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Senior care / New models of care

Call for vulnerable to be made a priority in new long-term care model

By Andrew Sansom 14 May 2020 0

The coronavirus crisis has underlined the need to reform the current model of long-term care to provide responses that are global, adapted to the needs and rooted in the community.

That’s according to the European Social Network (ESN), whose chief executive, Alfonso Lara Montero, has co-authored a declaration supporting a necessary change in the long-term care model in Spain.

While the declaration was drafted against the difficulties faced by healthcare professionals to support the most vulnerable in Spain, which is one of the most affected countries by the COVID-19 outbreak, the analysis and proposals outlined may be applicable to many other European countries.

“This health crisis has revealed the inadequacy of care systems to cope with the vast numbers of already fragile and vulnerable people who have become sick as a consequence of the pandemic,” says the declaration. 

“The analysis of this situation should help us identify and assess potential risks to inform future actions in community care. This analysis may include ensuring continuity of care; co-ordination between services but also between health and social care systems; addressing who is responsible for what; and balancing values and care with people’s health and freedoms.”

Ten proposals

The declaration sets out ten proposals under three broad areas – domiciliary care, residential care, and old age and disability stereotypes – aimed at creating a more effective and supportive model of care in the community for the most vulnerable. 

On domiciliary care, the declaration argues that the crisis has revealed the lack of visibility and means for practitioners working in domiciliary care. It also believes it is crucial to advance a comprehensive and integrated model of domiciliarycare that integrates and co-ordinates the stakeholders involved in adult social care: families; general social services; domiciliary care; primary and secondary healthcare; the home and care employment sectors; personal assistants; volunteers; local services; and community organisations. 

On residential care, the declaration acknowledges the huge risks being taken by care workers in the absence of adequate protection. It therefore advocates supporting them with training in integrated social and relational skills, investing in the necessary equipment for carers, and improving organisations. It also recognises the need to invest in sufficient and adequately trained carers.

People who become ill in care homes have the right to public healthcare and should not be deprived of this right because of advanced age or their degree of disability, says the declaration. 

A further proposal concerns transformation of the residential care model, with the document arguing for a change in the way older people and people with disabilities in need of support are housed. Ending institutional care is also recommended, given the difficulty in imagining “a living arrangement more poorly suited to a highly communicable disease outbreak than one in which large numbers of older people live in close proximity”. Therefore, says the document, “it’s crucial to advance towards a person-centred care model that promotes individual choice and support”.

Another reform proposal is a call for new models of architectural design, organisational and management formulas that are as close as possible to living in one’s home. “These models encourage living environments based on guaranteeing privacy, assuring personalised care, reducing staff turnover, and organising meaningful activities per people’s choice and in contact with the community,” says the declaration.

Finally, on old age and disability stereotypes, the document acknowledges that older people and people with disabilities are heterogeneous groups. Stereotypes that promote a distorted, negative and uniformed view of older people and people with disabilities must be eradicated, it says. 

And in a further proposal, the authors of the declaration believe that every individual should be treated alike according to their rights and responsibilities. Paternalistic language that argues that society owes older people care in return for their contributions should be rejected.

Concludes the declaration: “The current situation can become an opportunity to achieve better care for the people who need it, progressing towards communities of care that commit to ensure that the participation of the most vulnerable becomes a priority.”

Organisations involved