We admire them to .... their own families and interests, so it is appropriate to take care of them ... by the personality and self-sufficiency of senior citizens but also by responses ..... complete mental, physical, social and societal well-being while.
Uczelnia Warszawska im. Marii Skłodowskiej - Curie
Janka Bursová, Zuzana Budayová,
Adaptation of Senior Citizens to Conditions in Social Care Facilities
Adaptation of Senior Citizens to Conditions in Social Care Facilities
Janka Bursová, Zuzana Budayová
2017
Adaptation of Senior Citizens to Conditions in Social Care Facilities Editor © Janka Bursová, Zuzana Budayová, 2017
Reviewers: Prof. JUDr. Jozef Králik, CSc. Prof. PhDr. Miroslava Szarková, CSc. doc. PhDr. Irena Kamanová, PhD.
Scientific Council for the Monograph: Prof. PhDr. Karel Lacina, DRSc. Prof. ThDr. Cyril Hišem, PhD. Prof. Ing. Jaroslav Kita, PhD. Prof. ThDr. Jozef Jarab, PhD. doc. PhDr. Ing. Lýdia Lešková, PhD. For the Catholic University in Ružomberok, Faculty of Theology in Košice, TI Spišské Podhradie issued by:
Publishing House Uczelnia Warszawska im. Marii Skłodowskiej - Curie Warszawa Pages: 107, Number of copies: 200 pieces ISBN 978-83-937651-6-4
CONTENTS FOREWORD ......................................................................................... 5 1 SENIOR STAGE OF LIFE (old age, aging) .....................................7 1.1 Senior citizen age .................................................................. 17 1.2 Preparation for old age .......................................................... 19 2 INSTITUTIONAL CARE FOR SENIOR CITIZENS .................. 23 2.1 Forms of care for senior citizens ........................................... 26 2.2 Social services for senior citizens ......................................... 29 2.3 Facilities for senior citizens .................................................. 38 3 ADAPTATION OF SENIOR CITIZENS IN SOCIAL CARE FACILITIES ........................................................................................ 46 3.1 Senior citizens before admission to social care facilities ...... 57 3.2 Senior citizens in social care facilities .................................. 63 3.3 Activities contributing to adaptation to social care facilities, findings and recommendations ............................................ 77 CONCLUSION .................................................................................... 90 REFERENCES .................................................................................... 92
Foreword The academic monograph "Adaptation of Senior Citizens to Conditions in Social Care Facilities" is intended for the broad academic community and represents a comprehensive picture of the issue of adaptation for helping the social work profession. We rely on the theoretical basis and try to uncover the richness and wisdom of old age, to discover problems and to provide information about senior citizens and about the adaptation process in social care facilities. In the academic monograph, we deal with explanations of basic concepts, we present the results of the qualitative research and the opinions of the participants based on the interview of the participants in the qualitative research, we propose solutions and suggestions for practice. Old age, aging is considered an irreversible and lawful process that begins with man coming in the world. It is a natural process with specific changes in the biological, mental and social plane. Senior citizens can be in complex or risk situations. One way to help a person in a risk life situation is a stay in social care facilities. Social care facilities create a reasonable environment at the stage of life in which senior citizens find themselves. Ability to adapt to new conditions may be a problem for the senior citizen, so it is important from the point of view of the adaptation process to prepare for aging throughout a person´s life. The adaptation of senior citizens is diverse and depends on many factors. And while its outcome may be unpredictable, all activities should lead to a social care facility becoming a home for its senior citizens. Social
workers, along with other workers, are an important part of adapting to these new conditions in senior citizens.
1 SENIOR STAGE OF LIFE (old age, aging) Aging is the most important phenomenon of the present. It affects the life of each of us and each of us has an impact on the course of our aging and old age. The quality of life is now at the forefront of human interest over the course of life. The term old age is important to understand as a certain period of human life, starting usually after the sixtieth year of age. Old age is the age range starting when people retire. Some retirees have a greater need for health care and gradually lose self-sufficiency, but this is generally not the case that every person in old age is powerless, ill, depressed, or suffering from memory disorders and with motion devices. Aging is a lawful, biological process. Many people are considered as elders, but in fact they are jolly and cheerful. We admire them to keep this phenomenon in high age.1 Old age is the final stage of the aging process. Old age is a period of dependence on the young generation, it does not have to mean decreasing the quality of life, it is just enough for the elderly to take their old age with love and to understand that old age is not a pitiful fate. Each person experiences old age in a different way. Those who have understood the meaning of old age, experience this period peacefully with dignity, they consider it a source of new experiences and also new opportunities for growth and engagement. For many older people, old age is also a major trauma. They often pass through passive resignation, rejection and closure consolidating thus the process of physical and psychological decline. All of us prepare our model for living during old age when we are
1
KALANIN, P. Starý človek medzi nami. Ružomberok : Edičné centrum PFKU, 2003, p. 49.
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young. Its quality depends on the understanding of its meaning and value not only at the human level but also at the level of faith.2 Senior citizens organize thoughts more slowly than the young. The quality of thinking depends on how rich and qualitative their mental life in youth was, and what knowledge and experiences they have retained. Another feature of higher nervous activity is tiredness. Of all the manifestations, the changes of personality are most obvious, while the attitudes towards themselves and others change. Older people worse resist the psychological burden, stress or conflicts, e. g. an illness, the death of someone close to them, litigation, minor conflicts and arguments and so on. Morbidity increases in old age and diseases of older people have their peculiarities.3 Krajčík states the biological aspect of human life for the periods: Childhood and adolescence 0 to 18 years Adulthood 19 to 45 years Middle age 46 to 59 years Old age 60+ years Old age as a period of human life: Young old 60 to74 years Old old 75 to 89 years Oldest old 90+ years Another division: Young old people 65 to 74 years Old people 74 to 84 years Very old people 85+ years 2
KALANIN, P. Starý človek medzi nami. Ružomberok : Edičné centrum PFKU, 2003, p. 49. 3 TVAROCH, F. Všichni stárneme. Praha : Avicenum Zdravotnícke nakladateľství, 1984, p. 82.
8
For people aged 75 and more, the need for both social and health care is growing sharply.4 Old age is now referred to as the third age. We understand age as the definition of a certain period of time, a period of something characteristic, whether in a socio-historical meaning or in relation to human life.5 We define aging as a process of gradual involution with accompanying changes in the personality of man and throughout the human body.
6
We consider aging to be an irreversible biological
process that is related to the whole of nature. Life expectancy is genetically determined and is specific for each animal species. Similarly it is the case with people where a multifactorial type of inheritance is assumed.7 Aging is a complex multifactorial process that conditions the genetic conditions and factors of the external environment. It is highly individualized.8 Normal aging is a natural, biological process. First it is inconspicuous, with an advanced age it is accelerating. There are changes in the body depending on the effect of many external and internal factors.9 Aging is most often understood as progressive wear, negative changes are manifested by energy loss, fatigue, stagnation, functional downtime to degeneration. First of all, it is the biological process in
4
KRAJČÍK, Š. Geriatria. Trnava : SAP, 2000, p. 20. ČORNANIČOVÁ, R. Edukácia seniorov. Bratislava : FFUK, 1998, p. 54. 6 HATÁR, V. - PAŠKA, P. - PERHÁCS, J. Vychová a vzdelávanie dospelých. Andragogika. Terminologický a výkladový slovník. Bratislava : SPN, p. 421. 7 POLEDNÍKOVÁ, Ľ. a kol. Geriatrické a gerontologické ošetrovateľstvo. Martin : Osveta, 2006, p. 8. 8 BROMLEY, D. Psychológia ľudského starnutia. Bratislava : Smena, 1974, p.32. 9 ŽIAKOVÁ, E. Psychosociálne aspekty sociálnej práce. Prešov : Akcent print, 2005, p.192. 5
9
living organisms, the basis of which is the ongoing dying of body cells or their replacing.10 Aging is a process that generally leads to a loss of power, to slowing down or stopping the life processes. Its ending is natural death. This is a biological, psychological and social aging. People age at different rates. Aging touches all of up. We all must realize that if we try to reverse aging, it will wait for us.11 Aging is a continuous, natural and irreversible process resulting in the body changes depending on many internal and external factors. The most important factors include functional and structural changes, but also a decline in adaptability. Negative and positive effects affect aging especially in the middle age. Aging is accompanied by both functional and morphological changes.12 Aging is a complex process that is affected by many factors: biological (diseases, inheritance), ecological (the environment), social (family circumstances, economic matters and family), health and hygiene factors (healthy diet, lifestyle and nutrition) and living conditions. They all affect the aging process.13 Aging is divided into biological (decrease of immunity, reduction of sensory perception, impairment of adaptive and regulatory functions, vulnerability to accidents, visual and hearing impairment, reduced respiratory performance), psychological (changed personality traits, changed social status, decreased cognitive abilities, slowing the pace of life, memory impairment, less persistence and balance) and 10
Veľký sociologický slovník. Praha : UK - Karolinum, 1996, p. 12-16. TVAROCH, F. Všichni stárneme. Praha : Avicenum Zdravotnícke nakladateľství, 1984, p.59. 12 MARCINKOVÁ, D. - HROZENSKÁ, M. - VAŇO, I. Vybrané kapitoly z gerontológie. Nitra : FSV a Z UKF, 2005, p. 15. 13 DRAGANOVÁ, H. a kol. Sociálna starostlivosť. Martin : Osveta, 2006, p. 121. 11
10
social (adaptability to retirement resulting in change in social status, life programme, reconciliation with social consequences of diseases). An important milestone in the life of an elderly person is retirement, which causes fewer social contacts.14 ,,Old age as one of the later stages of ontogenesis of an individual is a manifestation and consequence of involutive and morphological changes that have different variability in different people. From the point of view of basic conceptualization of seniority, three approaches can be defined: aging and biological old age (biological changes of structure, appearance and functioning of the organism), aging and calendar old age (determining the age limit from which we speak of old age, usually from 60-65 years of age), aging and social old age (changes of social character or social roles of an individual such as career termination, retirement and associated lifestyle changes, empty nest phenomenon, a change in the economic situation, the place and space of the subculture of older people in the society, age discrimination, marginalization of the elderly, social isolation, loss of the meaning of life, status of widowhood and widowerhood, violence against the elderly, etc.).“15 Spiritual aspects of senior citizens are also important and spirituality necessarily belongs to the life of senior citizens. 14
MARCINKOVÁ, D. - HROZENSKÁ, M. - VAŇO, I. Vybrané kapitoly z gerontológie. Nitra : FSV a Z UKF, 2005, p. 10. 15 HROZENSKÁ, M. a kol. Sociálna práca so staršími ľuďmi a jej teoretickopraktické východiská. Martin : Osveta, 2008, p. 15.
