Problem addressed
The demographic situation in Poland, particularly the advancing aging of the population, calls for actions aimed at seeking and implementing new solutions in the field of accessibility to social and healthcare services. This need particularly affects rural residents, where general adverse demographic trends are compounded by other issues.
Many Polish villages are affected by depopulation, as younger generations move to cities, leaving behind elderly individuals, often alone, living in increasingly sparsely populated areas. As a result, older adults frequently have no close relatives who can assist them with illness and daily care, and the family members who do act as caregivers are often elderly and suffering from health issues themselves.
Additionally, the difficulties with access to public transportation significantly impacts the availability of services (both those provided on-site and those delivered as part of home care, due to the difficulties and costs associated with traveling to the clients).
These barriers also include the relatively lower availability, compared to city residents, of other services provided for example within the social assistance system.
Innovative solution
The home care model is designed for elderly people living in rural areas who are becoming increasingly dependent on others due to conditions like dementia, stroke, or those who don't receive curative treatment.
The model does not focus on improving just one element (e.g., solely working on an empathetic team, motivating neighborly assistance, or helping the caregiver) but proposes a comprehensive home care model for rural areas. In this model, assistance for individuals whose health condition requires care is tailored to their needs.
A new element in providing these services is the expansion of the home care team, consisting of doctors, nurses, physiotherapists, and psychologists, to include caregivers. They play a very important role in the team. Their task is to ensure the overall well-being of the patients. This can involve various activities, including having conversations, doing shopping, or engaging in exercises together. Furthermore, caregivers step in to provide relief for those who look after a sick person every day, such as when they have appointments or errands to run. This also has a positive impact on family relationships,
The introduction of caregivers has helped unburden the workload of medical personnel. It gave possibility of reducing the involvement of qualified specialists in caring for patients - from nurses and physiotherapists to doctors. Caregivers can perform basic nursing tasks for patients, monitor their health status, and conduct recommended exercises with them after a short training conducted by a physiotherapist.
The model combines standard social services with the provision of health services.
In each case, the situation and needs of the patients are assessed by a doctor, who then designs a treatment plan and schedules appropriate specialist visits.
At the beginning of the support, an Individual Service Plan was created for each patient, which was then monitored and modified depending on the changing situation.
It contains support in various areas - more hours of medical and nursing care in medically complex cases, rehabilitation tailored to the patient's condition and needs. In some cases, it was necessary to involve additional specialists, such as speech therapists or dietitians.
The team also educates and trains family members on exercises, caregiving techniques, and methods of care. Another crucial aspect of this home care model in rural areas is collaboration with existing social and health services providers, like family doctors, community nurses, and municipal social welfare center staff. This collaboration involves planning the most effective care for individuals in need, complementing standard services with the specialized care provided by the home care model.
Key results and benefits
Implementing the model in the proposed form allows for a comprehensive perspective on the patient's problems – both their health and social needs. Elderly people, especially those living in rural areas, face various challenges aside from illness: loneliness, age-related disabilities, poverty, and sometimes even abuse from relatives. Patients often feel uncomfortable discussing their situation, but regular and attentive contact with the home care team enables the observation of these issues, appropriate response, and incorporation of needs into the individual plan.
Thanks to the carefully designed and comprehensive care provided by a skilled team, patients experience fewer hospitalizations and feel better supported and safer overall. It improved not only their quality of life but also enhanced the well-being of the patients.
Better access to specialist care
Before the hospice team included caregivers, it was solely up to the medical personnel outlined in the regulations (specialist doctor, hospice nurses, physiotherapist, and psychologist) to provide all types of services to patients, even those that didn't necessarily require specialized medical knowledge or skills.
However, with the addition of caregivers to the hospice team, they took over some of the tasks that were previously handled by medical staff. This allowed doctors and nurses to concentrate more on patients who needed medical interventions, while caregivers handled other aspects of patient care.
Ad hoc respite support for family members
The inclusion of professional caregivers made it possible to provide additional support to the family members who care for their loved ones, offering them respite from their daily duties. What is more, patients no longer worried that their illness was keeping their relatives confined at home and prevented them from tending to their own needs.
Reducing the operating costs
Developing a model where certain services previously handled by specialized staff like doctors, nurses, physiotherapists, and psychologists are now carried out by trained caregivers has enabled to decrease the frequency of visits by medical professionals without compromising patient care. Considering the disparity in employment expenses, this adjustment has resulted in approximately a 30% reduction in staffing costs.
In total, the project provided care for 278 individuals. The average age of the recipients was 77 years old.
The model evolved over the years, and its expanded scope was tested as part of the project "To give what is really needed," led by Prophet Elijah Hospice Foundation.
This project was among the seven initiatives financed by the European Commission under the European Programme for Employment and Social Innovation ("EaSI") 2014-2020.
Two significant elements were added to the model:
• Establishing networks of local healthcare and social assistance institutions, as well as other invited institutions, to collaborate within the network.
• Supporting the assistance team by appointing a Coordinator of Care for Dependent Persons.
An important part of the project was also the scientific study, which allowed for monitoring the effect brought about over 2.5 years of the project implementation as well as for gathering good practice and recommendation for institutions acting in this field.
Potential for mainstreaming
On the one hand, palliative care (also in home hospice settings) is a specialized medical care that requires application of specific regulations. Those regulations regarding hospice care as well as national policies, programmes and resources, are likely to vary across different countries. On the other hand, the challenges in the area of palliative care and the needs of terminally ill people are the same in different places around the world. The model proposes universal solutions such as the collaborative efforts of healthcare and social care entities to provide tailor-made services adjusted to individual patient needs. The position of a caregiver exist in most countries. What is innovative about this model is that the caregiver’s role is defined and combines tasks of medical care and social care. The innovation was implemented by various types of entities - private, public, non-governmental organizations. These were not only hospices but also clinic or social service centers. This demonstrates the possibility of replicating the model in different environments - not only medical sector but also the social assistance sector.
