Delivering long-term care in rural areas – improving quality and supporting the workforce

Delivering long-term care in rural areas – improving quality and supporting the workforce

As Europe’s population grows older, so too does the need for care services and support for social services professionals and care providers, particularly in rural areas.

As part of the Rural Care project, which aims to develop a new model of integrated long-term care, the European Social Network (ESN), in coordination with the Department for Social Services of the Regional Government of Castilla y León (Spain), organised a seminar at the beginning of March focusing on the delivery of quality care and supporting the social services workforce.

The aim of the seminar was to share the results of the project and the lessons which have been learned so far with regional, national and European decision-makers and practitioners and exchange experiences and perspectives with organisations implementing other care models in Spain and Europe. Through presentations and small group discussions the participants were able to develop greater common knowledge and understanding of person-centred care models in rural areas.

Alfonso Lara Montero, ESN Chief Executive Officer and Benedicto Caminero Pérez, Technical Director for the Elderly and People with Disabilities of Junta de Castilla y León Social Services, highlighted the importance of person-centred care models, which allow the wishes and needs of people in need to be respected, and which value and promote the role of both formal and informal caregivers.

RuralCare promotes quality in home care through a person-centred approach – including an assessment of the household at risk and appropriate interventions based on the person’s life project and wishes under the leadership of the local authority in partnership with other agencies. The project also promotes the use of innovation and alliances between the public and private sectors.  Project partners such as the regional government, the University of Valladolid, and the People Foundation which represents people in need of support offered an overview of the main challenges faced, highlighting barriers like the organisational culture and changing the orientation of services towards providing care based in the community.

Participants reflected also on the challenges of ensuring the recruitment and retention of professionals with the right skills, to cover the different professional roles and to have training on the need for coordination between different agencies.

Speakers from other regions in Spain also shared their experiences.  María Pilar Hilarión, Deputy Director of the Avedis Donabedian Research Institute in Catalonia highlighted that to ensure quality care in rural areas, it is important that integrated care in the home is prioritised in public policy. Mariona Rustullet, Deputy Director of SUMAR Public Social Action Services, also from Catalonia, stressed that intervention models must not only focus on people’ s needs, but above all, on their preferences and desires. She also highlighted the importance of ensuring that those professionals providing services are also skilled in understanding people as well as the practical tasks their role involves.

Representatives of English and Irish quality agencies, researchers on person-centred long-term care, and organisations with proven experience in the sector from Austria, Finland, England and Wales also gave input. David James, Head of Adult Social Care Policy Department of the Care Quality Commission (CQC), England, highlighted that to make person-centred care real, we need to ensure that health and social services provide people with safe, effective, responsive, compassionate and high quality care.

RuralCare has so far enabled 165 people to stay and be supported and cared for in their homes. It has proved that it is possible to provide quality care services at home in rural areas at a reasonable cost.

The RuralCare project will conclude with two final conferences, in Madrid and Brussels in September 2023, where the full results of the programme will be presented.

The challenge of addressing long-term care in a rural environment

The challenge of addressing long-term care in a rural environment

By Fundación Personas, Project Partner

So far, the response to the care of people with needs in rural environments has been limited as a consequence of a dispersed population and the characteristics of the area (shortage of services; shortage of informal carers and professionals; difficulty for access to resources and increase of their cost; etc.). Therefore, RuralCare aims at facing this challenge and poses “a new way of approaching long – term care in rural areas respecting the rights of individuals, especially the right to remain linked in your natural environment and maintain a sense of belonging.” It is also intended to give a comprehensive response by combining social and health solutions.

This comparative frame of other care models versus the care model in long-term care that is being developed by this project.

Fundación Personas, a ” non – profit organization with extensive experience in providing support to people with disabilities and other long term care services” is responsible  for “testing an innovative systematic approach in relation to long – term care.

They are providing the services to people participating in the project pilot.  Their team of professionals are mainly settled in rural areas, and they work in close close collaboration with the social services and health care case coordinators, who are also situated in the area.

Once an individual’s participation has been formalized by the social case coordinator, Fundación Personas begins its intervention. The case manager builds a relationship of trust with the person, to understand their desires and preferences which form the basis for the provisional support plan, which after any necessary modifications becomes the final support plan. This plan gathers the person’s basic data, the actions which will be undertaken and the support which  will be provided so that the person can, according to their preferences, develop their life project. The plan must always remain truthful to their life story, an is an open document in constant evolution according to the beneficiary’s most important life events.

The project participants choose what levels of support they need to carry out the basic activities of their daily life. Their  personal assistant is a professional who provides this support to ensure their autonomy and independence, whose flexible approach adapts to their particular illnesses or disabilities.