11
According to Tokárová aging and old age are the natural and final stage of human life.16 Aging is a general process. It is the legitimate period of life that goes on for each individual in a different way. The calendar age would not correspond to the biological age if the organism undergoes aging changes. That is the reason why people over the age of 60 are not referred to as old but older, or we use the term post-productive age, age when retiring.17 What plays an important role in the life of aging persons is the image they have created of themselves, how they perceive themselves on the basis of his relationship with the past, the present or the future, the image they have created of their surroundings, the image of the aging process of their parents, grandparents, known and less wellknown people. Myths and stereotypes about aging and old age have also a significant influence. According to today´s knowledge, the person´s own personality, character, temperament and adaptability contribute to acceptance and attitudes towards old age. Many scientific disciplines including geriatrics, psychology, medicine, social work and others work together to tackle the problems of older people.18 An aging person begins to think and feel differently. Work is a basic human need and a person who has worked for decades managed to build a personality, to integrate into society or into a collective, to create or develop something, to acquire experiences and then to pass them all on to younger generations. Work was not only a means of
16
TOKÁROVÁ, A. a kol. Sociálna práca. Prešov : FF PU Akcent Print, 2003, p. 519. DRAGANOVÁ, H. a kol. Sociálna starostlivosť. Martin : Osveta, 2006, p. 120. 17 DRAGANOVÁ, H. a kol. Sociálna starostlivosť. Martin : Osveta, 2006, p. 59. 18 HROZENSKÁ, M. a kol. Sociálna práca so staršími ľuďmi a jej teoretickopraktické východiská. Martin : Osveta, 2008, p. 19.
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gaining livelihood, but also a driving force, enthusiasm. If man gets older, the forces leave him. People who are expelled from work need to preserve self-esteem. They often feel unnecessary; they need friendship, company, people, a good and loving word. Many of them are abandoned, lost a partner, their friends have died and children have their own families and interests, so it is appropriate to take care of them not only materially but in a complex way.19 Old age is also a period when there are increased demands for care that can be provided by social care facilities.20 A specific area of socially oriented counselling is gerontological counselling providing specialized services to clients of higher age groups in the health, psychological, legal and social spheres.21 ,,Aging is a specific process characterized by long-term encoding. It is irreversible, non-repetitive, has a different character, leaves permanent traces and its development is governed by a typespecific time law. It is also subject to the formal environmental impact. The public often perceives the period of senium as a period of human life that can no longer bring anything new, original or constructive. It is a period covered by myths and prejudices, the most widespread of which are the following ones: most elderly people live in the developed countries old people are the same men and women get old in the same way old people are fragile
19
PACOVSKÝ, V. Ošetřovaní starých a chronický nemocných. Praha : Státní zdravotnické nakladatelství, 1961, p. 29. 20 DRAGANOVÁ, H. a kol. Sociálna starostlivosť. Martin : Osveta, 2006, p. 61. 21 TOKÁROVÁ, A. a kol. Sociálna práca. Prešov : FF PU Akcent Print, 2003, p. 518.
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old people have nothing to contribute to the society old age is the economic burden of the society.“22 The desire to enjoy old age in good health and full of strength is the desire of every person. The quality of life for senior citizens is affected by various factors. It is very important to enjoy old age, to have a big amount of activities that can enrich the senior citizens. The level of care for the elderly is a manifestation of maturity of the society and its socio-economic level. Mature societies create conditions for the qualitative and full-fledged life of older people. They provide nursing care for the elderly.23 There are ways to prevent and strengthen the body to adapt to changing conditions of the environment and thus prolonging active aging. However, we strive to prolong active life and active old age, with the senior citizens being able to lead a content, full-fledged and happy life to a high age so that they could use their life experiences and their old age would not be distressing.24 It is very important to show respect to an older person. John Paul II states that „the burden of age is easier for those who feel respected and loved by the young.“25 Aging is considered to be a lawful process that leads to old age. Aging is a certain process and old age is the final stage of a person´s life ending with death.26
22
HROZENSKÁ, M. a kol. Sociálna práca so staršími ľuďmi a jej teoretickopraktické východiská. Martin : Osveta, 2008, p. 42. 23 Porov. POLEDNÍKOVÁ, Ľ. a kol. Geriatrické a gerontologické ošetrovateľstvo. Martin : Osveta, 2006, p. 19. 24 Porov. TRČA, P. Cesty k dlouhovekosti. Praha : Avicenum, 1987, p. 11. 25 Porov. JÁN PAVOL II. Apoštolský list Jeseň života, čl. 12. 26 Porov. KOCIOVÁ, K. - PEREGRINOVÁ, Z. Fyzioterapia v geriatrii. Martin : Osveta, 2003, p. 10.
14
Aging is characterized as a period when changes occur in humans, which reduces the ability to perform individual functions of the organism. The ability to adapt is diminishing. Adaptive mechanisms change qualitatively; the reserve of physical and mental forces diminishes.27 Old age is part of life. People often think about how they want to live during old age, where and with whom. Therefore the qualities of independence and the possibility of co-deciding for themselves are of high value in old age. Responses to changes are influenced by the personality and self-sufficiency of senior citizens but also by responses of their relatives. If a senior citizen needs help in many areas, it is necessary to look for a new way of life in old age. Most senior citizens live together with their relatives and close friends who provide them with help and support. It is the best way of life from the point of view of senior citizens. In case of serious health problems, loneliness or inability to get help from close relatives, institutional care is needed.28 Older people are also worried about the imminent death, the loss of close relatives and friends, the changes caused by retirement, by the departure from the place of current residence, by admission to social care facilities, by the loss of a sense of life or the loss of past values.29
27
Porov. HROZENSKÁ, M. a kol. Sociálna práca so staršími ľuďmi a jej teoretickopraktické východiská. Martin : Osveta, 2008, p. 9. 28 Porov. VENGLÁŘOVÁ, M. Problematické situáce v péči seniory. Praha : Grada Publishing, 2007, p. 11. 29 Porov. BALOGOVÁ, B. - ŽUMAROVÁ, M Medzigeneračné mosty. Košice : Menta media, 2010, p. 126.
15
Švancara speaks of a mental balance for optimal adaptation to old age, namely of perspective, flexibility, foresight, understanding for others and pleasure.30 It is important for senior citizens to maintain their physical and mental performance to a high age and be creative. In this case we can talk about successful aging. But in many senior citizens, physical and mental performance is declining. In that case we talk about normal aging. Next, there are senior citizens who start forgetting quite early, their creativity dissolves, they suffer from disturbances, are inefficient, tired, and sooner or later they are associated with other disorders that are rapidly worsening, which we call pathological aging.31 We consider a risky senior citizen a person who cannot effectively and quickly adapt to sudden changes in their state of health or to sudden changes in their living conditions. Risky senior citizens are considered to be very old people, elderly women lonely or widowed, elderly people living in institutions, elderly women living in single-person households, elderly people living in isolation, childless older people, elderly people with low incomes, elderly people with health problems and older couples with one of the partners being seriously ill.32 Aging is understood as a process in its health and social context.33
30
Porov. ŠVANCARA, J. Psychická involuce. In. BALOGOVÁ, B. - ŽUMAROVÁ, M. Medzigeneračné mosty. Košice : Menta media, 2010, p. 127. 31 Porov. JIRÁSKOVÁ, V. a kol. Medzigenerační porozumení a komunikace. Praha : Eurolex Bohemia, 2005, p. 59. 32 Porov. HEGYI, L. Vybrané kapitoly zo sociálnej gerontológie a geriatrie. Bratislava : IVZ, 1996, p. 35. 33 Porov. HEGYI, L. Vybrané kapitoly zo sociálnej gerontológie a geriatrie. Bratislava : IVZ, 1996, p. 7.
