EU Network Meeting on Elderly Care

9^th October 2009, Zurich

Elderly Helpline as social support and link between home care services and residential care: The Annousakeio Therapeutic Centre’s example.

Elina Petraki, Psychologist

Elderly Helpline Coordinator, Annousakeio Therapy Centre

SUMMARY

A brief summary of the Helplines which exist worldwide and serve the elderly needs will be introduced, explaining the reasons for their existence. The specific questions which were posed during the operation time of the helpline were: (a) what kind of problems do callers present? and (b) what kind of help do callers request? Moreover, it is intended to give the targets that a Greek Elderly Helpline sets in order to provide the help which is crucial for the Greek callers. The coordination between the home care service and the elderly that live at home is made easier through the 24hour operating Helpline. Furthermore, Annousakeio’s Elderly Helpline receives calls from people who would like to receive information about living in the Centre. After their relocation to the Annousakeio Centre our aim is to help them keep in touch with their relatives and provide them with sufficient counselling. In conclusion, telephone contact can provide a number of advantages and limitations and these will be discussed through everyday examples and presentation of statistical data explaining all possible ways of improving an old person’s life via a telephone call.

A. INTRODUCTION

1. Background

Some years ago, in addition to many other health problems giagia (grandma) Argentini had also lost her vision. This didn’t stop her from weaving and feeding herself whilst living at her son’s home. Every evening after 8 o’ clock she went into her room, listened to chanting of psalms on the radio and talking to her friends on the telephone till late at night.

When her health condition worsened, her son decided to bring her to the Annousakeio Centre, to live there with the necessary care of the medical and nursing staff. Even at the Annousakeio, she still called her friends and they talked about the everyday things in their lives.

The story of giagia Argentini inspired her son to found a helpline to provide the elderly with someone willing to listen to them, to discuss their problems, to keep them company, to offer support; and someone who could alleviate their loneliness, depression, grieving and the feeling of uselessness.

The son of giagia Argentini is the Director of the Annousakeio Therapy Centre, the Reverend Antonios Aretakis. Although his mother is no longer with us his idea became a reality and now plays an important role in providing counseling via telephone and also supports and links the home care and residential care that Annousakeio offers.

2. The problem in Greece

During the last forty years, the proportion of elderly people in the Greek population has doubled. In 2008 people over 65 years old represented 19% of the population.

In our community many elderly people can’t get out of their house for various reasons. They have many and variable needs that are recurring continuously resulting in frequent admissions to hospitals. Their discharge from the nursing institutions continues a cycle that shifts important practical and psychosocial pressures on their relatives. The monthly income of many elderly people is not sufficient for their medicines; special diets and equipment that can help them keep mobile and independent. Very often, elderly people are being treated as a nuisance and not valuable resulting in their direct or indirect social isolation. These circumstances tend to produce inflexibility, making them circumspect rather than adoptive toward any new idea, relationship or routine. In fact, the disease rate associated with the social problems they face leads them to a general psychological and mental deterioration and to the shaping of an unusual psyche, which in its turn limits the possibilities of breaking the cycle.

Today, the most important social problems the elderly have to face are related to: a) finance, b) residence and environment, c) independence, d) communication and entertainment.

3. Annousakeio foundation & Operation of Greek Elderly Helpline

Annousakeio was founded in 1970 aiming to offer care to those elderly or disabled who are financially or socially frail and are not able to care for themselves. Since its foundation Annousakeio has extended its care and has become an important social institution for the surrounding region and in 1995 was inaugurated as a modern centre having both residential and outreach facilities, including four Physiotherapy Centres and two Home Care Teams.

4. Annousakeio as an Institution

Residential care at Annousakeio is the safety net providing protective measures for the elderly when appropriate family environment is lacking. The existing social services or relatives can decide when residential care becomes the only option. From 2008 a special wing has existed in order to accept elderly couples or relatives who can live independently in a protective environment.

5. Helplines by Subject - Worldwide

Helplines have become an established component of many social services. Their popularity stems from the helplines’ accessibility, an increased willingness of people to seek help in time of stress, declining opportunities for intimate relationships, and, as some suggest, a preference for a “quick fix” over traditional therapies. A study in 1998 suggested that the increase of helplines is attributed to the weakening of traditional sources of social support – the family, church and community. Several studies have suggested that most callers seek first social support from the helplines. Other research has included informational and emotional support (Lazar & Erera, 1998).

However, information on how these helplines operate in actual practice is not often readily available.

