| 4. In which ways is the initiative creative and innovative?
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The GAPP comprises two major components in order to fulfil its objectives. The first is a training component where young persons between the ages of 18-30 are tutored in the areas of geriatric care, food and nutrition, life skills and literacy. The training is divided into a level I which is a basic programme and a level II which is a more advanced programme. The graduates of the training are thereafter invited to serve as caregivers in the second component of the GAPP which is care giving. Elderly persons who have been affected by infirmity, disease, disability and deteriorating health and whose financial and socio-economic condition may not allow them access to private medical support, are provided with the services of a caregivers. As such, the GAPP trains young persons to take care of the elderly, meeting the needs of two major sectors of the society. Skill training and part-time employment is provided to the youth (18-30) whilst the geriatric needs of the ageing population is serviced.
The objectives of the GAPP are as follows:
• Develop a sense of self-worth and discipline among young men and women;
• Develop caring skills in young people;
• Foster national consciousness among the nation’s adolescents;
• Bridge the gap between young persons and senior citizens, thereby allowing for more effective interaction and support;
• Improve social interaction between young persons and older people;
• Show appreciation and respect for appropriate work ethics within the care industry;
• Demonstrate improved communication skills with co-workers and significant others.
The GAPP was developed with the main objectives of bridging the gap between young persons and senior citizens, developing skills and discipline among young men and women, emphasizing the importance of work ethics and fostering national consciousness.
The initiative is a multidimensional programme with two main components.
1. The first component includes facilitating training for young individuals during two cycles at various centres throughout the country. The first cycle is Level I (conducted over a 14-week period) which equips individuals between the ages of seventeen (17) to twenty five (25) years with the basic knowledge and skills in geriatric care. Level II (conducted over a 16-week period) comprises more advanced training for individuals between eighteen (18) to thirty (30) years who have completed the first cycle or have acquired the relevant qualifications.
2. The second component involves placing trainees who have completed Level II as caregivers with elderly clients in order to apply their skills learnt and improve the quality of life of the elderly.
Multiple surveys were conducted with trainees and staff to gather feedback on the achievements of the programme objectives. Continuous centre visits and formal and informal interviews with trainees and staff also contributed to the programme evaluations. In 2012, an overall assessment of the entire programme was undertaken using both qualitative and quantitative methodologies which involved analysing secondary data, conducting in-depth interviews, focus groups, field surveys and telephone surveys. The sample groups evaluated included current trainees, former trainees, teaching staff, administrative staff, caregivers and elderly clients. The results of the assessment allowed for the formulation of short, medium and long term recommendations to enhance the quality of the programme.
The findings of the assessment revealed that trainees expressed high satisfaction levels with the content of the programme and felt that the programme allowed them to enhance their personal development. Many trainees felt that they were more hardworking (96%), took more initiative (96%), were more attentive (94%), better disciplined (93%), and more punctual (92%).
With regards to Caregivers, the majority (70%) indicated they wanted to continue in the area of geriatric care of nursing. Overall, elderly clients expressed satisfaction with the services received and felt that the caregivers were adequately trained (93%) to assist them. Most clients developed friendships with their caregivers (95%) and stated their daily routine and activities were much easier (95%).
Furthermore, over the last three (3) years, the programme had over six hundred (600) graduates, with one hundred and ninety six (196) graduating from Level I in 2013, one hundred and sixty eight (168) graduates of Level II in 2012 and two hundred and forty nine (249) trainees graduated from Level I in 2011.
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| 5. Who implemented the initiative and what is the size of the population affected by this initiative?
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The programme was designed and is currently implemented by the Ministry of Community Development. The administration and monitoring of the GAPP is undertaken by the Planning and Implementation Unit of the Ministry and the Director of the Unit is responsible for overseeing the overall management and monitoring of the programme and reports to the Permanent Secretary. The Research Specialist and Monitoring and Evaluation Specialist assist the Director and also collaborate on conducting regular evaluations and assessments in order to continuously improve the programme.
The organization of Level I, Level II training and placement of caregivers with clients are conducted by the GAPP Office which comprises the National Coordinator, Regional Coordinators and Field Assessment Officers, Operations Officer and Clerical staff. The training centres for Levels I and II are managed by Centre Coordinators who are responsible for supervising overall administration and training done by tutors and tutor assistants.
Further, private nursing facilities/homes for the elderly are also involved as participants are assigned to these facilities for the conduct of the practical aspects of the training.