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It is very important to realize that an aging person needs to walk their own way of life, needs their space, a space to express their own wishes and concerns. An older person responds sensitively to impaired interpersonal relationships or loneliness. It is a great encouragement if we give them recognition. It is necessary to come to terms with old age.34 The characteristics of old age are different, one of them characterizes old age as the wisdom that an older person draws from their life experiences and knowledge, other characterize old age rather as a set of difficulties that is brought about by a change in the mental and physical state.35
1.1 Senior citizen age According to the World Health Organization a human life can be divided on the basis of age categorization.36 ,,The age of man can be divided into several aspects: chronological age - a calendar age corresponding to the actual lifetime, regardless of the state of the organism, biological age - is the result of a genetically controlled programme, the effects of the external environment and the way of life and the presence of diseases or injuries, functional age - corresponds to the functional potential of a person, is given by the sum of the biological, psychological and social characteristics, 34
Porov. POLEDNÍKOVÁ, Ľ. a kol. Geriatrické a gerontologické ošetrovateľstvo. Martin : Osveta, 2006, p. 22. 35 Porov. POLEDNÍKOVÁ, Ľ. a kol. Geriatrické a gerontologické ošetrovateľstvo. Martin : Osveta, 2006, p. 22. 36 Porov. KOCIOVÁ, K.- PEREGRINOVÁ, Z. Fyzioterapia v geriatrii. Martin : Osveta, 2003, p. 11.
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psychological age - is the result of functional changes during aging, individual personality traits and subjective age, social age - includes the presence or respectively the absence of a life programme and to a certain extent depends on the retirement age.“37 Old age is also the time of the greatest life crises.38 Period of human life according to the World Health Organization: „childhood (0 – 14 years of age) young age (15 – 29 years of age) adulthood (30 – 44 years of age) middle age (45 – 59 years of age) older age – presenium (60 – 74 years of age) old age – senium (75 – 89 years of age) longevity (over 90 years of age).“39 Old age is also the last stage of the aging process, a period at the end of each person´s natural development process. Nowadays, in most countries, the human-age periodization proposed by the World Health Organization is used to divide the life of man into fifteen-year-long stages of old age: 60 to 74 years - early old age, older or higher age, young old age, 75 to 89 years - old old age, authentic old age, senium,
37
HEGYI, L. Klinické a sociálne aspekty ošetrovania starších ľudí. Trnava : Slovak Academic Press, 2001, p. 11. 38 Porov. KRAJČÍK, P. Geriatria. Trnava : Slovak Academic Press, 2000, p. 16. 39 HEGYI, L. Klinické a sociálne aspekty ošetrovania starších ľudí. Trnava : Slovak Academic Press, 2001, p. 12.
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90+ years - oldest old, longevity.40 Aging is a process that does not appear at the same rate in all people, but is influenced by various factors including the environment in which man lived and acquired genetic properties.41 We describe old age as the third age with the first age being childhood and adolescence, the second age is adulthood. Nowadays we also use the term of the fourth age, which results from the need to divide old age into two periods with regard to their different characteristics. An elderly 60-74 year-old mostly does not suffer from serious diseases, is still active, able to travel and integrated in the society; this active part of life is referred to as the third age. The fourth age usually starts after 75 years of age in the period of health deterioration. This age is marked by illnesses, decline of physical and psychological functions and the approaching end of life that is death.42 The stage of old age brings with it many crises one must count with.43 The life of a person is not easy and that is why we need to prepare ourselves for old age so that we can handle all the problems in the future more easily.
1.2 Preparation for old age We meet elderly people in our surroundings every day, but our everyday joys and the worries of life flow very quickly and it depends only on us how we prepare for old age.
40
Porov. POLEDNÍKOVÁ, Ľ. a kol. Geriatrické a gerontologické ošetrovateľstvo. Martin : Osveta, 2006, p. 8. 41 Porov. KOCIOVÁ, K. - PEREGRINOVÁ, Z. Fyzioterapia v geriatrii. Martin : Osveta, 2003, p. 12. 42 Porov. HEGYI, L. Klinické a sociálne aspekty ošetrovania starších ľudí. Trnava : Slovak Academic Press, 2001, p. 12. 43 Porov. FLORES, P. Starý človek. In Slovník spirituality, p. 945-947.
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Today´s medicine places emphasis on senior citizens and focuses on continuous lengthening of life while preserving its highest quality, but also maintaining self-sufficiency of senior citizens so that they can satisfy their living needs in particular living conditions up to a very high age.44 The most important task of preparing for aging is to prepare the aging person for psychosocial and biological changes, thus reducing the risks of the adaptation process. Preparation for aging is divided into psychological, medical and social. Psychological preparation is based on the recognition of the connections between mental health and the environment. It is important to recognize the factors that affect psychological performance negatively (isolation, illnesses, incorrect attitude to aging, unilateralism) because psychic functions can be activated and also trained up to a high age. Medical preparation consists in early medical examination of the health status of middle-aged people, early diagnosis of diseases, prevention and diagnosis of risk factors. Social preparation means organizing work (e. g. transition from work to retirement should be gradual).45 Social services for aging also include family care, which is a major factor in existential security, adaptation to new housing and so on. Preparation for aging has not only an individual dimension consisting of addressing the social, health and psychological problems
44
KOCIOVÁ, K. - PEREGRINOVÁ, Z. Fyzioterapia v geriatrii. Martin : Osveta, 2003, p. 9. 45 ČORNANIČOVÁ, R. Obohacovanie života starších ľudí edukačnými aktivitami. Bratislava : Národné osvetové centrum, 1994, p. 35-39.
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of an aging person, but also the societal dimension for intergenerational understanding.46 ,,There are numerous recommendations for extending the last stage of life: thinking of aging and old age when you are young - regular preventive examinations, saving; life insurance policies, additional pension insurance; protection against excessive wear and tear of the body; getting rid of bad habits in eating, drinking alcohol, smoking; creating
conditions
for
healthy
rest
and
physical
regeneration; remembering sufficient daily physical activity; every day acting conscientiously to maintain a balance between physical and mental health; finding new hobbies 2 to 3 years before retirement; preparing for old age so that it is a continuing active life; continuing lifelong learning, various courses, University of the Third Age; anchoring our life wherever we have survived its main part; if the situation so requires, adapting to loneliness.“47 ,,Radical changes in seniors´ lives occur when they are due to various reasons, usually due to social need that is ,,a situation in which a citizen cannot provide for their own care, care for their household, protecting and exercising their rights and the legally protected interests 46
HEGYI, L. Vybrané kapitoly zo sociálnej gerontológie a geriatrie. Bratislava : IVZ, 1996, p. 60. 47 DRAGANOVÁ, H. a kol. Sociálna starostlivosť. Martin : Osveta, 2006, p. 60.
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or the contact with the social environment, in particular with regard to age, unfavourable health conditions, social inadaptability or loss of employment” voluntarily or involuntarily placed in one of the social care facilities.“48 Among the problems of elderly people is stamping, which is a consequence of the lack of human relationships, as well as loneliness and isolation.49 Another problem of elderly people is care.50 We often do not understand that family and good family relationships play a significant part in the hierarchy of values for senior citizens. Truhlářová says that in the care of a senior citizen, the family must want to take care of the senior citizen even if it affects the whole family system or they are overloaded. Family must have conditions and enough knowledge about senior care. In her research, Truhlářová points out that the longer the family takes care of a senior citizen, the longer they are experiencing the psychological burden. Unless the family is able to provide care, it is advisable to provide institutional care for senior citizens.51
48
HATÁR, C. Inštitucionálna edukatívna starostlivosť o seniorov v Slovenskej republike. Nitra : PF UKF, 2005, p. 38. 49 PAPEŽSKÁ RADA PRE LAIKOV. Dôstojnosť starého človeka a jeho poslanie v cirkvi a vo svete. Vatikán 1998. Slovenské vydanie Trnava : SSV, 1999, p. 26. 50 BAKOŠOVÁ, Z. Sociálna pedagogika. Bratislava : UK, 1994, p. 22 - 23. 51 TRUHLÁŘOVÁ, Z. LEVICKÁ, J. VOSEČKOVÁ, A. MYDLÍKOVÁ, E. Medzi láskou a povinností – péče očima pečovatelu. Hradec Králové : Gaudeámus, 2015, p.33-36.