Helplines by Subject - Worldwide

6. Helplines in Greece

The following table presents the most popular Helplines in Greece. Unfortunately, there is no available statistical data concerning their progress.

Popular Helplines in Greece

6.1 Annousakeio Elderly Helpline

The Annousakeio Elderly Helpline is an increasingly popular telephone service that provides Greeks (at minimal call rate) with services that include: counseling, companionship, insurance related & current legislation information, reference to other services, information and arrangements about home care services and arrangements about staying in Annousakeio when required. The helpline is promoted in the Chania municipality by media campaigns, health care providers and local press. The helpline operates weekday evenings. Messages can be left 24 hours a day and staff will respond as soon as possible.

Through the helpline:

• Counselling via telephone is given.

We listen and offer encouragement responding to everyone.

Lonely or isolated individuals have the chance to talk about their problems.

We show respect for their personality, their individuality and their needs.

• Home care services are supported and coordinated.
• Face to face counseling is arranged for those who prefer personal contact at the Centre.
  
• Primary health prevention is promoted (e.g. the encouragement to stop smoking, the vaccination of the vulnerable population).
• The elderly, their families or members of the community are informed about the available social and other services.
• Articles are published through the local press.
• Our basic aim is to make the caller feel better after talking with us.

Continuing support, education and development for our staff is offered.

6.2 Advantages of the Helpline

Telephone contact can provide a number of advantages.

a. Accessibility: Elderly persons have access via a telephone line.

b. Ease: Those who have physical disabilities don’t need to move in order to find someone that can listen to them.

c. Trust: Issues such as social criticism or the difficulty in setting an appointment does not exist in this kind of communication.

d. Effectiveness: The telephone contact can also be effective.

6.3 Limitations

Telephone communication requires that the individual is able to hear well and speak clearly. The elderly that have hearing or speech impairments would thus benefit more from personal contact.

6.4 Team work

The Helpline is staffed by a psychologist who provides advice and information to the individuals who call. She is also responsible for connecting the people who call with the appropriate service of the Annousakeio in order to get the best care. At the same time, help is also provided by various professionals that work at or collaborate with the Annousakeio Centre. At midday, a meeting is held between the helpline coordinator and the social scientist of the home care team in order to discuss and exchange information about the people who need to be supervised and get a phone call during the rest of the day. Moreover, a call can have the purpose of making an evening appointment for those who like to have a face to face counseling at the Centre. The psychologist moreover supports the people or families under the care of the outreach team and the residents of the Annousakeio who require professional psychological care.

B. STATISTICS

Of the 612 calls received at the Elderly Helpline during the past 18 months, 384 were from females (63%) and 228 (37%) from males. In total, 132 people called.

1. Demographic characteristics

1.1 Gender

The majority of the callers were females (76%).

1.2 Age

The mean age of the callers was 60 years, ranging from 25 to 89 years old. Because of this wide age range it was decided to divide them into age categories (15 years per category).

The age group with most calls to the helpline was that of 36-50 years old (24%), followed by the group 51-65 years old (21%).

1.3 Relationship status

At the Annousakeio Elderly Helpline almost 50% of the callers were married, 24% widowed, 12% divorced and 6% single. (Generally, Greeks have a lower divorce rate than other populations (Greek crude divorce rate is lower than 1.5 while EU rate reaches 2.00, OECD Family Database, 2008).

1.4 Residence

Of the people who called 45.5% live in a village (place populated by less than 1.000 residents), 24% in a town (place populated between 1.000 and 10.000 residents) while the remainder 30% lives in the city of Chania (populated by 53.000 residents).

2. Elderly Helpline Characteristics

2.1 Number of calls

The callers of the Helpline were put into groups depending on the number of calls they made. Thirty six percent of the callers called only once and 39% called 2 to 4 times.

2.2 Length of the calls

The most calls made to the Helpline lasted between 16 and 30 minutes (33%).

2.3 Calls per month

The seasonal variation of the number of calls is shown in the below chart. The table demonstrates that April, August and September are the months which are characterised by the higher percentage of received calls. Bibliography suggests that on the days before or after the formal religious celebrations individuals experience a psychological and emotional distress (Jessen, 1998). Moreover, during August and September the children of the elderly who visited them during holidays return to their permanent place of residence. These may explain the increased number of calls in April and August.

