Guidance on caring for elderly relatives
A third of all Russian families have elderly relatives in need of constant care, numbering some 1.8 million people according to experts. How can limited mobility and seriously ill people be helped and what care options are available to families?
Most Russians take care of elderly relatives on their own. However, not everyone knows how to organise home care properly. Bodies that organise free training courses for families are stepping forward, e.g. the School of Home Care’s “Care and Attention” which was established on the initiative of the “Live now” and “Living” charities. Anyone can take part as no special education training is required. The course includes modules for dealing with home care processes, hygiene issues and toilet assistance. People will learn how to move a seriously ill person in a way that is safe both for them and their relative. The trainers cover new approaches for the treatment of wounds and pressure sores, as well as giving advice on how to organise an area around a seriously ill person in the home. All those taking part will receive a certificate for completing the course. You can register for the course by visiting the School’s website (http://www.allnurses.ru).
An elderly person’s relatives can access care advice by telephone, e-mail or online. Consultations are given by the home care provider “Compassion” which offers a visiting help service and teaches care techniques in the home. According to experts, two or three visits are usually sufficient to provide families with the basic care principles and how to organise the living area around a relative. As the head of home care services at “Compassion”, Alena Davydova, told ASI, care is provided not only in Moscow and the Moscow area but also in other far-flung regions.
“We help families assess their care environment, as well as advising them on which specialist to contact and on the type of care relatives would benefit from. One day, we received a call from a woman who was suffering from persistent back pain. She was looking after her mother and had wrenched her back. Colleagues suggested using sliding sheets that can be used to move patients which can either be rented or bought in shops. By the time the nurse arrived, the woman had already purchased the sheets which turned out to be very handy. After the nurse showed her how to sit correctly and to turn over her mother, her back felt much better”, said Davydova.
Training material for carers is available on “Compassion’s” website (https://patrdimitri.ru). You can also ask a question by telephone (499) 705-88-20, via e-mail to firstname.lastname@example.org, or by going directly to the service’s website in the pop-up window.
A care school for families who have relatives with dementia is held several times a year by the “Helping patients with Alzheimer’s disease and their families” NGO. The next school session will be held in May and registration is now open. Teachers in the school will explain the legal background to care provision, talk about care issues as well as Alzheimer’s and other forms of dementia.
Free schools for home care training are available in many Russian cities and are provided by medical institutions as well as NGOs and charities. Schools can be held in polyclinics, hospitals or medical colleges. Many specialist home care items for the elderly are available for rent, can be bought second-hand or obtained free of charge. One of the most important items is a functional bed which can cost anywhere between 20,000 and 100,000 roubles. There are a number of organisations that sell or rent rehabilitation aids, e.g. the Dobrota.ru network of medical stores. Dobrota.ru also runs a project to collect used medical products which can be passed on to those who need them. There are “Give a gift” stands in their salon shops in Moscow and St Petersburg which have wheelchairs, crutches, walking aids and medical beds.
Charities can also provide rental services. “We provide practical rehabilitation aids for those who are unable to obtain help from the State as not everyone is in a position to buy a functional bed or an anti-bedsore mattress straight away. We can set up a rental contract with a family member for six months and extend the term if necessary. Functional beds, wheelchairs, crutches and walking sticks have been donated to us. More than 250 people receive home care and medical equipment every year”, said Davydova.
Rented technical rehabilitation aids are also provided by population social service centres at a person’s place of residence.
Finding a care assistant
Caring for an elderly relative creates increased emotional and physical stress, tension and fatigue. If you feel you’re struggling, there is always the option of sharing responsibility with other relatives, applying to social services or trying to find a nurse. It’s worth mentioning that industry professionals don’t really like the word “nurse”, preferring to refer to them as “care assistants”.
Not choosing the right nurse worries a lot of people. Experts say there are several ways of finding someone suitable. The first is to look for personal recommendations. There are social network groups, websites and fora where people share their experiences and pass nurses on “from one person to another”. The second is through home care services and agencies which in effect perform the role of a recruiting agent for care assistants. The agency receives money for selecting a person and is responsible for them, as well as ensuring that nurses have the necessary qualifications. Speaking about what a nurse should be and what to look for, Alexei Sabadash, co-founder of the “Home Care” Association, said that he or she should be someone of high moral principles.
“Humanity is one of the most basic human qualities any nurse should have. The person should be physically strong, probably between 35-45 years of age. A nurse must, of course, have the necessary professional skills for caring for sick patients, including feeding and moving people, hygiene and rehabilitation work. Those with a medical background are considered good care assistants. A nurse should also have named references to vouch for their work”, said Sabadash to the ASI.