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2 INSTITUTIONAL CARE FOR SENIOR CITIZENS
Institutional care for seniors is provided by various institutions and facilities administered by the Ministry of Health of the Slovak Republic, the Ministry of Labour, Social Affairs and Family of the Slovak Republic (social care facilities, nursing homes, retirement homes, senior citizens clubs), the Ministry of Education, Science, Research and Sport of the Slovak Republic (Academy and University of the Third Age) and the Ministry of Culture of the Slovak Republic. We can also include pro-senior organizations, institutions, non-profit or volunteer associations in municipal, district, regional and parish offices.52 The placement of a senior citizen in a social care facility for permanent or long-term residence is understood as a form of social compensation for reasons of dependence, abandonment or if the family is not able to provide senior care for various reasons.53 Social care facilities for adult citizens provide services to individuals who, for various reasons, cannot live in their natural surroundings. They decide to stay on a voluntary basis because of a deteriorating state of health in an effort to avoid harassing or burdening the family or due to misunderstandings in the family and loneliness, even in a relatively good health condition. Reasons for an involuntary stay in a social care facility include circumstances such as adverse health changes, the loss of self-sufficiency associated with the inability 52
HATÁR, C. Inštitucionálna edukatívna starostlivosť o seniorov v Slovenskej republike. Nitra : PF UKF, 2005, p. 55. 53 PERHÁCS, J. 2000. Možnosti využitia sociálnej andragogiky v domovoch dôchodcoch. In. ČORNANIČOVÁ, R. Obohacovanie života starších ľudí edukačnými aktivitami II. Bratislava : Národné osvetové centrum, 2000, p. 124-127.
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to perform essential home care activities and care for themselves, which causes dependence on constant day-to-day assistance by another person, and if individuals in their natural surroundings are unable to provide them with adequate assistance or comprehensive care. Next reason may be the absence of relatives, their employment and lack of willingness or inability to provide the necessary care, either because of their poor health or pathology in their behaviour. Another reason may be the complete loneliness of the citizen in the absence or insufficiency of care or housing problems. The different reasons and causes are mutually intertwined. Social care facilities are full of senior citizens who deserve to spend their autumn years the same way as the rest of the population and to live this stage of their lives according to their own decisions, actively, in dignity and high quality, and it is therefore necessary to create the right conditions for elderly people to adapt in a new environment as early as possible.54 ,,What resonates most in the social policy in relation to elderly people is the need to secure: the independence of the elderly in their full depth and scope, their participation in the life of the society respecting the constitutional principle of equality in rights and dignity, a fair share of elderly persons in the use of society resources, integration of elderly persons into active co-operation in the formation of modern civil society,
54
MATULAYOVÁ, T. 2000. O sociálnej práci v domovoch dôchodcoch. In. ČORNANIČOVÁ, R. Obohacovanie života starších ľudí edukačnými aktivitami II. Bratislava : Národné osvetové centrum, 2000, p. 133-135.
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help in case of dependence on the assistance of another person due to the loss of self-sufficiency in the unconditional
preservation
of
personal
availability and quality of provided services.“
dignity,
55
Concerning the care of the elderly, the issue of prolonging life has raised. We can speak about the quality of life in relation to the definition of health under the World Health Organization as a state of complete mental, physical, social and societal well-being while preserving all the functions of the body and the ability of the body to adapt to changing environmental conditions.56 The problem of placement a senior citizen in a social care institution must be solved by choosing the appropriate facility or institution, deciding at the very beginning whether to place a senior citizen in a social care facility or whether another facility is more appropriate, with a strong link to house or family being an obstacle to admission to a social care facility.57 Good family background, love, understanding and contacts with their own family are of great importance for maintaining activity and improving the quality of senior life.58 Institutional care for the elderly represents a variety of risks depending on the state of health, age, the previous life and the previous situation that made them enter the institution. While care in social care 55
TOMANOVÁ, V. 2000. Národný programme ochrany starších ľudí. In. ČORNANIČOVÁ, R. Obohacovanie života starších ľudí edukačnými aktivitami II. Bratislava : Národné osvetové centrum, 2000, p. 31-35. 56 ŽIAKOVÁ, K. 2000. Edukácia pacientov v staršom veku. In. ČORNANIČOVÁ, R. Obohacovanie života starších ľudí edukačnými aktivitami II. Bratislava : Národné osvetové centrum, 2000, p. 136-138. 57 ŠTEFKO, A. Dôstojnosť človeka v starobe chorobe a zomieraní. Trnava : Dobrá kniha, 2003, p. 103. 58 BARTOŠOVIČ, I. Seniori v domove dôchodcov. Bratislava : Charitas, 2006, p. 59.
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facilities respects the principles such as the principle of dignity and quality of life of senior citizens at the highest level, maintenance of the seniors´ functional potential, personality integrity, access to social care facilities and adaptation is often stormy and problematic. A crisis in the process of adaption can cause complications that represent a serious threat to life or health, a lack of transparency, apathy and death.59 The quality of life will only be realized by a person when their life situation changes in a fundamental way.60 An elderly person has to cope with a number of problems while staying in social care facilities, especially with treatment complications, dietary habits, health problems, trauma and so on.61
2.1 Forms of care for senior citizens The best thing for a senior is their family that should want to, know how to and be able to take care of their older members. However, if one of these conditions is lacking in the family ,,want, know, be able“ the state has to take over. The care for elderly people is taken over by social care facilities, nursing homes and retirement homes.62 An alternative to caring for elderly people in their home-grown natural environment is home nursing care. In advanced economies, this component of health services is currently the fastest growing. It helps
59
KUFFOVÁ, J. Adaptácia v živote klienta v zariadeniach sociálnych služieb. In. Štvrtá medzinárodná konferencia FSVaZ UKF. Nitra, 2009, p. 395. 60 KAMANOVÁ, I. Inštitucionalizované sociálne služby a kvalita života seniorov. Ružomberok : Edičné stredisko PF, 2007,p. 32. 61 HEGYI, I. Niektoré riziká pobytu v domovoch dôchodcov. In HROZENSKÁ, M. a kol. Sociálna práca so staršími ľuďmi a jej teoreticko-praktické východiská. Martin : Osveta, 2008, p. 85. 62 ŠTEFKO, A. Dôstojnosť človeka v starobe, chorobe a zomieraní. Trnava : Dobrá kniha, 2003, p. 12.
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to improve the quality of life and speeds up the process of healing and gaining self-sufficiency and independence.63 Nursing homes are residential homes with small-sized flats providing care for an elderly single person. Services are also provided to married couples and to those who are expected to lose their independence. They are not suitable for people who are permanently confined to bed, suffer from mental disorders or would otherwise disrupt living together in a nursing home. For those people, other forms of care are more appropriate to be chosen according to the needs of a particular senior citizen. These are geriatric hospital departments or hospice care.64 Social care facilities or retirement homes will normally play their role if the care for the elderly by their own family has failed due to subjective and objective causes. Clients of social care facilities are predominantly people of higher age, heavily disabled, those who are unable to take care of themselves and their household.65 Social care facilities fulfil two basic functions: they disburden the family or family relatives and take over the system of general care for senior citizens and the other function is providing a wide range of services and care in different areas of the human being. Social care facilities create for senior citizens relatively good conditions for accommodation including personal equipment if senior citizens and their family do not have enough money, meals and care,
63
NATIONAL COUNCIL OF THE SLOVAK REPUBLIC. Act No. 448/2008 Coll. on Social Services and on the amendment of Act No. 455/1991 Coll. on Trade Licensing as amended and modified. 64 ŠTEFKO, A. Dôstojnosť človeka v starobe, chorobe a zomieraní. Trnava : Dobrá kniha, 2003, p. 105. 65 HATÁR, C. Inštitucionálna edukatívna starostlivosť o seniorov v Slovenskej republike. Nitra : PF UKF, 2005, p. 56.
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counselling, cultural and free time activities, rehabilitation and support for the social enjoyment of senior citizens in the facility.66 One of the oldest forms of care for the older generation are social care facilities that have a long tradition. Already in medieval monasteries there were hospitals with special departments for poor old people. Social care facilities are intended to serve elderly people who cannot or do not want to live alone in their own homes, and the family cannot or does not want to or is not able to care for them. Their task is comprehensive care in terms of health, age and financial security. In addition to healthcare and social security, an elderly person also needs a high-quality living space where an elderly person does not feel like staying in a hostel.67 At present a client can select a facility with more clients or fewer clients. ,,Clients´ needs vary depending on their age, their social situation, the lifestyle, but also the location in which they live. For this reason, social services will continue to meet the required criteria even more rigorously. Social services must be: addressable - it will be exactly determined what services will be provided, how long and so on individual - will be created in cooperation with family, service providers, social workers, or other persons to provide effective assistance in the area which cannot be secured from other sources and which is needed for an
66
HATÁR, C. Inštitucionálna edukatívna starostlivosť o seniorov v Slovenskej republike. Nitra : PF UKF, 2005, p. 57. 67 ČUNDERLÍKOVÁ, M. - VARSANYIOVÁ, O. 1994. Je domov dôchodcov skutočne domovom? In. Zborník Starostlivosť o starých ľudí v transformujúcich sa krajinách. Bratislava, 1994, p. 45- 47.
