Transcript Lucia Carragher

MS CARRAGHER:  So as Alison said I work in the Netwellcasala centre in the school of health and science in DKIT, the focus of our work is a bit different to what you've been hearing about today, the focus of our work is on older people trying to support independent living and support a quality of life for older people, how to ensure that services are integrated for older people in the community, more sustainable home and neighbourhood design, in its broadest sense, so that's not just physical sustainability, but social sustainability as well.  And we're also heavily involved in the development of age friendly technologies.

I suppose the context of our work is the shifting demographics towards a growing older population, we're all aware of population ageing in Europe, it's constantly on the news and it's fragmented, it's happening at different speeds in different countries, but in all countries across Europe and indeed in all developed countries, it's accelerating.  So in some countries like Germany, Italy and Greece I think about 20% of their population we're already seeing them comprising people over 65, while in other countries, a small group of other countries including Ireland we have still a relatively young population.

But while population ageing is something which increasing longevity and we want to celebrate that yes, it's good news, it does, it is associated with impairments, with physical impairment, with mental impairments, mental conditions that present challenges for services.

About one third of people over 65 in Ireland have some form of a disability and then obviously this increases in the over 80 population known as the oldest old.  So for very obvious reasons the thrust of policy is increasingly focused on this concept of positive ageing and active ageing, to support greater levels of independence and reduce the need for formal services.

And I suppose that's kind of where the Netwell centre is positioned.  The services are for older people in the community, increasingly they are fragmented and very much focused on institutional care first and foremost, that's always a relatively easy option, and very much episode all care and siloed pathways into primary care, into social care and into hospital care, so that real barrier being the fragmentation of services and that's really where the Netwellcasala centre is positioned addressing fragmentation services for older people, living in the community.

As a research centre, because we adopted a fairly flexible approach, it took us in all sorts of directions over the past ten years since we have been established, in directions we actually hadn't planned on going.

So for transforming services for older people, requires a shift from a system which is very often crisis driven, which is focused on health rather than on a social model, and so that shift ‑‑ to transform the services requires a shift to the centre if you like, to putting the person at the centre, to focusing around their needs, working with the family, working with the person, working with the community, and developing a whole range of services and supports that address the full and comprehensive changing needs of a person as they age.

So at heart of this approach is a preventive approach and an early intervention approach and that's really working very well for the Netwell centre across County Louth for the past ten years.

I borrowed this slide from John Baird because I think in a simple way it encapsulates some of the big society changes that are happening and it challenges us to think about these changes in the context of a growing older population and how we think about the different phases of our life and how we tend to put them into compartments.

So John Beard talked about, would argue that technological advances combined with a growing public appetite for personal growth and also on top of that challenges, lifestyle challenges at all ages, he would argue has rendered obsolete the linear paradigm in which people progressed, first through learning, then through work and into leisure and retirement.

And he would say that in its place we have a new paradigm emerging in which these phases of life learning, work and education are inter‑dispersed across the lifespan, repeated over and over again rather than you no longer have set periods for education, for production, for work and for leisure.

So he would say that people in the future, 50 year olds it will be commonplace for them to return to education, 60 year olds it will be commonplace for them to fall in love, 70 and 80 year olds to re‑invent themselves through new careers, so he would say rather than saving up leisure and retirement for the end of our life, it will be regular breaks will become common across people's lifespan for these periods of re‑invention and for a new career.

So retirement, flexible working, part‑time working, all of these will be viable options for mature adults in order for them to have new careers.  He would say that rather than us focusing on these old ways, what we really need to do is we need to encourage lifelong learning and to facilitate people to have different careers and we need to focus on how we'll move some barriers, in terms of ageing, to people to age in their own home and in their own community, and eliminate age discrimination.

We are involved in a lot of housing services and a housing project as well.  But the service I chose to speak about today, I think it's ‑‑ I chose it because for me it's what supportive community is all about in relation to older people and we call it Cultaca service for older people, that's an Irish word for strong support, it's a dedicated service for older people that's very flexible and respond to their needs.

It works with the older person, starts out in home visits, very regular home visits to the older person, working with services, working with the health service, connecting them to a service, in much the same way in some respects as service brokerage, brokering access to services like housing, NGOs sector, really whatever needs the person has.

But while I say it's like a service broker, it differs from a service broker in one important way, which I think makes it very unique.  A service broker simply brokers access to existing services, so if the service is not there then they move on and that's another service and that just has to fit, but the Cultaca service works with the community because we know that very often some of the services that are most important for people's quality of life are not necessarily readily available or accessible to older people and not necessarily prioritised in funding streams.

We know that for example active retirement groups are not necessarily a welcoming place for less abled older people.  Alzheimers daycare centres require participants to have a diagnosis of dementia before they can attend and we know that takes a long time very often to get a diagnosis, so older people living with memory loss, with dementia and not able to access a service, which they actually need, and need in the early stages as well.

We know that for some older people the person they see most regularly is perhaps their homecare worker and care workers are increasingly task orientated with little time for social contact.  So these were very real barriers to service integration and quality of life and to ageing in place that the Cultaca identified from an early stage, and because we were a research centre and because we were flexible, because we have capacity and researchers to look for funding streams, to support the ideas and the challenges that the Cultaca encountered in the community, that took us in directions that we hadn't actually envisaged at the start of the project.

So over the years the Cultaca has developed a whole range of services working with the community and developed them with little or no resources in some instances.

