Modern trends in providing social and psychological support for elderly people

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УДК 159.9

MODERN TRENDS IN PROVIDING SOCIAL AND PSYCHOLOGICAL SUPPORT FOR ELDERLY PEOPLE

Petrova K.

Assoc. prof. PHD, Bulgaria,

Lecturer at ST. Cyril and ST. Methodius University of Veliko Turnovo, faculty of philosophy, department of psychology e-mail: kraska_vt@abv.bg

The purpose of this paper is to identify the key issues and challenges in providing social and psychological support for the elderly in Bulgaria. Based on the criteria for the analysis of the social services now appear to present the basic principles and the difficulties that accompany the process of helping.

Key words: social and psychological support, social services for the elderly, the principles of social work with older people, training for professionals working with older people.

Петрова К.

доктор психологічних наук, доцент кафедри психології факультету філософії, ВТУ «Св. Кирил і Мефодій»

СУЧАСНІ ТЕНДЕНЦІЇ У ЗАБЕЗПЕЧЕННІ СОЦІАЛЬНОЇ І ПСИХОЛОГІЧНОЇ ПІДТРИМКИ ДЛЯ ЛІТНІХ ЛЮДЕЙ

Резюме

Мета даної роботи полягає у визначенні основних аспектів і проблем у наданні соціальної та психологічної підтримки для літніх людей в Болгарії. На основі критеріїв аналізу існуючих соціальних послуг в даний час відображаються основні принципи і труднощі, які супроводжують процес допомоги.

Ключові слова: герантологія, соціальна та психологічна підтримка, соціальні послуги для літніх людей, принципи соціальної роботи з літніми людьми, навчання фахівців, що працюють з літніми людьми.

Петрова К.

доктор психологических наук, доцент кафедры психологии факультета философии, ВТУ «Св. Кирил и Мефодий»

СОВРЕМЕННЫЕ ТЕНДЕНЦИИ В ОБЕСПЕЧЕНИИ СОЦИАЛЬНОЙ И ПСИХОЛОГИЧЕСКОЙ ПОДДЕРЖКИ ДЛЯ ПОЖИЛЫХ ЛЮДЕЙ

Резюме

Цель данной работы заключается в определении основных аспектов и проблем в предоставлении социальной и психологической поддержки для пожилых людей в Болгарии. На основе критериев анализа существующих социальных услуг в настоящее время отображаются основные принципы и трудности, которые сопровождают процесс помощи.

Ключевые слова: герантология, социальная и психологическая поддержка, социальные услуги для пожилых людей, принципы социальной работы с пожилыми людьми, обучение специалистов, работающих с пожилыми людьми.

Стаття надійшла до редакції 05.06.2014

social psychological support older

The increasing number of elderly people on our planet is an undeniable fact, since, the development of health services, education, social services, the economic growth and policies for supporting retired people have led to an average life expectancy around and over 70 years, which has posed different challenges related to the adequate provision of social help and support for the elderly. The number of families taking care of their children as well as their older relatives is on the increase. The time of placing the elderly in institutions and abandoning them is passing away. The role of the family in elderly people's care and health has been recognized. The present paper aims to outline the main guidelines and problems in providing social and psychological support for the elderly people in Bulgaria. We have been looking for alternative forms of care homes where, instead of the institutional principle, apathy and biological survival, a life not so much different from their previous lives is provided: a well-deserved life of the elderly as equal citizens, an honorable way of living their last days in a family-like environment.

In most countries there is a reliable insurance and pension system. Each civilized country allots considerable means to health care and social services and has socially relevant laws, regulations and rules concerning disadvantaged people. They reflect the guidelines, principles of work and the general programme components, which can be implemented and adapted to each concrete region.

The theoretical research in the fields of differential psychology, gerontology, gerogogics and social sciences benefit the development of the support to elderly people. It reveals that the elderly are useful to the society and that taking care of them is what makes humans different from the animal species. Aging does not make you useless to the community, where young people's patterns dominate and premise discrimination and negative attitudes towards third-aged citizens. The elderly can keep their vitality for a longer period if social integration conditions are provided to them.