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individual or for his or her family to ensure adequate quality of life in the natural environment selective - aimed at achieving certain goals and regularly evaluated perspective - will take into account the future of the individual and his or her family, change of the needs and interests over the years and will lead to the integration of the citizen into the life of the community as a full member integrative - will also give priority to the sources of support that enable the citizen to live in the environment and have activities that are appropriate to his or her age group and are in line with his or her needs and interests natural - will preferably use the sources of help that are available as close as possible to the place of residence, which least interfere with the normal family style and at the same time seek to improve the quality of life of family members and increase their own contribution to the living conditions.“68
2.2 Social services for senior citizens Act of the National Council of the Slovak Republic No. 448/2008 Coll. on Social Services and on the amendment of Act No. 455/1991 Coll. on Trade Licensing as amended and modified, which is
68
Act No. 448/2008 Coll. on Social Services and on the amendment of Act No. 455/1991 Coll. on Trade Licensing as amended and modified. HOLÚBKOVÁ, P. Kvalita života občanov vo vzťahu k formám poskytovaných služieb. In. MARCINKOVÁ, D. - HROZENSKÁ, M. - VAŇO, I. Vybrané kapitoly z gerontológie. Nitra : FSV a Z UKF, 2005, p. 94.
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effective from 1 January 2009. At present, the whole philosophy of providing social services and care in individual institutions and social care facilities has been changing. They have to be adapted to the new trends that are common in the developed countries of the European Union.69 ,,Act 448/2008 Coll. on Social Services defines social service as a professional activity, service or other activity or a set of such activities which are aimed at: preventing the occurrence of an unfavourable social situation, solving the unfavourable social situation or mitigating the social situation of a natural person, family or the community, preservation, restoration or development of the ability of a natural person to lead an independent life and to promote his or her inclusion in the society, ensuring the necessary conditions for satisfying the basic needs of a natural person, solving the crisis social situation of a natural person and family, prevention of social exclusion of a natural person and family.“70 ,,Social services are a special set of activities aimed at meeting individual or collective needs that are done in a different way than the transfer of material goods. This set of activities mainly includes activities focused on:
69
ONDRUŠOVÁ, Z. a kol. Základy sociálnej práce. Brno : MSD, 2009, p. 91. Act No. 448/2008 Coll. on Social Services and on the amendment of Act No. 455/1991 Coll. on Trade Licensing as amended and modified. 70
30
ensuring adequate living conditions for people who cannot deal with their own situation, creating appropriate conditions to prevent the occurrence or growth of negative social phenomena, creating supportive activities that will prevent the unfavourable social development of an individual, family or society.“71 Care in social care facilities is provided to a citizen who cannot be provided any other social services or the social or material need of that citizen is not sufficiently addressed.72 The whole system of social services has undergone changes in recent years, there has been a quantitative increase in the amount of social services provided until then, new methods and forms of working with senior citizens as well as new types of social institutions and facilities have emerged. We consider social services to be an extremely important part of the activities of the state, self-governing organizations or non-state facilities that solve the problems of the elderly and thus positively influence the social climate of the society. Social services are important not only because they are needed by a lot of people but because without their work, a significant proportion of citizens could not participate in all aspects of the life in the society, they would be prevented from exercising their human and civil rights, which would lead to their social exclusion. Social services are provided to citizens who need them because of their state of health or age and who, without the assistance of the society, would not be able to overcome their
71 72
TOKÁROVÁ, A. a kol. Sociálna práca. Prešov : FF PU Akcent Print, 2003, p. 478. DRAGANOVÁ, H. a kol. Sociálna starostlivosť. Martin : Osveta, 2006, p. 84.
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difficult social situation or unfavourable conditions. They include severely disabled persons and senior citizens.73 The position of an elderly person is given not only by the obligations and the prescribed privileges, but also by the respect and appreciation.74 Social services are specialized activities to address social needs and include: Nursing service. It is provided to a citizen in his or her unfavourable condition and when he or she needs help of another person in providing the necessary work in the household, necessary life actions or in ensuring contact with the social environment. Communal catering. It is provided to a citizen who cannot be catered for otherwise because of his or her state of health is dependent on communal catering and who is a retirement pension receiver. Transport service. A citizen is dependent on individual transport if he or she is unable to get in and out of a vehicle, rail or public transport and is unable to move to a means of rail or public transport. Care in social care facilities. Social care facilities are established by the municipality and the competent authority or by the self-governing region. Social care facilities provide care to people with disabilities, physical impairments, mental disorders, behavioural disorders, sensory disabilities. They are provided in cases in which other social services cannot be provided or they do not sufficiently address a social or material need, to a citizen receiving a retirement
73 74
KOZLOVÁ, L. Sociálni služby. Praha : Triton, 2005, p. 17. DRAGANOVÁ, H. a kol. Sociálna starostlivosť. Martin : Osveta, 2006, p. 124.
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pension that has an unfavourable health conditions, the family cannot provide ongoing care or cannot provide care for other serious reasons.75 A nursing care facility provides care to a citizen who is dependent on providing the necessary life services in accordance with the opinion of the competent authority. A senior citizens club creates conditions for cultural and interest activities and for maintaining the psychological and physical activities of a citizen who is a retirement pension receiver or a citizen in unfavourable health conditions. A senior canteen provides meals to citizens who cannot be provided meals otherwise, the condition is that they are retirement pension receivers and are dependent on communal catering for their unfavourable health conditions.76 All social services exist to protect people from social exclusion and to help them maintain their place in the society. To the maximum extent, they should help people live their normal lives, take care of themselves, of their household and of all the things that are perceived as self-evident until the moment when they are prevented in doing so by any event, condition or disease.77 ,,Social services for senior citizens are services for dealing with an unfavourable social situation due to severe disability, unfavourable health conditions or retirement age, which include: Facilities for natural persons who are dependent on the assistance of another natural person and for natural persons who achieved retirement age (housing support facilities, retirement homes,
75
DRAGANOVÁ, H. a kol. Sociálna starostlivosť. Martin : Osveta, 2006, p. 85-86. DRAGANOVÁ, H. a kol. Sociálna starostlivosť. Martin : Osveta, 2006, p. 88. 77 HAVRDOVÁ, Z. a kol. Hodnoty v prostŕedí sociálních a zdravotních služeb. Praha : Fakulta humanitních studií Univerzity Karlovy, 2010, p. 115. 76
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nursing facilities, rehabilitation
centres,
social
care
facilities,
specialized facility, day care centres). nursing service,
transport service,
guide service and pre-reading service, interpreting service, mediation of interpreting service, mediation of personal assistance, lending of aids.“78 Social care facilities, retirement homes and individual types of social care facilities provide services that aim to promote selfsufficiency and ensure the conditions for a dignified and active life. The target group is represented by people who due to health reasons or because of high age are unable to provide for their own needs in their environment and their situation cannot be solved with the help of the family or the use of terrain social services. Social care facilities are primarily intended for people who have reached the retirement age and who need comprehensive care for permanent health changes. Retirement homes provide social services to persons who have also reached the retirement age, but their state of health and age allows them to lead a fairly independent life in appropriate conditions.79 In all developed countries of Europe, a whole range of non-state organizations have been established that complement state social care for senior citizens. Some are charitable, some of them are profitable, but most of them are self-help, built on the activities of senior citizens.
78
Act No. 448/2008 Coll. on Social Services and on the amendment of Act No. 455/1991 Coll. on Trade Licensing as amended and modified. 79 KOZLOVÁ, L. Sociálni služby. Praha : Triton, 2005, p. 26.
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In Slovakia, many charitable facilities have been established, founded by the Catholic Church. Some self-help activities are partly developed by retirement unions. The category of activities belonging to the individual assistance activities of individuals to help reliant seniors in a traditional form covers voluntary engagement in social service groups and facilities. These self-help activities differ from a typical family care and a professional support provided in the state or private social care facilities. In Slovakia, the Association of Senior Experts (ASE) was set up associating experts in pre-retirement and retirement age and dealing with the elaboration of expert opinions on the required problems of senior citizens. From an international point of view, we can mention EURAG, a non-governmental, non-profit, non-political European organization that advocates the rights of senior citizens to shape their lives and their right to participate in the life of the society. It emphasizes that self-help is not a substitute but an important complement to professional health and social services.80 ,,Social service are provided in outpatient form, in terrain form, in residential or other form, according to the unfavourable social situation and the environment in which the individual resides. Outpatient social services are provided to a physical person who commutes, is accompanied or transported to the place of social services provision. The place of social services provision may also be a facility. Terrain social services are provided to a natural person in his or her natural social environment.
80
HEGYI, L. Vybrané kapitoly zo sociálnej gerontológie a geriatrie. Bratislava : IVZ, 1996, p. 67.
