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Call to embed social inclusion strategies in home care


New research has identified high levels of serious psychological distress and social isolation among home and community care clients.

The study of 265 Benevolent Society clients found that one in three were classified as socially isolated by their case managers and psychological distress was common and often quite severe.

Over a quarter of community care clients indicated serious psychological distress and a further 28 per cent indicated some anxiety or mood disorder.

The Benevolent Society study echoes similar concerns raised in a report from COTA Victoria which, as Australian Ageing Agenda reported earlier this month, warned the policy reform to support more older people to live at home may lead to higher levels of social isolation and associated mental health issues.

According to The Benevolent Society study, the reasons given by clients for their psychological distress included complex health and social issues, anxiety about the future if their health declined, concerns about money and the ageing process itself.

In light of these findings, principal researcher Judith Teicke from The Benevolent Society said holistic, comprehensive assessment of clients’ psycho-social needs should be built into community care services.

She also called for case managers and coordinators to explore issues of social connection and inclusion more fully during care planning.

Ms Teicke said:

“We need to get better as a sector at looking at a more holistic way at clients’ needs and seeing that interconnection between different social, emotional and physical needs.”

Improved holistic assessment also needed to be underpinned by access to appropriate services such as mental health and allied health services.

While clients’ psycho-social needs were high, the evaluation found community care staff were not always good at recognising those at risk.

For example, case managers were much less likely to classify clients requiring domestic assistance as being socially isolated, despite them showing broadly similar levels of loneliness and higher levels of psychological distress as other clients.

Social isolation among CALD clients was also not as well identified, which could be linked to staff overestimating the social support networks of CALD clients.

Ms Teicke said this highlighted the need to challenge staff assumptions about the clients that they work with and the importance of more thorough assessment including the mapping clients’ social connections.

Key factors 

Financial disadvantage was also identified from the study as a strong predictor of poor psycho-social wellbeing. Of clients indicating serious psychological distress, 42 per cent were classified as financially disadvantaged.

Surprisingly, living with others was not considered a protective factor against loneliness, with clients living alone and living with others reporting similar levels of loneliness.

Ms Teike said the results showed that social inclusion is related to the quality of a person’s social networks rather than proximity to others.

Funding and hours available to clients under home care packages were identified as key barriers to addressing social isolation among clients.

In addition to improved assessment and staff awareness, Ms Teike advocated for the outcomes of community care services on clients’ wellbeing and quality of life to be measured across the sector.

“While it is important to look at service output and quality, we need to ensure that the outcomes that clients want for themselves are measured and we need to know whether we are actually making a difference to clients’ lives,” she said.

The Benevolent Society is embarking on a review of evidence-based social inclusion strategies and services.

Read the full report and recommendations: Your life Your wellbeing

Related AAA coverage: ‘Concerns of lonely seniors in home care push

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One Response to Call to embed social inclusion strategies in home care

  1. Caroline April 3, 2014 at 9:19 am #

    While I agree that social inclusion helps to alleviate social isolation, the reasons for people’s isolation is often not so clear and is actually not articulated in the summary above (hope I find it within the main report).

    Increasingly the demands on case managers, care workers and care workers is rising and becoming complex. While I agree that a holistic, comprehensive assessment of clients’ psycho-social needs should be built into community care services, it also needs skilled staff to do this type of assessment in planning.

    I am now of the view, built on family experiences, that social isolation is much more than facilitating participation. It’s about working with the older person and/or carer to identify some of the reasons that reduce or stop their willingness to participate and the possibilities within their limitations or challenges. I see the need for skilled counsellors as part of a holistic response to caring for socially isolated older people. This is a specialist skill. We should allow case managers, coordinators and care workers to form part of that circle of care while recognising the distinctiveness of each role to support the person.

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