3. Comparisons

The role of the helpline in providing social support for the elderly and their relatives is considered as an issue that has received little attention in the literature and in our communities. We set out to examine the relationships by comparing different demographic characteristics and data collected from callers to the Helpline. We didn’t find any significant correlation between:

a) Relationship status to number of calls made (non significant correlation) or between,

b)  Topic of discussion to age group (non significant correlation)

Correlating:

c)   Age categories to frequency of the calls made, a trend (but non significant) is observed that older people call more frequently. It is possible that younger people call a few times when they have to face an urgent situation, and when this is solved they no longer feel the need to call again.

d)   Relationship status to Length of call (a correlation is demonstrated, p=0.12). Married people tend to talk longer on the phone, and this may be explained by the fact that they need more time to talk about their relationship problems. This result must be interpreted with care as only the longest phone call from each caller is included in the analysis.

C. DISCUSSION

1. Results

The analysis of the available data showed that Greek females of all ages living in the Chania municipality are more likely to call a confidential Helpline than are males. This could be explained by taking into consideration the social role of the males in this Greek region who are traditionally permitted to speak more freely about their family concerns than women. Moreover, males of all ages show less trust in, or are less motivated to call, a helpline. This finding suggests that a new approach should be planned to motivate Greek males to call the Helpline. For example, this approach could aim to encourage better health practices and to help them avoid a risky lifestyle.

It was apparent that there were three situations which most people wanted to avoid: isolation, loneliness and helplessness. Moreover, recently there is an increased fear by the elderly of being robbed or abused, or of being exploited by their carers (who are most commonly foreign) because they live in abandoned and sparsely populated villages. It is indeed very important to have someone to talk to on the phone till the late hours of the evening.

The phone calls made were received from a wide geographical area and by various ages. In fact, this resulted in our changing the name of the Helpline to The Young & Elderly Helpline in order to encourage its use by all age groups.

2. The type of problems callers presented

The topics discussed were various and most importantly were requesting information about the Helpline and the Annousakeio Centre (15%), expressing their loneliness and the difficult time they were going through with the health problems they suffered from (15%) and finally, for people who already were under the care of the outreach team, expressing their loneliness and the pain (physical or emotional) they were suffering from their illnesses (15%).

Other most important problems were: stress and depression from persons who wanted a counselling session at the Centre (9%), spiritual/religious matters, communication with home care service, financial problems with concurrent stress or depression, relationship problems and abuse, counseling to psychiatric patients (6% each).

The percentages of the problems or their combination is presented to the below table.

3. Type of help requested

Our research revealed five main type of help requested by the callers:

1. Discussion via phone

2. Connecting them with home care services

3. Requesting information about Annousakeio

4. Requesting that they or their relatives live in Annousakeio

5. Counseling at Helpline’s Centre

As a result of 5 above, 10 females were provided with 46 sessions of counseling during which stress management and family-relationship problems where the main topics of discussion.

4. Limitations

The results of this research are preliminary and should be carefully interpretated because of the small number of the callers (n=132). Moreover, in this country there isn’t available any research data by other Helplines with which a comparison could be made. Furthermore, given the cultural differences of the populations any comparison made with data obtained by foreign Helplines should be very cautious.

5. Future aims

1.      To extend the operation of the helpline to 24 hours

2.      To staff the Helpline with middle aged and elderly volunteers

3.      To extend the promotion of the Helpline to a wider geographical region.

4.      To create a network of volunteers that could offer practical help to anyone who needs it.

5.      To provide the elderly with a remote appliance that can be worn as a bracelet in order to inform the Centre of an emergency. The possession of this appliance will reinforce the elderly’s feeling of safety.

6.      To found and operate the program “Nursing at Home” in collaboration with the hospital and the doctors who follow-up the elderly and with the outreach services when specialized care is required.

Elderly helplines, in many countries including Greece, help individuals to combat isolation and ageism. The demonstrated efficacy and the convenience of telephone based counseling have led to a better evaluation of their condition offering a solution for depression or other problems.

In conclusion, the Annousakeio’s Helpline is a telephone and personal counseling service available to the whole community. Every evening of each workday there is someone who can provide the support that is needed.

It would make us very happy if this Conference could be held in our beautiful country next year.

Thank you for your time.

References

Jessen et al. (1998). Attempted suicide and major public holidays in Europe: findings from the WHO/EURO Multicentre Study on Parasuicide. Acta Psychiatrica Scandinavica, Vol. 99, Issue 6, p. 412-418).

Lazar, A., Erera, I. P. (1998). The telephone helpline as social support. International Social Work, Vol. 41, No 1, 89-101.

OECD Family Database – Social Policy Division – Directorate of Employment, Labour & Social Affairs (2008). Available at www.oecd.org/els/social/family/database.