The case manager follows up and monitors the process and the care provided, and they make the necessary modifications to the support provided such as increasing or decreasing the timing of support, providing any technical and technological support, and managing any housing adaptations which might be required so the beneficiary can stay in their own home.

The advantages and disadvantages of living in rural areas are highlighted in the development of these individual plans.  Many of the characteristics of rural environments turn out to be facilitators for the development of a project like RuralCare in which attention to one’s neighbours is the focus of the intervention. However, some of the disadvantages are also reflected in the project’s challenges: the lack of qualified professionals in the area; dispersion of the population, services and resources, leading to higher costs; isolation and loneliness; slow paperwork and excessive bureaucracy; services very widespread and not adapted to the individuality of each person, etc.

Therefore, the Rural Care project aim to make resources and tools available to the rural environment so that local people can stay in the area and their homes for as long as they wish.

 

 

 

Thanks to the Rural Care project, we, the people of the villages, can stay in our own homes” (Participant in the RuralCare project , 2022).

A vision for rural care

A vision for rural care

The model that RuralCare aims to implement, assumes that each of the people who require some kind of support by Social Services is the centre of the intervention he/she receives and that professionals and resources are organized according to the needs and preferences of that person. In order to accomplish this, good local coordination of everyone involved in the process is absolutely essential. The Provincial Council of Valladolid is the RuralCare partner in charge of the coordination and provison of primary care services in the area where the project pilot is being developed. Besides this, the Provincial Council of Valladolid is committed to the activation of community resources to promote a cohesive and inclusive society.  

The Provincial Council of Valladolid offers a detailed vision of its experience in RuralCare and explains how this good coordination is articulated and guaranteed between all agents, professionals and users who are part of the project. 

RuralCare is included as an example of transfer and scalability in the guide “Social Experimentation; a practical guide for project promoters” of the Directorate General for Employment, Social Affairs and Inclusion of the European Commission.

RuralCare is included as an example of transfer and scalability in the guide “Social Experimentation; a practical guide for project promoters” of the Directorate General for Employment, Social Affairs and Inclusion of the European Commission.

The Directorate General for Employment, Social Affairs and Inclusion of the European Commission has published the guide “Social experimentation; a practical guide for project promoters”.

A practical tool that combines knowledge and experience with some theoretical information, providing a solid understanding of social experimentation and practical advice for project development.

The guide, which includes a variety of examples of tools, models and methods used, lists the RuralCare project as one of these good practices. It especially highlights the phases and methodology used during the development of the project, which are described below.

In the first place, the importance of involving the political leaders who participate in the definition of social policies, thus guaranteeing their commitment and therefore increasing the impact at the level of social policy. With this objective, in the initial phase of the project, those responsible for RuralCare conducted interviews with the mayors of the municipalities of the pilot territories to learn about their interests and needs, involving them in the entire process.

Another aspect of RuralCare highlighted in the guide is the fact that it takes into account, on the one hand, an extensive literature review of existing good practices; on the other, an in-depth analysis of the state and context of the territory, and shaping the project from contrasting both and thus designing a sustained model in practices with proven success and at the same time adapted to the particularity of the territory.

The guide also highlights RuralCare’s person-centered approach. Placing the individual life plans of the users at the center, based on personal interviews that lead to an agreement between the user and the professional based on the expectations and vital desires, is given as an example of a model that manages to integrate a person-centered approach, with empowerment activities to benefit from their active participation in the design and implementation of the pilot.

Finally, the guide highlights the design process that RuralCare has followed to ensure the scalability and transferability of its results. Firstly, taking the pilot to 74 municipalities; with the results, developing a feasibility study for its implementation throughout the region and preparing a roadmap for its implementation; finally, presenting the project to other regions and raising the learnings at the national level to contribute to the policy of long-term care.

For all these reasons, RuralCare is already an example of good practice for the design of social innovation projects whose learning and results can be transferred and scalable to other regions, which is the ultimate objective of the financing plans that the European Commission makes available to its member states in favor of a continuous improvement of social policy.

RuralCare professionals participate in the Closing Conference for the Evaluation of Social Innovation Calls

RuralCare professionals participate in the Closing Conference for the Evaluation of Social Innovation Calls

On 10 and 11 May took place in Brussels the closing event of the study on the evaluation and dissemination of the social innovation calls for proposals co-funded by the European Union Programme for Employment and Social Innovation (EaSI). Among the 44 projects of the 7 calls for proposals of social innovation which were supported by the Programme between 2014 and 2020, the Regional Government for Social Services in Castilla y León – coordinating partner and leader of the RuralCare project – , was invited to present its experience with the PACT and RuralCare projects. (More information at https://lnkd.in/eBqm3Teu).

