Comparing the impact of services in Kent and Calabria on the quality of life of older people Fiorella Rizzuti (Ph.D. student – M.Sc.) University Of Calabria Department of Sociology and Political Science

Objectives:  To describe the health and social services in Kent and Calabria and their influence on the elderly people’s quality of life ;  To illustrate the strengths and weaknesses of social care services and their relationship with health services in providing care for elderly in Kent and Calabria;  To underline the main reasons for the institutionalisation of elderly.

Methodology: Grounded Theory  To obtain data through an inductive procedure discovering the theory from data;  To limit the possible bias of previous research;  To start the research with an open mind to discover new categories, properties and dimensions.

Face-to-face semi-structured interviews  The experiences and opinions related to working collaboration between health and social professionals to provide community care;  The main reasons for residential care in place of community care services;  The old people’s perceptions on the quality of services received in order to compare the old people’s quality of life between community care services and residential care services.

Professionals  Team leaders of adult services;  Home care managers;  Day care managers;  Social workers;  District nurses;  Care workers;  Occupational therapists;  Physiotherapists.

Users  10 old people who receive domiciliary care services;  10 old people who receive day care centres;  10 old people who receive residential care for less than one year;  10 old people who receive residential care for more than one year.

What’s Community care ? Community care involve all those services and supports that allow people to live in their own homes in place of residential care home.

Care in the Community:  Social services departments;  Local Health Authorities. by Community:  Family;  Friends;  Neighbours.

 Domiciliary care services: are those services that clients receive in their own home e.g. home helps, managing medication, visit by district nurses and help with dressing, washing and getting in and out of bed;  Day care centres: are places where people can meet other people, have lunch, have bath and, get involved with a variety of activities and then return to their home.

 Direct Payment: it consists into giving money on the hand of users to purchase the services they need rather than services arranged for them by local authority (as alternative to residential care services clients can use direct payments to buy exclusively community care services).

Residential care Residential care means care in institutional social or health settings for a short or permanent period of time.

Short time  Rehabilitation care: is targeted to regain the abilities and confidence needed to return as independently as possible at home;  Respite care: is a support aimed to offer a regular break to careers ranging from someone looking after the older people while carer goes out, to admission of the clients to a residential settings for a short period of time.

The choice of residential care happens when:  People need 24 hours of care attention for illness;  People do not have support from their families because of work and time.

Why is community care better than residential care ?  To contain the growth of health and social expenditure caused by long term care and unnecessary hospital admission;  To improve the old people’s quality of life maintaining them in their own home.

Weaknesses in providing care services in Kent  Health and Social services have got different priorities and criteria to follow; hold different budgets and belong to different organisations: “We have different budgets, targets, priorities and criteria and we have got completely different departments and health and social professionals are employed by different people but all we work for the same client so it is crazy... do not you think?...” (Interview n°9: Team Leader SSD)

Weaknesses in providing care services in Kent (2)  Social professionals’ role and competences are still misunderstanding: “I think that people mainly do not know what social worker actually do… I think there is a negative attitude about social services because there is a great misunderstanding about our role...” (Interview 5: Social Worker)

Weaknesses in providing care services in Kent (3)  Health professionals hold negative stereotypes against social professionals because they tend to see their work as more skilled and professional; “[...] I think that sometimes health professionals tend to consider themselves as the real professionals in the care […]” ( Interview n°6: Team Leader SSD)  There are deficiencies in resources and staff to involve more people into community care services.

Strengths:  The developing of joint training across the country is increasing the awareness of mutual roles and competencies between health and social professionals in the care; “[...] there is a lot of joint training at the moment between health and social services and that means that in the future we will have much more idea about how each other works so I think that something is changing hopefully” (Interview n°5: Social Worker)  The NHS Plan 2000 is encouraging the working collaboration via a new range of services called Intermediate care as alternative to residential care which involve health and social care together.

Intermediate care: Intermediate care is a new range of services such as intensive rehabilitation services, recuperation facilities and rapid response care located in community based settings or in patient’s own home and provided under a joint initiative between health and social services (maximum six weeks).

Intermediate care (2)  Rapid response teams: made up of nurses, care workers, social workers, therapists and GPs in order to provide emergency care for people at home and helping to prevent unnecessary hospital admissions;  Intensive rehabilitation services: to help older patients regain their health and independence after a stroke or major surgery. These will normally be situated in hospitals;  Recuperation facilities: many patients do not always need hospital care but may not be quite fit enough to go home. Short- term care in a nursing home or other special accommodation eases the passage;  Integrated home care team: so that people receive the care they need when they are discharged from hospital to help them live independently at home (DoH, 2000).

Health and Social services in Calabria  There is a lack of collaboration between health and social services to deliver the care at home so it is provided in separate way;  Health professionals tend to see social professionals as unskilled and not professional.

Health and Social services in Calabria (2)  Domiciliary services are provided by untrained and unqualified personnel that are usually chosen more on the basis of political and economic reasons than on the quality of the care;  There are not day centres but leisure clubs for old people managed by older people themselves where they can go whenever they want to socialise and play cards;  Rehabilitation care is really poor and respite care services are not delivered.

Why is Calabria so different from Kent?  In Italy the provision of social services has always been characterised by confusion on the responsibility and accountability among state, local authorities, private and voluntary organisations due to the lack of a national framework for the provision of social services since when the National Health System has been introduced in 1978;  The new national framework (328/2000) related to social care services which encourages community care services as alternative to residential care has not been implemented yet in Calabria;

 Collaboration has always been complicated to achieve because of the cultural assumption that collaboration means loss of power and responsibility on the services that health and social organisations have to provide. “We have never had collaboration with social services departments [...] and this because of there is the fear that one organisation could steal something to the other. As a consequence, each organisation works in separate way to another and collaboration is really hard to achieve [...]” (Interview n°30: Manager for Health Services)

Thank you for your attention