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Supporting elderly care givers in sparsley populated areas
Association of Local Authorities in the County of Västernorrland
Sweden

The Problem

Problem:
Most of the county of Vasternorrland is countryside, with a few small villages, and mostly sparsely populated areas. A great part of the elderly population live alone or together with a spouse, in the countryside, far from towns and services provided by the local authorities. Many of the elderly live together with a spouse who needs 24 hour care. The number of elderly in need of care is increasing and at the same time availability of nursing homes is decreasing.

Most of these elderly people have a desire to live in their own home as long as possible, and that is also an expectation from society. The problem is to reach family caregivers in sparsely populated areas, and offer them good, flexible and interactive caregiver support.

Being a caregiver is a difficult task that often leads to isolation and loneliness which has negative affects of health and quality of life of the care giver. Health professionals have advanced education but the family caregivers are doing the same job as the professionals, but without specific knowledge. Depression and other health problems are common among informal care givers.

The authorities have several programs to support caregivers as they provide 70% of all the care given to elderly living at home. The elderly in sparsely populated areas are not able to benefit from this support due to the geographical distances. Recruiting health care professionals in rural areas is difficult, due to that the number of habitants is decreasing because many persons moving out of the area.

The future elderly care is therefore highly dependent on the efforts of family care givers.

Solution and Key Benefits

 What is the initiative about? (the solution)
Key benfits:

Aim for the project is to reach family caregivers in sparsely populated areas, and offer
them good, flexible and interactive caregiver support. ICT (Information and Communication Technology) is used in order to bridge the geographical gap. ICT as a tool is usually not used for this target group but as this particular tool it is specially designed and adapted for elderly peoples needs, they have no problem learning to use it.

It is a matter of justice that elderly people living isolated in the countryside also should be able to take part in social activities, using modern technology and service.

The project is still ongoing and data is currently being collected, therefore we will present the benefits expected due to the data collected so far. The impact is being measured using both quantitative and qualitative methods. Questionnaires, which have been validity and reliability tested, are being used as well as semi-structured interviews.

Giving the target group access to care giver support by using ICT as a tool has opened up a new world to them and has provided them with several benefits such as
increased health and quality of life of family care givers. The negative aspects of care giving such as isolation and loneliness will decrease due to new social networks developed during this intervention. Access to videophone and specific educational programs have opened up new possibilities. For example having social interaction with fellow caregivers, being able to share experiences and making friends has been proved to improve the quality of life. Being able to take part in education regarding the disease of the spouse, receiving advice on how to cope with care giver matters and communicating with health professionals gives security and improves quality of care giving.

Care givers with social net work and good knowledge about their care giving situation will maintain their care giving role for longer time which means that the ill spouse will be able to live in his/her home environment for longer time. The need for nursing home placement will be postponed or not necessary at all.

Better health for care giver as well as the person being cared for enables improved quality of life for both of them.

Actors and Stakeholders

 Who proposed the solution, who implemented it and who were the stakeholders?
The project is a co-operation among five local authorities in Vasternorrland county and the Head Office of the Association of Local Authorities of the Region of Vasternorrland, Sweden. The project was initiated by the regional care giver consultant in co-operation with the regional social care counselor. After proposing the idea to the local head of social departments, the local authorities decided to co-finance a project and provide staff recourses in order to make it possible for their elderly citizens to use this new kind of support service.

The project is partly funded by the Swedish Institute of Assistive Technology and the Telia Sonera, a telecom company.

(a) Strategies

 Describe how and when the initiative was implemented by answering these questions
 a.      What were the strategies used to implement the initiative? In no more than 500 words, provide a summary of the main objectives and strategies of the initiative, how they were established and by whom.
Strategy:
The initiative was deeply rooted and approved through out the different leves of local governments and service departments. Politicians, Heads of departments and Clinical workers and Care giver consultants all participated in the process.

(b) Implementation

 b.      What were the key development and implementation steps and the chronology? No more than 500 words
Key development and implemnetaion:
Development and implementation steps:
The initiative was initially taken by Care giver consultants who provided support services for elderly care givers. In order to make a project come to life it hade to be taken through different steps of the democratic structures.
1. The initiative was presented for the Social Boards.
2. The initiative was approved by Politicians.
3. Presentation and approval from Heads of Departments.
4. Preparations among care giver consultants and clinic workers; organization, education and obtaining special designed ICT-equipment.
5. Information to target group, elderly care givers in sparsely populated areas.
6. Recruiting participants according to given inclusion criteria.
7. Education of participants.
8. Installing ICT- equipment in the participants homes.
9. Continues support given to participants by care givers consultants and clinic workers.
10. Continuous follow up and evaluation.
11. On going activities.

(c) Overcoming Obstacles

 c.      What were the main obstacles encountered? How were they overcome? No more than 500 words
Obstacles:
The main obstacle was that the geographic area was said to have appropriate broad band coverage. But due to the fact that there were different telecom companies having contracts on supply, with different broad band solutions, problems occurred when trying to install the ICT- equipment. A larger area than expected, did not have appropriate broad band system, therefore recruiting participants took longer time than expected as broad band coverage needed to be secured. After adjusting the technical equipment solutions could be found in most cases.

(d) Use of Resources

 d.      What resources were used for the initiative and what were its key benefits? In no more than 500 words, specify what were the financial, technical and human resources’ costs associated with this initiative. Describe how resources were mobilized
Recourses used for three years 2007-2009:
Financial:
Technical Equipment & software 2.905.200 SEK ($363.150)
Staffing costs:
193.680 SEK ($ 24.210)
Project management and evaluation:
1.512.000 SEK ($ 189.000)
Total:
4.610.888 SEK ($ 576.361)

Sustainability and Transferability

  Is the initiative sustainable and transferable?
Yes.
The sustainability is secured by the fact that any user can use this service as long as they have broad band and the special designed soft ware. This opens up for eligibility for both elderly care givers as wells as health care providers.
This initiative is also being used in a few Swedish cities where users have pointed out how valuable it has been to make new friends on this secure internet platform. One of the high lights is to also be able to meet them in real life, for example at a café.
Persons in sparsely populated areas are not able to meet in real life due to the geographic distances but appreciate the possibility of making friends and meeting them visually through the computer and the web camera.

This initiative also opens up for the possibility of making new friends in other countries. The only “equipment” necessary is to have the appropriate broad band, the software and get access to the secure platform. So we see no limitation in replicating the initiative all over the world. However security is though essential, and the regional support service provider guarantee through personal knowledge of the users, that the platform is used for its purpose and not being improperly used.

Lessons Learned

 What are the impact of your initiative and the lessons learned?
Impact and lessons learn:
The initiative opens up the possibility of a social life for elderly care givers. It prevents loneliness, feelings of being part of society and sharing experiences, are important factors for health and quality of life. Even the people who took this initiative were overwhelmed when realizing what a big difference in the care givers every day life this support service made. The positive impact has been greater that anybody dared to hope for!

There is a prejudice in society that elderly people do not want to use ICT and that it is difficult for them to learn how to use it. Our experience, so far, is that they think it is a lot of fun and not that difficult. However receiving technical education and technical support is essential.

Contact Information

Institution Name:   Association of Local Authorities in the County of Västernorrland
Institution Type:   Government Agency  
Contact Person:   Gunhild Nyberg
Title:   Project Manager  
Telephone/ Fax:   +46-611-55 78 55
Institution's / Project's Website:   +46-611-231 39
E-mail:   gunhild.nyberg@y.komforb.se  
Address:   Gånsviksvägen 4
Postal Code:   871 03
City:   Härnösand
State/Province:   County of Västernorrland
Country:   Sweden

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