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The revitalisation of the rural environment as a key factor in the care model

The revitalisation of the rural environment as a key factor in the care model

The RuralCare project aims to support people to remain at home until the end of their lives, if that is their wish, and to do so while maintaining their lifestyle. One of the key elements of the project to contribute giving meaning to people’s lives is the dynamization of the territory so that it becomes an environment that offers alternatives for participation in meaningful activities, through collaborative work, the natural leadership of each territory, integration, social cohesion and social interaction.

On 7 April 2022, the RuralCare project organised, at the Matallana Nature Interpretation Centre in Villalba de los Alcores (Valladolid), a conference on good practices and experiences for the revitalisation of the rural environment carried out at local, regional, and international level.

The event provided an enriching space for sharing experiences and learning together to promote the transfer and replication of those methodologies and practices that have succeeded in transforming territories into opportunities for community participation, and progress towards an inclusive society in which everyone can find their own space.

Key elements in the dynamization process

Josefa Martín, an expert in community development dynamics in rural environments, began with a presentation that provided guidance on some of the aspects to be taken into account in order to enhance the opportunities that the territory can offer. Dynamization is about speed and velocity in a process that has no end; it has to be open, fluid, inclusive, comprehensible and participatory; its key elements are a territorial and bottom-up approach, integrative partnership, network and cooperation and proximity management.

Intergenerationality

To learn about specific examples of revitalisation practices adapted to different communities and contexts, the conference featured Juanjo Pulido, representing UNDERGROUND Arqueología, Patrimonio y Gente, who presented dynamization actions that have provided people with greater opportunities for social interaction and participation in cultural processes. He particularly emphasised the importance of intergenerationality for a more cohesive and connected rural environment, and therefore better prepared for future challenges.

Gema de la Fuente, Technician of the Federación de Jubilados y Pensionistas de Soria, also highlighted the importance of intergenerationality, explaining as an example of good practice and constant learning the dynamization model implemented in Langa de Duero (a municipality in the province of Soria with less than 1,000 inhabitants), which has used the methodology of focus groups to identify common interests and has managed to involve people of different ages in local projects that have worked on issues such as recycling, road safety or the recovery of traditions, promoting a cohesive and proactive community.

Social factors such as health determinants

“If most of the determinants of health are social, so must be their remedies”; Emiliano Rodríguez Sánchez, Family Doctor in Salamanca and collaborator in multiple national and international projects, focused on the importance of “prescribing health”, referring to the risks of normalising the medicalisation of processes often generated not so much by health factors, but by environmental and social factors, and should therefore be treated from this perspective, prioritising aspects such as lifestyle and social relations for people’s wellbeing.

International Perspective

The international perspective was provided by Francesco Casabianca representing “Quartiers Solidaires et Villages Solidaires” (Solidarity Villages and Neighbourhoods): an initiative carried out in the Canton of Vaud, Switzerland, which since 2002 has developed 37 projects in favour of the integration of older people in their neighbourhoods and communities. The project again stresses the importance of intergenerationality and understanding the diversity of people as key factors in achieving a more cohesive community in which its members play a more active role.

Giving voice to experience

Isabel Vega and Ángel de Prado contributed the vision and experience of the Solidarity Action Collectives of Castilla y León, an organisation that has been working for years in rural areas, based on proximity, listening and participation. “Contributing to give meaning to people’s quality of life by encouraging their participation is important; but if it is also done by listening to those who have been working in the territory for years, it builds on an important road that has already been travelled”.

The richness of interpersonal relationships

Another concrete example of good practice, this time from the Community of Madrid, is the La Konectiva initiative of the Aprocor Foundation. Nieves Casas and Ester Ortega explained how to work on community building from the neighbourhood, focusing on the relationships established between people, and the wealth that is generated when neighbours with different abilities contribute to the common good with concrete and free actions. La Konectiva develops a model based on the territory itself (neighbourhood or community), oriented towards the relationship and connection between people and based on people’s potential and assets – rather than their limitations – that is citizen-led and focused on social inclusion.

Care as a common good

The event was closed by Marisol Tundidor Gago, who, in addition to being a gerontological psychologist, defines herself as a lover and advocate of friendly environments and community dynamics.. Marisol explained “The need to understand care beyond dependency and to think about it from different areas of everyday life. To understand care as a social organisation, as a common good that guides the collective action of integrating and inclusive community initiatives, adapted to the rural environment, that offer and strengthen the feeling of belonging and usefulness to the community, of closeness, proximity, identity and community bonding”. With conferences such as this one, she insisted, “we are making progress in a firm, coherent, sustainable, committed and connected to the local level, taking advantage of existing resources and creating a network”.

