No long-term care system until the “right” plumbers are in place

Apr 26, 2019 at 14:01 • Culture

The conference was hosted by the capital’s Izmailovo hotel complex and had 100+ attendees: chief executive officers and key staff of social services in the pilot regions, elderly centres and non-profits. They discussed the outcomes of the first year of the pilot project to put in place a long-term care system, compared notes and discussed the challenges and ways to address them. The conference included plenary sessions, section-specific activities and an open mic.

As part of its Elderly programme, the Timchenko Foundation was involved in the pilot project, first of all by implementing educational projects. In 2018, the foundation sponsored 5 traineeships abroad in Israel, Czechia, Finland and Germany, as well as organizing training for care coaches in Moscow. The Timchenko Foundation also sponsored a training project for geriatricians. It is important to us that all conference attendees who interned highlighted the critical importance of education – it is namely a direct involvement in arrangements for long-term care that enabled many to understand how to build a system, reform establishments and realize that some solutions are effective, while not requiring financial outlays.

The results of the first year of the project to put in place a long-term care system were reported at a plenary session by Yelizaveta Oleskina, head of Starost v Radost [Happy Old Age/Golden Years] foundation, who is responsible for the project’s methodology.

According to her, the system is up and running. One of the first tasks was to switch the system from a notification paradigm – everyone in need of assistance must be “found” by setting up liaison between the national health and social services. “One will be able to say that the system works when a plumber visiting an old woman to fix a tap sees that she lives alone and knows that he has to phone a coordination centre. We don’t have such plumbers as yet,” Oleskina said in her address.

The right plumbers are not yet available, but there is some progress already.

To ascertain what and how much assistance a person may need, the long-term care system provides for “categorization”, which divides those in need of social and medical assistance into 5 groups, where 1 is people who require minimum assistance and 5 are the bedridden. At year-end, more than 24,000 people have been categorized in all of the pilot regions. Categorization is a handy tool that makes it possible to plan expenditures and measure the load on social workers.

Yelizaveta Oleskina also reported that all pilot regions have already opened or are about to open daycare centres, as well as hire outlets. Care schools are available, which also offer group training to relatives who care for their elderly; also available are home visits and so-called bedside advice on how to refit the home, how to care for a patient and what to take out at the hire centre.

The changes also affect establishments: they set up personal space using screens and arrange social meals and walks. Incidentally, the establishments celebrated 40 weddings over the year. The unexpected outcome was the result of people starting to notice their neighbours on walks and during social meals and activities, with somebody even bumping into the love of their younger years.

In rounding up, Yelizaveta said that the long-term care system is sure to face more challenges down the road that are yet unknown.

The plenary session also saw contributions from representatives of the pilot regions. Yelena Trishina, deputy chair of the Welfare Committee of Volgograd Oblast, said that the region now has 40% and 35%more citizens who receive assistance in live-in facilities and at home respectively.

She told about foster families for the elderly – the model is quite suitable for rural areas and has been promoted in the region since 2011. Foster families have accommodated 234 senior citizens since then. Caregivers have been active in the region as part of the pilot project since 2018. The region has opened 2 daycare centres for people with cognitive disorders; they had actually been in place already, but the pilot project made it possible to rethink them. The region is also growing geriatric services.

At the sections the conference attendees discussed daycare centres and categorization issues. Best local practices were described by senior executives of establishments; they talked about special paperwork management arrangements, personal space solutions for inmates and even about bags than can be made for buns that babushkas like to keep on their bedside cabinet. Many facilities have started teaching classes, opened potteries and other workshops; they made an evaluation of cognitive abilities of inmates and assessed the risk of falling. One of the establishments started using colour coding for inmate room doors: red, yellow and green nameplates indicate the high, medium and low risk of patient falling.

The conference also discussed the model of Care Within Reach, a grants programme being developed by the Timchenko Foundation, to replace the Active Generation competition, running since 2011. Vadim Samorodov, head of the Timchenko Foundation’s Elderly programme, said that the new competition can be launched as early as next year and will support models and solutions for elderly care. The models will first of all benefit people who either need constant care or are on the verge of becoming dependent on others for assistance. “We do our best to focus on those who have lost some of their autonomy in an attempt to keep them self-reliant as long as possible or to bring them back into active life,” said Vadim Samorodov. He cited statistics from the Higher School of Economics, which indicate that 14% and 55% of those in need in Russia receive formal and family care respectively. The “grey area” is 31% — those are the people who need support and medical and social assistance and of whom we know nothing, know nothing about how they deal with their problems. The Care Territory competition is expected to help set up coordination centres for the care and patronage system with the involvement of territorial associations (TSZh [housing co-ops (HCOs)], TOS [local councils (LCs)]), service providers (bank branches, post offices), utilities – the local entities that are aware of single old people and those in straits. The competition’s concept is still on the drawing board, and social workers have been invited to contribute.

The Long-Term Care System conference was organized by the charities Starost V Radost and Starshiye [Seniors] and the Timchenko Foundation.