Background
The health and social services in Israel provide multiple services to elderly people with illnesses or disabilities, but family members play a key role in caring for them. Family centered care (FCC) is a new approach to caring for the elderly that has developed in recent years with the aim of meeting the needs of both the elderly person and the family member looking after them. This approach considers the elderly person and the family caregiver as partners in care management and decision-making. In this spirit, since 2013, JDC-ESHEL, in partnership with the Fund for Demonstration Projects at the National Insurance Institute, the Ministry of Labor and Social Affairs and Services (MOLSA), and the local authorities in Bat Yam and Bene Beraq, has been developing the Shaked program, aimed at providing a comprehensive response to the needs of family caregivers through the local authority.
In 2015, the program set up two municipal centers – the Shaked Centers – in Bat Yam and Bene Beraq, in order to identify the needs of family caregivers in their capacity as care coordinators for an elderly person and in their own right, to develop a preliminary care program that would refer them to services in the community, and to monitor implementation of the care program. The centers aim to provide a variety of services to the primary caregivers – individual support, counseling and information, support groups, workshops to impart skills to the participants, respite from the care burden – and to provide public information in the community. All this is intended to provide the best possible service to elderly people and their caregivers. Another goal of the centers is to build municipal partnerships and raise awareness among professionals in the municipal services of the needs of caregiver families.
Evaluation Goals
1. Formative evaluation: To design a tool for use by the centers (intake questionnaire), to examine the target population, to examine organizational aspects of implementation of the program, and to design measures for ongoing evaluation.
2. Summary evaluation: To examine satisfaction with the program and its perceived contribution for family members and the elderly person and for the municipal social service system.
Method
The evaluation included the following: analysis of administrative data about the centers’ service recipients; telephone interviews with a sample of recipients; face-to-face interviews with the program operators and other program partners.
Findings
With regard to the target population, we found that the centers had established contact with people who had been caring for elderly family members for a lengthy period of time and that most of them reported feeling a heavy or very heavy sense of burden. The findings also reveal that the centers had succeeded in becoming a source of long-term support for family caregivers. Most family members reported that they had had more than one counseling session at the centers, and 30% reported having more than six. Most reported that they found a listening ear at these sessions, which gave them the opportunity to talk about things that bothered them, as well as emotional support and a feeling of meaningful connection with the center.
Most of the family members reported that the Shaked Center had become a place they could turn to (35%, to a very great extent; 37%, to a great extent). In addition, almost all (94%) noted they were satisfied with their connection with the center to a great or very great extent.
Most of them reported that the program had contributed to them by providing emotional support. Fifty-three percent reported that the center had helped them think about positive aspects, cope with difficulties (52%) and meet people like them (46%). Thirty-nine percent reported that the burden had been lightened, in that they learned to take care of themselves (39%), to cope with emotions (36%), and to take a break from caregiving (30%). With regard to improved care of the elderly person, 48% of the family members reported that they received information about their rights, 44% received information about the illness, and 35% acquired tools and skills and learned how to improve their relationship with the elderly person.
At the municipal level, the centers raised the awareness of senior officials in the city about the social phenomenon of family caregivers, created organizational mechanisms to coordinate activities designed for that population, and established partnerships with other organizations. However, there is still a palpable need to extend the cooperation to all echelons working in this field.
Conclusion
The Shaked Centers have reached their target population and they have become familiar to professionals and local residents. The centers have provided a range of services for family caregivers: personal counseling, support groups, information evenings, and workshops. Their strong points are proactivity and raising awareness of the family members’ needs. The main contribution for the family caregivers is that they have established themselves as an address that caregivers can refer to, maintained ongoing contact with them and given them emotional support, and have provided counseling and referrals to services for the elderly.