The criteria that can be adopted in the analysis of the practical social and psychological work in Bulgaria could be summarized as follows:

Studying the individual person in their social environment, i.e. how the separate older person feels in the society;

Studying the role and status of the elderly /regarding policies, practices, protection/;

Studying the social and cultural environment of the elderly.

Most experts agree that it is difficult to work with old people, in some cases even harder than work with children, which justifies the strict rules of work, including clear terms, documented informed agreement, a high level of responsibility and willingness to bear insults, dissatisfaction and unsubstantiated claims.

That is why, when preparing specialists, it is necessary to take into account the following specificities characterizing the support process for aging clients. These specificities are psychologically determined:

continuously changing demands, determined to some extent by changes in the physical and psychological state, as well as changes in the emotional and behavioural sphere;

decreasing control and self-control capabilities, which causes a wide range of feelings -- from fear to anger and self-loathing, sometimes expressed in self-harm;

changing, with aging, morals, which is based on the pleasure principle -- if the elderly person does not like a certain thing, they do not feel inhibited to keep silent, to conform, etc.;

increasing selfishness related to the fear of death or, at least, to the raising feeling of helplessness, lack of autonomy and need of care from strangers;

bouts of depression leading to suicidal thoughts, attempts and acute forms of depression;

alternating bouts of aggressiveness and depression, sleepiness and inability to sleep and, similar to cyclothemic disorders, emotions and reactions dependant on the momentary state.

It is my opinion that in Bulgaria there is not a comprehensive methodology covering all aspects of elderly people care. There is a lack of adaptive methods and techniques, as well as thorough training of specialists focused primarily on the elderly. There is a lack of traditions in this respect. At present, the social and psychological practice is a modified version of case study, partially, family work and not good enough methodological guidelines for social work in the community and with institutions and systems.

The applied methods do not always take into account the psychological specificities of the elderly clients and are stained by an one-sided view of the old person as either extremely helpless and incapable of personal opinions or as an annoying member of the community who is due to reach the end of their life being a grumpy and aggressive character not willing to accept the offered help. Furthermore, there is even the cynical view that the laws of natural selection theory should be followed leaving elderly people to die without giving them special care.

It is a fact that the whole society being focused on the young and the maximum preservation of youth, or maturity at least, does not want to listen to the elderly people's problems, in this way, denying old age. Placing old people in institutions is seen by some as the best form of care or keeping them closed behind the walls of their homes left only to the care of their relatives.

The research on the care provided for the elderly shows the need for belonging and friendliness, which are rated as the highest benefit in the supportive process. It is important to the elderly who takes care of them, who is allowed to enter their homes, who they communicate with, etc. They look at the caring process from a different point of view -- as a partnership, as an opportunity for both sides to be satisfied, as a social and professional contact. Thus, care for the elderly is not seen as a pitiful and shameful service but as teamwork in a partnership. Hence, the need for matching the client with the social worker, choice and an opportunity to re-choose who is going to be the helper and how to personalize the help provided.

The specificities of the social and psychological support of the elderly set out particular requirements to the person providing support, especially in regard to the basic principles for carrying out individual and group work, work with the family and the community. They can be describes as:

The client should be treated as an individual person not as a case, type or category.

The client wants to be able to express freely his or her feelings -- be they positive or negative. These feelings could be fear, insecurity, hatred, unfairness or their opposites.

The client should be seen as a person who has his or her own values. These should be possible regardless of the client's dependency, weakness and fragility, faults or denial.

The client needs friendly understanding and response to his or her feelings.

The client would not like to be assessed or judged because of the difficulties he or she is living through.

The client wants to make their own choices and decisions regarding their future. He or she does not want to be given orders, commanded and pushed. The client wants to be given help not orders.

He or she wants confidentiality to be preserved and would not like for the neighbours and the «whole world'' to know about their problems.

The following principles could be drawn based on the above-mentioned rules:

Individuality: seen not only as uniqueness of one's personality but also as a personal path of development and accumulated experience.

