A Pilot for the Elderly

1. A Pilot for the Elderly - Listening to elderly help-line users in collaboration (Integrated Care) Rebecka Arman, R.N. and phd student

2. The promise… ”If You live in the central or western parts of Gothenburg City and are 75 years or older, you now have another number to call about questions concerning home-help services, healthcare and rehabilitation, but also other things that You are wondering about. You are welcome to call, around the clock”

3. Who chose to listen? • The initiative came from the head of the Geriatrics department at the hospital. Inspired by a similar project in Stockholm and EPICS • A collaborative group of managers from the municipalities met together with primary and specialized healthcare managers • The idea was planted there and grew roots: a project-organization was constructed: • the Home-help services, Home-healthcare services, quality developers from the municipality, the A&E department, the Geriatrics department, the Primary healthcare (the GP:s and Health Advice help-line) and rehabilitation took part in the planning and implementation (18 persons) • A network of fifteen organizations with different services. Written contracts of collaboration • The staff answering the phones also answer the home-help security-alarms. Mostly social workers

4. Goals • To improve older peoples feelings of “security/safety” • To improve availability, reliability and trust/faith • To help people to stay living at home • To decrease unnecessary visits to the A&E; “the right kind of healthcare at the right level” (primary/secondary, home) • To guide the person to where the help can be found in spite of the complexity of different services • A second stage with preventive services was planned

5. Who did they choose to listen to? • Decisions based on the representatives own experiences and one survey done at the A&E • No initial investigation of the population’s needs • What age limit is appropriate? • Only people who do not already receive help in their homes? • Only the frequent users? • Choice: everyone 75 years or older

6. What kind of listening occurred? • Healthcare needs (40 %): • I can not reach my GP. • Who can help me with my hearing-problems? • What should I do about my symptoms? • My medicine runs out on Wednesday, is the new batch arriving soon? • I have already been to the hospital but I am still not well. • I was treated badly (demeaned) and I do not want to have to call back to that person.

7. What kind of listening occurred?continued • Social care needs (~29 %): • I need a security alarm in my home, how do I get one? • My mother is getting too frail to take care of her-self all alone, what kind of help can she get? • My home-help assistant is late, is she on her way? • The Pilot is a higher level within the social care organization, to complain to

8. What kind of listening occurred? continued • Information needs (~25 %): • May I have the number to the convenience store on NN street? • How can I reach the social insurance office, it is always busy. Do you have any alternative numbers? • Where can I get free computer classes? • I need to call a taxi, can you give me the number? • What time does the local bus leave? • What food are they serving at the nursing home?

9. What kind of listening occurred? continued • Other needs (~15 %): • “Freedom from the telephone-tyranny” • When it is hard to hear what the answering machine says or hard to read the phonebook • Loneliness: I feel so anxious sometimes, since my husband died • What kind of help can the Pilot offer?

10. How is the listening carried out? • An assessment of what the need is about. If it has anything to do with healthcare is should be directed to the Healthcare Advice help-line • An assessment of how frail or independent the person is, if the person can make the phone call on her own • Listening and keeping company • Offering advice, based on ones knowledge and experience • Perhaps not listening too much, when the call is piloted to another service

11. What do the pilots say about the users? • It is satisfying to be able to give help by simple means such as searching on the Internet. • I can call to many different places and say our name and then they help us • Some people use us as a simple and free version of the yellow pages information service • The questions are mostly the same as the ones we got before too. More variety now

12. What do the users say about the Pilot? • How does it effect your feelings of security/safety? (percent)

13. What do the users say about the Pilot? • How does it effect your trust that there is help to get, when you need it?(percent)

14. Examples of the uses • (- What feelings does it awake in you, knowing that this number exists?) Security. It is an incredible security. For me this is pure medicine. • (-How did you perceive the contact you had with the Elderly Pilot?) It was completely fantastic to be able to call them. /…/The best part was that I felt so secure with the Pilot. • Actually, what I fell for was that it was so nicely put together with the lighthouse and everything. /…/She was so friendly, it turned my whole situation around. • Now I don’t need the Healthcare Advice Line and all those things. I just need to call there (the Pilot) when I have fallen. Either the send someone here or when they consider it serious enough then they send an ambulance. • I couldn’t look in the phonebook so I think I would have called SOS. It is a little stupid, but what should I have done? So this was of course much better, one feels secure. Even now when I feel better something might still happen. Then I know about the Pilot and there I get all the information I need (- about your health, or other things?) No, it is about my health, if I fall or become sick. Otherwise I have the number everywhere else.

15. Less enthusiastic examples • (-Had you solved it otherwise?) Yes, I most certainly would have. With a some rounds or referrals. Yes, I would have but it might have taken a little bit longer. • It was as usual. I do not think that it was anything special. But that might be because I am jaded on telephone calls. • But I don’t think that I got any particular help. /…/ I called but nothing happened. I don’t know if they can help me.