Transversality and creativity in the practice of community revitalization

In addition to the presentations, the day included an exhibition of six posters representing more examples of good practices in community revitalisation carried out by different organisations.

Ricardo Velasco, Mayor of Ventosa (La Rioja), presented the project Un kilómetro de arte; a participatory space that generates a permanent artistic intervention every year in the physical kilometre between the beginning of the municipality of Ventosa and the church of San Saturnino. A meeting point between tourism and culture that connects with the values of the inhabitants of Ventosa and nearby towns through the Way of ”El Camino de Santiago”.

Alexandra Posac, representing La Candela Teatro y Comunidad, explained another example of how art can be a tool for community dynamisation through a collective artistic laboratory that promotes social participation and community development for the creation of neighbourhood networks, the improvement of social cohesion and the promotion of citizen participation in the city of Valladolid.

From art to culture by the hand of Fundación Intras, whose representative Adrián Pérez introduced us to the Centro Sociocultural Peromato; a social innovation project where social care services aimed at people in vulnerable situations and sociocultural services aimed at the whole population converge, with the aim of generating a space for participation, respect, and understanding of diversity.

Community revitalization can also play a fundamental role in caring for caregivers through the creation of support networks. An example of this is the project Por ti, Por ellos of the Diputación de Valladolid, whose objective was to share a framework for joint reflection between professionals, social agents and family carers, on whom the dependent persons were, what their needs were and the repercussions that the provision of this care entailed for the carers and their families.

The Diputación de Valladolid presented a second project, Nuevas Riendas, framed within the area of active ageing and through which an Interdisciplinary Working Committee has been set up, made up of representatives from numerous municipalities in the province, which serves for the continuous renewal of the Seniors Programme as well as to analyse the needs and demands of the group and to make its own proposals to the institutions.

Finally, we learned about an example of how community dynamisation can also be a way to facilitate the construction of new narratives. Naomi Hasson, representing the Fundación Doble Sonrisa, explained the Getxo Zurekin initiative, a space for experimentation in the field of compassionate communities for social awareness, training and research into the welfare and improvement of the quality of life of people in situations of dependency and end of life, taking advantage of existing community strengths and networks.

This conference has once again highlighted the need to focus care on a model centred on the person and the community, which respects the environment and the context of each territory and values the resources already available, innovating in the ways of promoting their potential and in favour of a more cohesive and inclusive society, which favours care in all its forms.

RuralCare continues to advance in the piloting of its model and in future stages of the project it will hold more best practice workshops and exchange of experiences and knowledge.

Rural Care Model

The Rural Care Model: rethinking long-term care for elderly people in rural areas

RuralCare is a social innovation project which aims to design, test and evaluate a new approach in the provision of integrated long-term care for elderly people living in rural areas depending on their values, desires and individual preferences.

A new report now outlines how the proposed model, being trialled in Castilla y Léon in Spain, would work. Based on current practices, the report identifies the information required, the way in which it will be collected and the tools required to carry it out. It also outlines the way referrals will be made and different services will coordinate their services to support elderly people living in rural settings within the framework of the National Dependency Care System and the Chronic Patient Care strategy in Castilla and Leon.

Castilla y Léon is also experiencing the same demographic ageing of the population which is taking place in other parts of Europe. Currently 60% of the elderly population, in Castilla y León are living in rural areas and are susceptible to loneliness and isolation. The model at the heart of the project aims to support the ability of people to live in their own homes, according to their choices and arranging the necessary support to realise their wishes.

To do this, a full assessment of the person and their environment will be carried out. In this way, the approach shifts to being preventive and proactive, in which the person requiring care is at the centre of the model, making the decisions about the whole process. This entails the design of new holistic assessment and intervention tools, as well as the necessary reorganization of professional roles, coordination between multidisciplinary teams and true care integration which will ensure cohesive and continuous care.

Next steps

Once the Model has been defined, the pilot has been launched for its experimentation in rural areas of the Province of Valladolid, accompanied by an evaluation process with periodic assessments. The pilot will be active until the first quarter of 2023 and during its validity, updates about its progress will be published.

 

The RuralCare Project team actively participates in the 3rd Co-Creation Workshop for the Assessment of EaSI funded activities 2014-2020

The RuralCare Project team actively participates in the 3rd Co-Creation Workshop for the Assessment of EaSI funded activities 2014-2020

A representation of the RuralCare consortium of partners has participated today in the 3rd Co-Creation workshop organised by the group of operators responsible for Assessing and Disseminating the Results of the Social Innovation Calls Financed by the EU Programme for Employment and Social Innovation (EaSI) 2014-2020. RuralCare´s objectives, ambitions, innovative dimension and results delivered so far have been presented in order to contribute towards the participatory development of a future Social Innovation Guide.

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