforts harder even with the support of private care givers. The increasing number of older people and “very old” people is increasing the demand of residential services, and the provision of these kinds of service is slowly growing, but with wide regional differences between North and South.
The offer is still poorly differentiated, and it is developed per typologies, without a networking system, yet to be developed. From research of the regional AUSER (national association for older people linked to the trade union CGIL), Sicily has the worst performance in the provision of residential care, with an index of 0.9 beds for elderly care per 1,000 older inhabitants versus a national average of 14.5 beds. And the care integrated services at older people’s home is 2.14 versus a national index of 4.12 of older people assisted at their homes per 1,000 of older inhabitants{5}.
In Italy, health and care systems are managed by Regional authorities, so part of the features described below could be peculiar to the Veneto Region and not to be considered as a general national rule.
Veneto is an Italian region with about 4,921,140 inhabitants, located in the North-East of Italy. Historically, the natural yearly demographic increase rate has always been one of the highest in Italy, but in 1983 it was negative for the first time.
The negative trend is still ongoing, and it’s even growing year by year.
The population structure in terms of age can be represented as follows:
Table 1. Population structure per age from 2002 to 2015 (source: ISTAT)
It’s clear that there is an increasing process of aging ongoing, which is leading to having an increasing average age of Venetian inhabitants (from 41.7 years in 2002 to 44 in 2015 – source: ISTAT 2015). The number of over-65 people keeps growing: if in 2002 it was around 827,630 nowadays it counts 1,066,900 people. Active aging becomes a topic more and more realistic in the social and political agenda, since this demographic structure has a strong impact on welfare needs and costs.
Veneto regulates Elderly Care Centres (ECCs) management by requesting a series of common standards necessary to obtain the regional accreditation. When the Centre does not meet these standards, the Region denies the accreditation and the structure cannot be included in the public system.
One of these standards also includes the presence within the Centre of the so-called “educative department”, which is supposed to work in cooperation with other professionals in order to promote educative and learning activities.
This represents the big added value, discriminating ECCs from hospitals. [take part to our POLL N°3 on Innomec.eu]
Notwithstanding the existent separation between care and educative services, social operators remark how difficult it is sometimes to consider the two aspects as separated, when dealing with elderly people.
In fact, many times the caregiver has to spend “educational time” with hosts, especially if s/he makes the host do things (washing, dressing, eating, etc.) by her/him-self.
In any case, educative and learning activities are a specific point in Elderly Care Centres agenda. Professional trainers are crucial components of the multidisciplinary team assigned to each host, and once a host is welcome in the centre, an evaluation is done in order to identify aspirations, stories, competences and interests. This is done for better proposing activities and initiatives, fitting the guests’ profiles, and thus guaranteeing a customized service.
Starting from this general background, and considering that the Italian partner SCV was supposed to test APP and MEMORO methodologies, SCV got in touch with different organisations and stakeholders working in the field of elderly services and policies.
In particular, we identified 2 organisations managing elderly care centres, which were very interested in experimenting directly with their guests the innovative tools and approach proposed by INNOMEC.
Therefore, we scheduled with them and according to their availability which methods would have been experienced for each of them.
The 2 organisations are:
1. Cooperativa La Goccia (Marostica, Vicenza) [link to their website]
2. Fondazione OASI (S. Bonifacio, Verona) [link to their website]
They are located in two different provinces of the Veneto region, so the impact of the validation has been extended beyond Vicenza itself.
Both of them decided to validate the APP method, while only OASI decided to also test MEMORO.
Demographic convergences of the recent decades impact population age structures and result in the ageing of society in Lithuania. According to the Lithuanian Statistics Department (2013) 102 social care institutions were providing social care services in 2012, 4,500 older adults received these services. The majority of the above institutions function within the regulatory supervision of local municipalities; others are public enterprises or private institutions. Stationary care institutions for older adults are the following types: care houses for older people, geared for people who are in need of permanent nursing and care and for people who, because of their old age and deterioration, are unable to live on their own at home; independent residences, which are mainly for older people, who are in no need of permanent care and nursing, but may require minor assistance or some social services.
At present the measure and evaluation of the quality of social services for different groups of clients is only at the initial stage. In the attempt to achieve the quality aims of social services in Lithuania, the definition of the concept of social service quality is constructed as well as the criteria of its measuring. In other words, at present the social service quality concept is being discussed. It is very important for social workers who provide social services for elderly clients; the quality assessment is associated with the growth of the professional prestige in the society [take part to our POLL N°4 on Innomec.eu]. In the Catalogue of Social Services (of 05 April 2006 Order No. A1-93, (Žin., 2006, Nr. 31-1092) educational activities are not listed directly, however, in practice, implicitly they are carried out as sociocultural services, which are listed in the Catalogue as leisure activities provided to avoid social problems (prevention aims), to bridge social exclusion, engaging the whole community and which enable individuals (families) to communicate, to participate in group social work function, undertake favourite activities. The key providers of such services are social workers.
Quality evaluation of social services in social care institutions for elderly people was started in 2013. Criteria for social service quality evaluation is infrastructure (building) status correspondence to standards, qualification of the personnel, presence of standard documentation, correspondence to the norms of social service development. These criteria consist from objective, quantitative measures which allow for easy assessment of some aspects of the quality assurance. Licensing social service institutions started in Lithuania in 2013 and it embraces only objective criteria, which are listed in the Social Service Institution Licensing Regulations approved by the Government Decision No.528 of 16 May 2012 (Žin., 2012, Nr.: 57 - 2864). Institutions wishing to acquire a license fill out questionnaires consisting of objective measures: the correspondence to the legal requirements regarding the ratio of social service receivers per personnel, the structure of the institution, personnel education, size of residential and personal hygiene areas.
By 2015 all the care institutions that provide social services for elderly people will have to acquire licences or else close down. Licensing of enterprises, institutions or families to provide social care in the institutions or within the individual homes is carried out by the Department of Social Service Supervision (DSSS). It is estimated that there will be about 500 licensed services providing institutions of different competence.
In Lithuania, the National Pilot was realised engaging the 3rd year students of Social work programme who were introduced to the methods: TBW, Memoro and APP. Theoretic knowledge on methods were integrated into the following courses: “Fundamentals of Andragogy” and “Social gerontology”. During the internship period, students who did their practical training at elderly care institutions, were encouraged to apply these methods in practice. After completion of the internship, students were asked to reflect on their experiences and to discuss findings and improvements. Also seminars for practitioners who work in social service institutions in Vilnius city were organised: care and nursing homes, independent households, Senior citizens daily centres and services provided to the older people residential centres.
{3} Bureau Fédéral du plan, Inventaire des Equipements pour Seniors, Bruxelles-Capitale, Inventaire analytique, novembre 2010 - Le Carrefour de l’Economie Sociale, www.econosoc.be
{4} Source: ISTAT National Institute of Statistics at http://www.tuttitalia.it/sicilia/statistiche/indici-demografici-struttura-popolazione/
{5} Auser Sicilia, “Non è una regione per vecchi” (It is not a region for older people), 2011