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Residential social services in the facility are provided if accommodation is part of social services. Residential social services are provided as all year-round social services or weekly social services. Providing terrain social services or outpatient social services takes precedence over residential social care. If terrain social services or outpatient social services are inappropriate, expedient or do not adequately address the difficult social situation of a natural person, residential social services are provided. As for residential social services, weekly social services are preferred over all year-round residential social services.“i When looking for a suitable social care facility for senior citizens, there are many factors that play a very important role. These include placing a senior citizen in a facility close to his or her family, maintaining friendly relationships in the original environment, acquiring new friendly relationships in the facility and the new environment. Other important factors include diverse activities offered by the facility, seniors’ state of health, a degree of dependence, independence or self-sufficiency, ability to plan new activities, address previous hobbies, grow hobbies from the previous life and organize life for a sense of satisfaction because they affect positive adaptation. Additionally, catering, social nursing and social care, medical care, staff attitude, religiosity, cultural and social activities are among the important factors influencing positive adaptation.81 However, the family continues to be the most reliable support of an older person in every situation. It can make a significant
81
KUFFOVÁ, J. 2009. Adaptácia v živote klienta v zariadeniach sociálnych služieb. In. Štvrtá medzinárodná konferencia FSVaZ UKF. Nitra, 2009, p. 397.
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contribution to adapting the older person to a social care facility and therefore contacting the closest relatives is very important. 82 It is also very important for senior citizens living in social care facilities to maintain relationships with their children. Then they are also satisfied that they have contributed to the happy life of their children.83 Working with the family offers a large number of choices, especially the assumption that social care institutions and facilities do not relieve the family of responsibility for caring for their relatives. The transition to a social care facility does not end family relationships, nor the obligations and rights of children towards their parents.84 Elderly care is currently multidisciplinary, multi-department and team-based, and is considered to be the issue of the whole society with the aim to preserve the health of senior citizens and their ability to live a quality and independent life in their natural environment as long as possible. The desire to be in a familiar environment and to preserve privacy has stimulated lately the development of intermediary and noninstitutional care. 85 The most important task in working with senior citizens is to work with trust and relationships, to create a sense of assurance and security, as it is one of the most basic needs of the elderly.86 Many elderly people and their family members do not know about these new options and therefore prefer to choose a classic form of
82
BARTOŠOVIČ, I. Seniori v domove dôchodcov. Bratislava : Charitas, 2006, p. 57. BALOGOVÁ, B. Seniori. Prešov : Akcent Print, 2005, p. 47. 84 MATOUŠEK,O. - KOLÁČKOVÁ, J. - KODYMOVÁ, P. Sociálni práce v praxi. Praha : Portál, 2005, p. 183. 85 DRAGANOVÁ, H. a kol. Sociálna starostlivosť. Martin : Osveta, 2006, p. 121. 86 KASANOVÁ, A. Sprievodca sociálneho pracovníka II. Nitra : Univerzita Konštantína Filozofa v Nitre, 2008, p. 150. 83
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care. Social and health workers as well as authorized representatives of towns and municipalities should provide more information about social care options and recommend appropriate care to improve the quality of life of the elderly.87 When deciding on the form and type of social services for seniors, it is necessary to rely on the kind of social services that a particular person needs in order to reflect his or her real needs. The social services provider, together with the user, is required to determine what needs in the social field the user has and which is best suited to him or her.
2.3 Facilities for senior citizens The issue of senior citizens is gradually coming to the attention of various organizations and institutions, the third sector and political subjects. The comprehensive institutional care of a multifunctional character about senior citizens in Slovakia and in the world is becoming more and more intense as the theme of the day. However, it remains questionable to what extent the care is done in favour of the senior citizens themselves. However, any progressive and forward-looking progress in institutional social and educational care for the elderly must be appreciated.88 Social facilities set up by municipalities and self-governing regions are referred to as public providers. Social facilities established by church organizations, civic associations, non-profit organizations or natural persons are designated as non-public providers. Both public and
87
DRAGANOVÁ, H. a kol. Sociálna starostlivosť. Martin : Osveta, 2006, p. 121. HATÁR, C. Inštitucionálna edukatívna starostlivosť o seniorov v Slovenskej republike. Nitra : PF UKF, 2005, p. 24 - 25. 88
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non-public social services providers have the same obligations towards applicants and recipients of services, citizens have the same rights in relation to them.89 ,,Social care facilities provide social services to: a natural person who has reached the retirement age and is dependent on the assistance of another natural person and his or her degree of dependence is at least IV, a natural person who has reached the retirement age and needs social services in the facility for other serious reasons. Facilities for senior citizens: a) provide: help in dependence on the assistance of another natural person, social counselling, social rehabilitation, nursing care, accommodation, catering, cleaning, washing, ironing and maintenance of laundry and clothing, personal equipment, b) create the conditions for the safe-keeping of valuable things, c) ensure interest activities.“90 ,,In a social care facility, social services are provided in form of weekly social services or as outpatient social services to a natural 89
WOLEKOVÁ, H. Potrebujem pomoc, čo mám robiť? Bratislava : SOCIA, 2010, p. 3. 90 Act No. 448/2008 Coll. on Social Services and on the amendment of Act No. 455/1991 Coll. on Trade Licensing as amended and modified §35.
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person up to the retirement age if he or she is dependent on the assistance of another natural person and his or her degree of dependence is at least V or to a physical person who is blind or virtually blind with the degree of dependence of at least III. Social care facilities a) provide: help in dependence on the assistance of another natural person, social counselling, social rehabilitation, accommodation, catering, cleaning, washing, ironing and maintenance of laundry and clothing, personal equipment, b) organize: work therapy, hobbies, (c) create conditions for: education, saving valuable things.“91 As the economic conditions of senior citizens change, the social conditions of their daily lives are changing rapidly and most often this is due to the changed conditions of family functioning. The distance between parents´ homes and the families of their children increases, thus reducing the possibility of taking care of one of the parents who is already dependent on such assistance. Changes in social and economic 91
Act No. 448/2008 Coll. on Social Services and on the amendment of Act No. 455/1991 Coll. on Trade Licensing as amended and modified §38.
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conditions put pressure on the development and search for new forms of institutionalized care for senior citizens. In this search for new options and methods, NGOs and civic associations focusing on seniority issues have an important role to play.92 Most elderly people want to spend the last stage of their lives among their loved ones, in their family circles, or in their own wellknown environment where they are able to adapt to new conditions. If, due to their age, health, loneliness or social circumstances, they are forced to give up their home, they must accept that they will become residents of some institution or facility and then their adaptation has the character of passivity, is forced by circumstances.93 The state and the society can provide seniors with accommodation, catering, medical care trying to fill the day with different activities, but cannot provide them with love, emotional background, the feeling that they are needed and that they have somebody to live for.94 In case of the loss of self-sufficiency of seniors, mostly under the pressure of the family and the environment, they are placed in a social institution. The vast majority of applicants for placement in social care facilities are people living alone, widowed and childless people. The most common reason for seniors to be placed in a social care facility is the loss of self-sufficiency due to deterioration in health and the fear that domestic care in their immediate neighbourhood will not be able to take adequate care of them. In recent years, one of the
92
MALÍKOVÁ, Ľ. a kol. Inovácie v sociálnych službách. Bratislava : Univerzita Komenského, 2007, p. 62. 93 HEGYI, L. Zlyhanie adaptácie vo vyššom veku. Bratislava : Asklepios, 1993, p. 53. 94 HROZENSKÁ, M. Sociálna práca so staršími ľuďmi a jej teoreticko praktické východiská. Martin : Osveta, 2008, p. 30.
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reasons is also related to the fear of job loss in the care of the sick in the home environment.95 Not every elderly person has to be the subject of social work, but one who lives alone and cannot provide basic subsistence for example due to his or her bad health. It is very important to choose a social service that will not restrict seniors. If seniors want to be over the weekend with their family, you should ask for them to be placed in a senior home for weekdays only. If seniors are alone and need help, you should ask for a home care service for the whole week, including Saturdays and Sundays. The law gives the right to demand a service that best suits the legitimate needs of seniors and guarantees their dignified life.96 Every change of the environment and admission to institutional care is a big change, causes some trauma in the life of the elderly. Admission to residential care institutions is for elderly persons connected with fear and they feel very sensitive about it.97 The society that is grateful to the elderly for its development must also realize its obligations towards this generation of citizens and create appropriate social services, appropriate facilities and institutions. It is necessary to provide the elderly with the possibility of living in their own apartment and the familiar environment by providing help around the home, by day care centres. In this context, the issue of residential care is very important. Seniors living in social care facilities,
95
SMOLEŇOVÁ, L. - DUŠEKOVÁ, N. - LOVÁSOVÁ, M. - FEJEŠOVÁ, M. 2000. Starostlivosť o seniorov z aspektu verejného zdravotníctva. Osme stredoerópske sympózium o sociálnej gerontológii. Bratislava : Charis , 2000. 96 WOLEKOVÁ, H. Potrebujem pomoc, čo mám robiť? Bratislava : SOCIA, 2010, p. 6. 97 KOTRADYOVÁ, K. - KALANIN, P. Rezidenciálna starostlivosť a jej formy. Ružomberok : PU KU v Ružomberku, 2008, p. 90.