The Association is currently developing a project called “Poisksidelki.rf” (Searchforanurse.rf). This will be an information site that gathers data on all the nurses, as well as offering help in looking for care assistants.
Reputable agencies will be able to find care assistants (nurses) who have been working in the market for more than seven years and are Association members. The list can be found on http://www.patronage.ru.
Bring in a social worker
A person is entitled to social help if they have completely or partially lost the ability to move independently or are unable to have the basic life requirements. Services are provided by population social service centres or NGOs listed on the State’s register of social service providers. Receiving these services will involve applying to social protection authorities or the multi-functional centre for State service provision and providing the required set of documents, in particular medical history extracts, proof of family background, pension size, disability and a relative’s place of residence. Decisions on whether such services will be approved will be made within five working days from the application date.
A list of services is selected on an individual basis in accordance with Federal Law No.442 on “Basic Social Service Provision for Citizens in the Russian Federation”. An individual’s programme can include purchase and delivery of food, help with cooking and cleaning around the house, as well as hygiene and sanitary procedures, first-aid provision and ensuring that doctor’s advice is followed.
Choosing an old people’s home for the elderly
Surveys show that 90% of those in need of constant care for the rest of their lives would prefer to stay in their own home. However, a person in the latter stages of dementia requires specialist medical care.
According to the non-profit partnership “The World of the Older Generation”, demand for accommodation in specialist facilities is around 630,000 Russians. It’s worth remembering there are State and private institutions that cater for the elderly which have paid or subsidised places available. In order to obtain a voucher to stay in a residential home, a range of documents needs to be assembled.
“The documents required for both State and private institutions are practically the same. Free places are available in private facilities, provided the care provider is listed on the State register. Clients say that private institutions explain fully what is required for the placement of a relative, that they help with medical assessments and that Senior Group centres will carry out free and comprehensive geriatric evaluations. Being admitted to a private institution on a quota or subsidy basis is more difficult. That is not to say that these places don’t want to accept people, it’s just the journey to get there is more complicated. At the same time, there are private boarding houses which accept people more quickly and help in putting together the necessary documentation”, said Alexei Sidnev, Chair of the Board of the “World of the Older Generation”.
According to Sidnev, families won’t have to wait for months to get their relatives into Senior Group boarding houses as an elderly person’s condition will only worsen without proper medical care. In order to save time, they are prepared to accept an elderly person straight away with a future subsidy only taking effect from the person’s first day at the centre.
“The list of documents includes a certificate of a person’s state of health, family history and income, assessment results and confirmation from a medical panel that there’s no reason why an elderly person shouldn’t be placed in a residential facility. Documentation should be sent to the social services department at their place of residence which is then forwarded to the Department of Social Protection for evaluation by the relevant panel prior to a decision on whether a voucher should be issued”, said Ramaz Akhmeteli, Director General of the “Yellow Cross” company and Board member of the “World of the Older Generation”.
In-patient social services are provided on a contractual basis involving payment of no more than 75% of the pension amount. For some citizen categories, e.g. the disabled and Second World War veterans, services are subsidised in full by the State.
Choosing long-term care for an elderly person is no easy decision. The “World of the Older Generation” has compiled a check list of criteria (https://www.seniorgroup.ru) which families should consider when looking around an institution, including adequate fire safety provisions, building adaptability, staff qualifications, quality of care, medical provision and respect for patient dignity. In particular, it’s worth checking whether the employees have a relaxed and dedicated attitude to their work (speak to the senior nurse, the head of the institution and the carers; ask where the staff live and about their work schedule; ensure staff don’t spend the night with residents and that they don’t work all day long).
Immobile elderly people still have to be dressed, have their hair combed and should have an opportunity to take part in social activities in the common room as socialisation among the elderly is extremely important. Eating in bed, lack of exercise and a pastime reduce life expectancy and quality of life. Ask what documentation is kept, whether progress of elderly people is monitored and where such data are held.
“Alarm bells should start ringing if you are told that an elderly person with dementia doesn’t need a toilet or shower in their room. This most likely means that there is no respect for a patient’s human dignity and that elderly people are wearing a nappy even though they can still control their bladder. Remember, there should always be a toilet and shower in the bedroom”, says the check list.
When there’s an elderly person in the family in need of special care, it’s not so much the medical assistance but comfort and companionship that matters. Make sure your grandmother’s or grandfather’s home and room is as comfortable as possible and surround them with their favourite things. Don’t lose touch with them even though you may be far away. Give them a ring and let them know what you’re up to, as well as going to visit them.