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| 6. How was the strategy implemented and what resources were mobilized?
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The GAPP is an extremely large programme in terms of financial cost and human resource. In fiscal 2013, GAPP cost the State TT$22 million to undertake training and pay caregivers. The training includes the issuance of stipends to trainees, centre co-ordinators, administrative assistants, tutors, tutor assistants and facilitators for a period of thirty (30) weeks every year. Funding is also expended for advertising, team development activities, training material and stationery as well as equipment for the centres. The training is undertaken in community centres across the country. These centres were constructed by the MOCD but are maintained and managed by the respective communities.
The programme staff of the GAPP is also sizeable and includes, a National Coordinator, Operations Officer, Regional Coordinators (4), Placement Officers (2), administrative, clerical staff and drivers (2).The GAPP reports to the Planning and Implementation Unit of the MOCD, which provides the technical support in terms of research, monitoring and evaluation as well as strategic planning.
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| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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• Strong commitment to and understanding of the programme from all the main stakeholders involved, including the Executive of the Ministry of Community Development, the programme staff and axillary personnel;
• The highly commendable work of the caregivers have allowed the reputation of the programme to be enhanced through word-of-mouth;
• The continued financial support from Government given the positive outcomes of the programme;
• The continuity of programme staff which has improved the administration of the programme through strong institutional memory;
• Introduction of new methods of administration in an effort to continue trying to always improve the programme.
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| 8. What were the most successful outputs and why was the initiative effective?
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Since its operationalization, only one comprehensive evaluation exercise of the programme was undertaken in 2000. With the advent of a new national administration, a second evaluation was conducted in 2012. Based on these results, numerous recommendations have since been implemented, including the development of a draft policy governing the administration of the programme. In addition, the programme is also monitored vis-a-vis the conduct of training cycles. For example, in 2012, there were start- and end-cycle assessments which have now been institutionalised. Consequently, the conduct of all cycles is now monitored on an annual basis.
Further, a caregiver and client census is planned for 2014. Another full-scale evaluation is planned for 2015.
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| 9. What were the main obstacles encountered and how were they overcome?
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There were several obstacles encountered at every stage of development as expected with 600 caregivers employed as service providers, 600 clients being serviced and over 300 trainees graduating each year and an annual programme expenditure of over TT$20 million. These include, among others, the lack of proper recruitment, late delivery of supplies to training centres, late payment of stipend to trainees, caregivers and centre staff and non-performance of duties by caregivers in some cases.
Over the years, trainees, caregivers and centre staff have managed to enter the programme without having the requisite qualification and/or experience. In the case of trainees, this has frequently resulted in slow progress through the curriculum whilst with caregivers, many personnel issues have emerged. In an attempt to deal with this issue, the criteria for eligibility has been reviewed and hence is more streamlined, targeted and specific. Additionally, a more suitably comprised recruitment committee has been set up to evaluate applications and interview candidates. This will provide the necessary check and balance for recruitment and selection.
The delay in the delivery of necessary resources to trainees is also an obstacle. This creates a stressful environment for trainees as the time frame remains set and the curriculum must be adhered to despite the late delivery of material. GAPP, in conjunction with the PIU is developing a processing mapping exercise for each level of the training. Each stage of the training from advertising to course assessment would be guided by a rigid time frame, the resources needed and the person(s) responsible. Adherence to the timeline would ensure that the course material is timely and trainees can focus on learning.
A perennial problem for caregivers, trainees and centre staff is the late payment of stipends. Stipends are often received an average of two months late and in some cases, at an even later date. The GAPP has sought to streamline the accounting process to reduce the amount of time between the submission of pay sheets and printing of the cheques. All trainees, centre staff and caregivers have also been briefed on expected time of payment as the processing of stipends can only begin after a month’s work has been completed.
Over time, many issues have arisen with caregivers such as tardiness, absenteeism, reports of abuse of the elderly and poor/non-performance of duties. Further, clients have also requested caregivers’ assistance in performing duties which are entirely outside of their scope of works. These have largely resulted due to the lack of legal agreements between the caregivers and the MOCD. Steps have been made by the PIU in conjunction with the Legal Department to ensure that agreements are put in place to protect the interests of all parties involved. The agreements would specify the work schedule in terms of days and time, entitlements and non-entitlements as well as the duties and responsibilities of the caregivers and clients. These legal agreements would standardize the work of the caregivers, remove ambiguity and help serve the clients more efficiently.
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