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in the residential care setting, had to leave their home and should therefore feel as if they were in the family, should be allowed to practice activities according to their interests, and their personality and autonomy should always be respected. It is also very important to provide all the necessary care and the regime system should be open or semi-open.98 ,,Every institution of residential care which is a retirement home should make every effort to fulfil the needs of the elderly to the fullest extent. The principles of residential social work with seniors: take into consideration the heterogeneity of the older population (the difference between young and old seniors); integration of seniors into the society (not to create ghettos for the elderly); support of self-sufficiency, activities; support of education, activation; services must come to the elderly; emphasis is placed on ensuring safety and feeling of security (barrier-free, credibility); prevention of health and social problems; residential facilities to be built as part of the community.99 The basis of residential social work with seniors is to work with trust and relationship, to create a maximum sense of safety and security. An important role of a social worker in the transition of a senior to an institution is to prepare him or her for a fundamental 98
KOTRADYOVÁ, K. - KALANIN, P. Rezidenciálna starostlivosť a jej formy. Ružomberok : PU KU v Ružomberku, 2008, p. 91. 99 KOTRADYOVÁ, K. - KALANIN, P. Rezidenciálna starostlivosť a jej formy. Ružomberok : PU KU v Ružomberku, 2008, p. 92-93.
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change in life. A voluntary decision to stay in a social care facility is a good starting point for managing the adaptation process. Indicators of quality residential care for the elderly are the satisfaction of clients, their relatively good health, a lower consumption of health and social services, a lower consumption of medications and a decrease in morbidity.100 Seniors placed in a residential care facility must take on a number of important tasks and manage inclusion in a new community. They must interrupt the usual life style, change the life programmeme and give up their priorities. They come in contact with people with similar problems or people who are similar in terms of health. They are forced to adapt their behaviour and habits to the surroundings, to deal with the roommate. Seniors placed in a residential care facility lose the closest social support.101 The adaptation of seniors placed in a residential care facility takes place in several phases. Upon admission, the adaptation phase begins; seniors adapt to the new environment, meet the surroundings and the regime. In the second phase there is a confrontation with the environment when seniors seek to define their territory, it is a confrontational period. In the third socialization phase, seniors are gradually incorporated into the community of the residency. When the socialization phase runs smoothly, the cooperation phase comes. Seniors begin to work with the staff and the residents. This phase may or may not be followed by a phase of demotivation or apathy. The last phase is independence phase, in which preparation for the transition to 100
KOTRADYOVÁ, K. - KALANIN, P. Rezidenciálna starostlivosť a jej formy. Ružomberok : PU KU v Ružomberku, 2008, p. 91. 101 LABÁTH, V. Rezidenciálna starostlivosť. Bratislava : Občianské združenie sociálnej práce, 2004, p. 85.
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the natural environment occurs. Sometimes this phase does not follow.102 A continuing increase in the elderly forces every society in the world as far as possible and in line with the economic possibilities, to develop professional care as well as volunteering and humanitarian activity for the elderly. The whole society and every one of us should do something for the elderly. This is the only way to secure the human right to peaceful and dignified old age.103 Seniors can only adapt their personality to new changed living conditions, but they are not able to radically alter inherited and lifelong formed character traits. Many paths lead to satisfactory old age, but they all predict in principle a reduction in responsibility without a sad feeling of loss and confinement with constraints. Old age and a disorder of health disrupt man´s ability to meet in the desired range his own needs and the society´s requirements in terms of work activities of the family members, social contacts and self-sufficiency in everyday needs and activities.104 In Slovakia, social services are a means of providing social assistance for those who need them.105
102
LABÁTH, V. Rezidenciálna starostlivosť. Bratislava : Občianské združenie sociálnej práce, 2004, p. 85. 103 DRAGANOVÁ, H. a kol. Sociálna starostlivosť. Martin : Osveta, 2006, p. 145. 104 DRAGANOVÁ, H. a kol. Sociálna starostlivosť. Martin : Osveta, 2006, p. 126. 105 KASANOVÁ, A. Sprievodca sociálneho pracovníka II. Nitra : Univerzita Konštantína Filozofa v Nitre, 2008, p. 310.
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3 ADAPTATION OF SENIOR CITIZENS IN SOCIAL CARE FACILITIES
The word adaptation is of Latin origin and is usually derived from the Latin word ,,adaptare“, where ,,apto“, ,,aptare“ may mean to adjust, prepare (e. g. prepare for a journey), arm oneself to fight (by pruning weapons, armour and clothing) or prepare for some incoming life test. Its deeper meaning means being well prepared for what is waiting for us in the next period.106 ,,In the social context, social adaptation represents a change of behaviour and adaptation to the permanent or changing conditions and requirements of the society in which the individual lives. It is finding a place in a group or community in altered conditions. Social adaptation is dependent on many factors: on the size of the changes directly or indirectly relating to the client, on the client´s sociability and adaptability, on defence mechanisms and also on the social environment pervasiveness for the complex development of an individual. An important aspect of social adaptation is the acceptance of roles. Social adaptation is one of the basic mechanisms of socializing the personality and expressing the state of balance and the harmony of the client with the social environment.“107 ,,Adaptation is a general feature of organisms to adapt to the conditions in which they exist.“108 Adaptation of seniors in a social care facility depends largely on the motivation for their stay, their health, emotional momentum, the 106
KŘIVOHLAVÝ, J. Jak zvládať strep. Praha : Avicenum, 1994, p. 41. STRIEŽENEC, Š. Úvod do sociálnej práce. Trnava : AD, 1999, p. 187. 108 HARTL, P. - HARTLOVÁ, H. Psychologický slovník. Praha : Portál, 2000, p. 16. 107
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degree of disability, the degree of independence, personality assumptions, strategy to deal with stress and crisis situations, stress resistance, relationships with relatives, the size of the desire for home, managing an inconceivable situation or working with worker assistants. An important factor is the satisfaction with fulfilment of life, achievement of defined life goals, which also facilitates the willingness to cooperate with the environment. But the whole process also depends on the intervention of a social worker and the creation of adequate conditions for coexistence in the facility and its community. The longer the organism will be able to maintain a high level of adaptation, the longer it will live. Adaptation can be understood as the process of relationships between man and the surrounding world, the ability to control the environment by appropriate solution of situations, the ability to restore or acquire the inner dynamic balance of a person, to satisfy the needs in a manner appropriate to reality, a suitable form of interaction with the environment. Adaptation at a biological level can be understood as a process of adapting the organism to new changed conditions. At the psychic level, it is a person´s adaptation in opinions, actions, thoughts and attitudes. At the social level, it is the ability of a person to adopt certain norms in a given society. The socio-psychological level also manifests itself in the ability of persons to adapt to new relationships in a group without conflicts, without deviating in satisfying their own needs.109
109
KUFFOVÁ, J. 2009. Adaptácia v živote klienta v zariadeniach sociálnych služieb. In. Štvrtá medzinárodná konferencia FSVaZ UKF. Nitra, 2009, p. 395.
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Germain and Gitterman In: Levická defined adaptation process in the following way. „Adaptations110 are continuing, change-oriented, cognitive, sensory perceptual and behavioural processes that people use to maintain or enhance the level of consistency between them and their environment. Adaptations include environment-oriented actions (including moving to a new environment) or changing people themselves or both factors, and then adapting these changes and changes made to the environment (such as natural disasters or new social expectations) into the never-ending process.“
111
Here are some
of the participants responses to the adaptation: K7 „The facility was very difficult to get used to, but going back no“. K10 „It was difficult to get used to the roommates, I was alone and it took me a long time“. K4 „I got used to it hard because I had no one and no family“. We recall that the adaptation process takes place in a variety of ways, as we can see from the responses given by the participants. K5 „I feel good and I did not have a problem“. K8 „I have made a good decision. I had no problem“. K9 „I am fine here, I hope I will live long when they care so well about us.“
110
In terms of ecosocial theories, human life is understood as a series of more or less successful adaptations that are brought about by changes in individual human life. According to Křivohlavý, poor adaptation can cause mental and physical health disruption. According to Labat, in the adaptation process, we talk about socialization because seniors are socializing in the environment. 111
GERMAIN , C.B., GITTERMAN, A. 2011. In. LEVICKÁ, J. a kol.2012. Ekosociálne prístupy v sociálnej práci. Trnava : Oliva, 2012, p.9.
