Care at home for elderly – lessons learnt from the Swiss Red Cross “Integrated Home Care” in Eastern Europe/CIS

Introduction: The Swiss Red Cross (SRC) is supporting local partners in Eastern Europe/CIS in developing services to allow elderly a dignified ageing in their homes. SRC promotes integrated medico-social home care services in agreement with the local partners, their strategies and capacities. “Help to self-help” is crucial besides the provision of good quality low cost services, accessible for people in need. In many post-Soviet countries, cooperation between Health and Social Ministries is rather weak. Access to health/social care services is a challenge for older people due to low pensions, lack of transportation means and low self-mobility. At policy level, the SRC facilitates the collaboration between health/social care policy makers and fosters exchange with advisory boards or working groups. At practical level, the SRC links medical and social care workers and puts a model of nurse-led care into practise.

Introduction: The Swiss Red Cross (SRC) is supporting local partners in Eastern Europe/CIS in developing services to allow elderly a dignified ageing in their homes. SRC promotes integrated medico-social home care services in agreement with the local partners, their strategies and capacities. "Help to self-help" is crucial besides the provision of good quality low cost services, accessible for people in need. In many post-Soviet countries, cooperation between Health and Social Ministries is rather weak. Access to health/social care services is a challenge for older people due to low pensions, lack of transportation means and low self-mobility. At policy level, the SRC facilitates the collaboration between health/social care policy makers and fosters exchange with advisory boards or working groups. At practical level, the SRC links medical and social care workers and puts a model of nurse-led care into practise. Objectives: -Strengthening health care systems and enabling access for all, -Engaging in advocacy for health and social inclusion, -creation of workplaces for nurses and new profession of home-helpers/care assistants Results: In all six SRC partner countries, SRC and parners gathered their experiences: The health and social needs and type of services to be provided needs to be confirmed by in depth surveys/assessments and to be demand-driven, with user-and provider integration.
In all five countries, approx. 12'000 elderly, chronically ill persons are cared for by 60 home care centers[1] and authorities (local, national) are co-funding.
The existing legal framework is an important factor when considering sustainability issues.  In 2013, the SRC and partners established their knowledge management group with all six partner countries. The aim was to analyse different home care models and define core areas for cooperation. To learn from each other bears many advantages. Successes in one country encourage others to work and advocate for positive approaches. Exchange also involved peertrainings, peer-coaching and peer-reviews as well as peer-evaluations, mainly in 2015-2016.
Based on the exchange, once a year a meeting in one of the project countries including field visits and every 2nd month discussions in skype-meetings proved to be effective. Hence the SRC has a community of practice established for the knowledge-management group in Home Care, Active and Healthy Aging on its intranet. Uploading and screening of applications, reports, evaluations is a common practice nowadays in the network between the six countries.
In cost-efficient and effective care models for the growing parts of vulnerable populations not able to "pay-out-of pocket" and thus not having even access to basic services.
12'000 clients in 6 countries in 4 ½ years of work is a step forward in systems, that not think integrated and in interfaces and where health and social areas are strictly separated. Hence only in Moldova a small funding for "nurse led" home services are paid by the national Health Insurance Fund. In all other countries, either HIF is not existing (Semashko-system) or only Rutschmann; Care at home for elderly -lessons learnt from the Swiss Red Cross "Integrated Home Care" in Eastern Europe/CIS doctor-led services are funded and thus, changing of mind-sets in people and across the cultures is needed -behaviour change needs time. Nurse-led services present a change in paradigm in all these countries and cultures. Thus, social authorities and family doctors/general practicioners, Policlinics/hospitals, specialist doctors ought to be step-bystep taken on board as partners.
Not the competition on sometimes scarce funding in some countries should be the issue, but to build a case-and care-management and referral system. The aim is: The General Practitioners/Policlinics/Social Workers & the Home Care staff form one "Care" Team with one goal: to improve the health and well-being of the client; The information about the client is with all partners/stake-holders in the system (e.g. patient card); Functional up and down-referral system is developed within the state/public system Taking all in mind, we may even speak of a partial reform in "Primary health care/ Community health and social care". Before Governments are not ready to change for such new model scalability ought to be planned but the numbers of clients kept lower in order to not create new dependancies on external funding We know from "Community based home care provision" in Switzerland, Austria and Germany that for building such a service a minimum of 15-20 years of continuous processes is needed in a stable economic environment. Referenses: 1-By professional nurses, home helpers, care-assistants, volunteers.
Keywords: integrated care model; supporting carers; resilience/coping in old age; involving communities; older people's care in the home environment; promoting dignity and end of life