So for example they have social groups and these social groups were responding to the limited access by some older people to some of the existing social groups that were in the community, and they were really targeted at more active older people, so they developed lots of social groups.  And now we'll see right across the ‑‑ certainly across Dundalk is that there's no problem with accessing any groups anymore, it's like a monopoly has almost been broken.

They have a good morning service that stretches across the country that connects older people and one of the speakers earlier on talked about connecting to communities, that connects them at one level is just a social chat, but within that social chat they always feed in ‑‑ and it's run by volunteers, they feed in key pieces of information to the older people and the volunteers that run that service were recruited by the Cultaca as well.

And these social home visits are reserved for the most vulnerable older people who tend to be house‑bound and that's a way of maintaining after the Cultaca has finished their work essentially and dealt with a range of issues of what the issues are in the home, they maintain a presence by the volunteer social home visit and they are able to go back in, when the need comes for them that they need more expertise than a volunteer.  So the volunteers, at the moment there are 50 volunteers providing social home visits they are recruited by the Cultaca, Garda vetted, trained and matched depending on the needs and interests and the interests of the older person.

They have three men's sheds across County Louth for the more active older men who can work on lots of meaningful projects, with other men in their own time and in their own space as such.

They have a home respite project for people with family looking after someone with dementia and they have access to the care and repair and technologies.

Up on top you have the existing services that, the more formal services feeding in and underneath you, you have all these community services that support older people, that support all the different ranges of needs and complexities over time.

So referrals to the service come from a whole range of sources and I'm sorry the text on this is quite small, but I still couldn't fit in all the sources of referrals, they come from, in some instances from the Cultaca themselves from the work they do in the community, they are very familiar with the communities at this stage, every day they are out and about.

Some come from the family and also from self referrals over the years, older people have got to know the service and to know how to access it.  We get quite a few referrals from HSE, Public Health Nurses, from the Guards, their work in the community as well, from a whole range of sources.  So when we get a referral we make a home visit, this is where we begin to develop the relationship of trust with the older person.  So working very closely with them, identifying their, what it is that they want, because you can go into a home that you think that you know exactly what's needed, but that might not be what the person wants, and they certainly mightn't want that immediately.

I was with one of the Cultaca last week and did a home visit, this particular home visit, the house was in complete squalor and the person wasn't interested in the squalor, first and foremost they had an issue with the telephone and they wanted it disconnected.  That was the issue first and foremost and yet there was complete squalor right around them.  So there's a range of issues they deal with.

They work their way through the issues with the person, they are never really off their books as such.  It's not a case that you don't see the older person again, sometimes it's a matter of time, if the person, if it's relatively straightforward and simple, it's always deal with practical issues first and then when the practical issues are dealt with they deal with the social issues and make a range of referrals to services, so that might be to a Public Health Nurse, to OT or physio, supporting the person to complete application forms, that's a big thing, access to information and interpreting information and understanding what's being asked for and sometimes the same piece of information asked for in ten different ways on one application form.  So supporting them to access grants and sometimes it's just a volunteer home visit that the person needs, or access to some of the social groups that they have developed in the community.

I think I'll skip on this one, I'll go to the next one because I think it's the same.  At the moment in terms of numbers, the Cultaca, it's a little more than that number, they have almost 1,100 older people on their books.  There is two people employed to work in the community, they have 50 volunteers doing the social home visits every week, we have a very low turnover of volunteers, we source our volunteers ourselves, we don't go through the volunteer centre, we find it works really well, just word of mouth and we would have some of our volunteers with us from the very start.

They have a person now, a coordinator on the social groups, which is great, that has taken a lot of work off, there are five volunteers that work with the coordinators of social groups, so they have 40 events in the year in which they take older people away, not just from their own social groups, they take them from other social groups, active retirement are all very welcome as well and from nursing homes as well, so they communicate regularly with all the nursing homes, so we have a wide spectrum of abilities and of interests at the outings.

They have the good morning service, which is run by volunteers, similar number of volunteers working on shifts on that service and they have 380 older people getting regular calls.  They have three men's sheds and that's 175 men, but that's men that are actually coming, there are more men on the database than that because I was looking at it last week, but each week they have 175 older men.

And the idea is we support them, because we have people that come to the centre to hear about the work we're doing, that come to listen to different aspects of the work and older men seem to be a big interest for some reason recently.  I say don't just go off and develop a men's shed because you're going to take vulnerable older men at a difficult life transition and give them a wonderful experience, but what happens when they're into the next stage and not as able for the shed anymore.  You need to think about that, about the services that they can access after that.  So it needs to be a continuum of services.

So that's there almost 11,000 clients, a growth of about 120 older people ever year.  They would have of those probably around 80 of them are very frail, 20 at the moment are diagnosed with dementia and we would work closely with families in relation to dementia education.

I suppose dementia is one of those illnesses, if you have any other major illness, if you have cancer or you know if you go to your consultant you know exactly what to expect and you know where to go for help, you have a clear pathway, but dementia is one of those illnesses that you can leave your consultant and not know how, the behaviour changes to expect or how to respond to those behaviour changes.

So we have families coming to us for support in terms of how to support someone to live with dementia, so we work very closely, we developed a training programme for families and we go through it, depending on what, the type of dementia that the person is dealing with, and depending on the stages and we break it into stage specific care.

So families now feel more supported, they now know what to expect and again that's something that's responded all the time to the needs, it grew the need of the community, and it responds in terms of what it is that they need.  So that's it, thank you for coming along to the session.