Abstract
The Supportive Community Program was developed some 25 years ago to help elderly adults continue to live at home and to enjoy quality of life, security, and independence. The program provides community members with a fixed basket of four services: a community facilitator; an emergency call service, medical services, and social activities. This basket has remained fixed throughout the program’s operation. However, due to the members’ aging and changing needs, and to make the program attractive to additional populations, it had to be modified. The current study included a formative evaluation and a summative evaluation to examine the pilot (the upgraded Supportive Community Program) which provides a more flexible, expanded basket of services. The pilot was implemented in 2016-18 in nine local authorities. It permitted members to exchange the existing basket of services (except for the community facilitator) for a broader one (e.g., personal grooming, transportation, and paramedical care) or to purchase, flexibly and dynamically, additional services for pay as they saw fit, the underlying conception being to allow the older population greater autonomy. The pilot made it necessary to change the work processes of the program staff, notably to increase the management and budgeting inputs. It was conducted in conjunction with the Ministry of Labor, Social Affairs and Social Services, JDCESHEL, local authorities and NGOs.
Study Goal
The study was conducted to examine the extent to which the program achieves its goals, and to provide program developers and decision-makers with feedback to redesign it down the road and incorporate it in additional communities.
Study Method
The study was based on administrative data received from the upgraded supportive communities, on telephone interviews conducted with program members in two rounds (in June-July 2017, and February-March 2018), and on interviews with 15 officials at various stages of the pilot’s implementation.
Findings
■ 88% of the members of the upgraded supportive communities reported high or very high general satisfaction versus 77% in a 2010 study of a representative member sample.
■The general satisfaction of members suffering from mobility problems was comparable to that of members able to move freely, unlike the low satisfaction expressed by the former in previous surveys.
■ 61% of the members participated in social activities. Special attention was paid to making activities outside of the home accessible to members with mobility problems. Moreover, the expanded service basket attracted also younger, mobile members to the program and its courses, hobbies and lectures.
■ The basic services – community facilitator, emergency call service, and social activities – remained important to members after the new services were added in the upgraded basket (more than 90% were not prepared to forgo these services).
■ The two services most in demand in the upgraded basket were social activities and personal grooming.
■ The program’s greatest contribution was the sense of security experienced by its members.
■ 30% of the members were aware of the possibility of changing the basket’s composition during the pilot and most were satisfied with the option of choice from the variety of services offered, to which they attributed great importance.
Conclusions
Compared with the original program that provided a fixed basket of services, the pilot improved the services offered to members of the upgraded supportive community. The improvement was particularly prominent among members with mobility problems. The option of choice of service is part of the change away from the paternalism of the past in the development of elder services, particularly supportive community programs.
These changes make it possible to adapt the program to additional target populations and render it more competitive with other service providers. Nonetheless, it is important to learn from the pilot as regards the changing role of the community facilitator, and the training of staff in building, budgeting, and managing a basket of services.
In light of the importance attributed by members to community facilitators, as found in this and previous studies, and given their considerable contribution to the members’ sense of personal security, we believe that this service (or a similar one by another official) should be compulsory and non-exchangeable as it reinforces the community component connecting members to the program.
Furthermore, steps should be taken to conduct periodic surveys of member needs and preferences for purposes of ongoing service adjustment and individual follow-up of service consumption.
The study reveals that there is room for the improvement of service accessibility and its adaptation to special populations such as immigrants, the housebound, and “younger” elders; e.g., by utilizing volunteers and interpreters.
We believe that the longstanding supportive communities should be expanded in line with the upgraded ones to avoid competition and a situation whereby both the upgraded and basic service baskets are offered in the same city.
Finally, it is necessary to adopt an efficient information system to help community facilitators and program operators manage the supply of the upgraded basket of services.