Freedom of expression: people experience positive and negative emotions and feelings, which are even stronger in the process of support. Their suppression causes inner tension and conflicts within the clients.

Adequate expression of the clients' feelings, thoughts, experiences and behaviour: not from the position of condescension, pity, reproach or mentoring attitude.

Accepting the other for what he or she is with no intention for the person to be changed, especially the elderly: a friendly and empathic attitude, which does not contradict professional ethics.

Non-judgmental attitude: the elderly person is an entire person, with his/ her strengths and weaknesses, which sometimes means behaviour that is not socially accepted. Still he or she is an integral person who is currently in a delicate situation, which requires taking into account his or her needs.

Right of choice: the right to choose the treatment, the quality of the provided care, the social worker. All that means the elderly need to be fully informed about the possible options in this field.

Confidentiality: it is a necessary condition for an effective interaction and interrelation between the elderly and his or her family and the social services because, unlike children who are under their families' control and protection, the elderly person is a mature person and it is possible for him/her to have secrets from the family which the social worker has to keep.

Different authors of European and world dimension have different understanding about the education and training of supporters for elderly people. The focus is most often on the training duration, which should be at least two years. In Bulgaria, the training lasts at least four years.

The challenges in providing social support could be found in a number of spheres connected with the understanding of the psychological and social specificities of older people:

Elderly people are seen only in their current state and a full picture of them having been children, adolescents and young people is not developed. Such a picture they have about themselves and it is a significant part of their self-perception, which makes them dream, stay alive and preserve themselves in certain serious health conditions, such as dementia.

Some aspects of older people's behaviour cause annoyance, intolerance and even anger. They can be labeled as immoral, strange, old-fashioned as views and ideas. But it is their personality with its past, which is changed now and their behaviour might even cause revulsion in the professionals working with them.

It is possible for the negative attitude of the elderly supporters to be triggered by their interaction with professionals providing other services who share their own negative assessments of the elderly. Another kind of shared attitude, which is also very offensive and burdensome, is that of pity and condescension, often combined with offence and disregard.

A serious problem in communication with older people is establishing a contact with those who refuse it and behave aggressively, belligerently and arrogantly. This could be explained either with the fear of getting close to other people or the fear of parting, illness and death. If we find the true reason behind such behaviour, we can establish a normal contact with the older person.

Another danger in supporters' behaviour is the empowerment. Since the older person has a concrete problem, illness, or need and cannot cope independently with certain difficulties, it is possible for the supporter to develop a patronizing and mentoring attitude and to disregard the older person's right to make independent conscious choices and to start giving advice and guidance when it is not really needed. When the client uses the help of the supporter to cope with a certain task, he or she can have positive or negative emotions. Sometimes the client feels affection for that caring and supportive person. Other times the client gets angry with the social worker who wants him/her to have a responsible attitude to life. Unfortunately, the issue of authority and power is one of the most persistent taboos in our society. The skill to cope with the issues of authority and power involves a constant review of the client-supporter liaison. Negotiating is viewed as an alternative to imposing power, an entirely new outlook on the problem.

Modern social and psychological support for older people has been influenced by the demands of the European practical social work. It is based on theoretical research in the fields of developmental and social psychology and takes into account the specificities in Bulgaria. Newly established social services have been undergoing a process of trial and approbation as organization and essence. They are governed by the principle of de-institutionalization, at the same time, being in accordance with the specific regional conditions, the individual preferences of the elderly and their families, as well as the skills and capabilities of the supporters. The implemented foreign experience is not always relevant to the socio-economic environment of the elderly, which is a prerequisite for the development of a new social model for social and psychological work. It has been observed that older people lack motivation to use the available social services because they do not match their real needs; they are not accessible and sustainable in time. The lack of succession, long-term existence and changing conditions of service delivery make older people distanced, restrict their choice and lead to help rejection.

Social and psychological support for older clients is complex, inconsistent and sometimes marked with disappointment and rejection to perform the professional duties, but if it is accepted as a mission, a humane act and moral responsibility of a mature society, it becomes a challenge, creativity and need.

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