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According to Draganová (2006, p. 125) ,,Social adaptation is an interactive process of adapting to the changing social and material environment in which a senior citizen lives. It is a bio-psychobehavioural process of adapting an old person to a new status and a new role in the society - the role of a retired person. Retired people should have the right conditions to adapt to a new lifestyle, a new social status, a new status and a role to play in the community“.112 Socio-psychological adaptation is a process that is ongoing without pathological changes in the human structure and without breaking the standards in the group. Deviant adaptation is a process in which one satisfies his or her own needs in a way that is not consistent with the expectations of other people. Pathological adaptation is a socio-psychological
process
where
one
adapts
to
the
new
environment.113 Significant factors in the use of scientific knowledge also include preparing the senior to be able to adapt effectively to every changed, new or a difficult life period. This period may also be a positive period where it is possible to find space for different activities.114 It is not only the environment that affects the process of adaptation but also the acceptance of the senior in the society. Good social adaptation is needed at every stage of human life, but especially in the risk periods of a person´s life, including a higher age. Adaptation to the change of lifestyle including admission to social care facilities is
112
DRAGANOVÁ, H. a kol. Sociálna starostlivosť. Martin : Osveta, 2006, p. 126. KUFFOVÁ, J. 2009. Adaptácia v živote klienta v zariadeniach sociálnych služieb. In. Štvrtá medzinárodná konferencia FSVaZ UKF. Nitra, 2009, p. 395. 114 MALÍKOVÁ, E. Péče o seniory v pobytových sociálních zařízeních. Praha : Granada Publishing, 20011, p.24. 113
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a very difficult situation for the elderly, and appropriate social adaptation can prevent social problems of adaptation. 115 The word adaptation is also replaced by the word adjustment and social adjustment is the measure of all human relationships in the group.116 If certain behaviours and pathological norms that limit the possibilities of proper human formation exist in a certain environment or in a particular group, a maladaptation process is in progress, resulting in a person who can deal with his or her difficulties and problems at a lower quality level. Then maladaptation will be manifested by behavioural
disorders, delinquency,
criminality,
emotional and psychological disorders, inability to get on with other people, inability to respond adequately to certain situations.117 There are many problems coming with aging and old age which are related to adapting a person to new changed living conditions. Additionally, the length of the adaptation process depends on a number of factors and one of the factors is also the type of personality of a person.118 ,,M. Vagnerová distinguishes five basic types of personality of an older person in relation to the overall ability of man to adapt to old age: a person who genuinely accepts his or her old age and is optimistic and active,
115
HEGYI, I. Súčasné možnosti sociálnej geriatrie. Geriatria č. 3, 2003, p. 98-99. STRIEŽENEC, Š. Slovník sociálneho pracovníka. Trnava : AD, 1996, p. 235. 117 KUFFOVÁ, J. 2009. Adaptácia v živote klienta v zariadeniach sociálnych služieb. In. Štvrtá medzinárodná konferencia FSVaZ UKF. Nitra, 2009, p. 395. 118 HATÁR, C. Inštitucionálna edukatívna starostlivosť o seniorov v Slovenskej republike. Nitra : PF UKF, 2005, p. 37. 116
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a person who is realistic and reasonably optimistic but passive, a person who rejects the fact that he or she is getting old, a person who is both realistic and pessimistic, a person who resigns and is pessimistic.“119 The social environment in which seniors find themselves after retirement is very important. Fascinatingly, persons living in the countryside or in their own family are reconciled with aging more easily, because they are more burdened by duties, care of grandchildren and the household than persons living in the city or in some of the social care facilities.120 ,,Social adaptation is an interactive process of adapting to the changing social and material environment in which a senior citizen lives. It is a bio-psycho-behavioural process of adapting an old person to a new status and a new role in the society - the role of a retired person. Retired people should have the right conditions to adapt to a new lifestyle, a new social status, a new status and a role to play in the community. Acceptance of a new state can positively activate an elderly person in favour of his or her new life. However, this is not the case for any senior citizen who retires. In that situation we can talk of maladaptation, a negative adaptation that can lead to mental or social disorders.“121 The issue of senior adaptation to a social care facility is complex, because admission to the facility means accepting some negative features. In the community where seniors in social service 119
VÁGNEROVÁ, M. Vývojová psychologie. Praha : Portál, 2000, p. 447. HATÁR, C. Inštitucionálna edukatívna starostlivosť o seniorov v Slovenskej republike. Nitra : PF UKF, 2005, p. 37. 121 DRAGANOVÁ, H. a kol. Sociálna starostlivosť. Martin : Osveta, 2006, p. 125. 120
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facilities get, they are afraid of their integrity, want to be themselves, with their own values and inner world. It is very difficult for them to bear the lack of privacy. The consciousness of belonging to the group develops very slowly.122 ,,In higher age, a new type of adaptation develops, other than in the youth and adulthood. Adaptation is understood as adapting to new, altered or different conditions and circumstances.“123 A decisive milestone in a person´s life is retirement because it places great demands on the adaptive abilities of an aging person. It is associated with the limitation of social and working contacts, the change of the social status of the breadwinner and the change of the hierarchy of values of life. Each person is confronted with their ,,rest” in their own way. Scientific researches prove that women are ,,looking forward” to retirement, they are planning to help children with grandchildren, men are looking at it rather with fears that have a negative impact on their mental balance.124 ,,In case of a voluntary stay in a social care facility or a senior home, seniors pass through two phases: a phase of uncertainty and the creation of a new stereotype, a phase of adaptation and the adoption of a new lifestyle.“125
122
ŠTEFKO, A. Dôstojnosť človeka v starobe, chorobe a zomieraní. Trnava : Dobrá kniha, 2003, p. 103. 123 MARCINKOVÁ, D. - HROZENSKÁ, M. - VAŇO, I. Vybrané kapitoly z gerontológie. Nitra : FSV a Z UKF, 2005, p. 18. 124 POLEDNÍKOVÁ, Ľ. a kol. Geriatrické a gerontologické ošetrovateľstvo. Martin : Osveta, 2006, p. 36. 125 HATÁR, C. Inštitucionálna edukatívna starostlivosť o seniorov v Slovenskej republike. Nitra : PF UKF, 2005, p. 39.
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,,If seniors are placed in social care facilities against their own will, the adaptation process to the new socio-cultural conditions is accompanied by many problems and complications. The phases which seniors gradually go through resemble a child´s separation anxiety. The first phase is the phase of resistance when we can experience negative, aggressive or hostile behaviour towards other clients and the staff of the social care facility. However, it is necessary to understand this behaviour not as a pathological phenomenon but rather as a certain defensive reaction, the signal given by the older person to reveal their dissatisfaction with the involuntary placement in the facility. The phase of despair and apathy occurs when seniors find out that their resistance does not lead to any beneficial solution. Consequently, it can lead to the very resignation, the attenuation in life and apathy to others and to one´s own life. The last phase is the creation of a new positive feedback which usually occurs when the client establishes a new contact with clients or with the staff of the facility.“126 ,,Hegyi differentiated the adaptation process of seniors to a social care facility or a senior home into three periods: the expectation phase - this is a period beginning with the decision, filling in the application until the admission of the elderly to a social care facility, the adaptation phase - this period occurs after admission of a senior citizen to the facility and can last six months on average. Both phases are marked by stress and possible health complications from stressful situations
126
VÁGNEROVÁ, M. Vývojová psychologie. Praha : Portál, 2000, p. 448.
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that can lead to the so-called geriatric maladaptation syndrome. the phase of the subsiding stress response - this period is accompanied by an active and positive adaptation of seniors to new social conditions and lifestyle.“127 ,,In order to prevent similar psychosocial conditions and the aging process itself and thus to prolong the active life of seniors, it is necessary to thoroughly reflect and organize socio-andragogical work with an elderly person, that is the client of a social care facility.“128 The adaptation process is complicated and mostly long-term. Therefore, it is very important that a helping hand is provided to the elderly at the right time and in the right place to help them successfully and quickly overcome this life situation. Providing support can help not only to overcome this problem but also to stabilize the status of the elderly in the social system.129 ,,Researches show that the adaptive capacity of the elderly is decreasing due to altered living conditions in old age. Changing living conditions can cause stress mechanisms leading to failure to adapt and the development of a geriatric maladaptation syndrome. The WHO expert group on risk gerontone identified these groups of old people: very old persons, persons of higher age in one-person households, old women in particular lonely, old people living in institutions, old people living in isolation, childless old people,
127
ČORNANIČOVÁ, R . Edukácia seniorov. Bratislava : UK, 1998, p. 156. HATÁR, C. Inštitucionálna edukatívna starostlivosť o seniorov v Slovenskej republike. Nitra : PF UKF, 2005, p. 40. 129 HATÁR, C. Inštitucionálna edukatívna starostlivosť o seniorov v Slovenskej republike. Nitra : PF UKF, 2005, p. 40. 128
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old people suffering from health disabilities, old couples where one of the spouses is seriously ill, old people with minimal income.“130 Adaptation in higher age is conditioned by: a failure of adaptive mechanisms in higher age, altered living conditions in old age, altered functional status of the organism, polymorbidity and frequent complications. The aetiology of adaptive failure is chronic stress, with stressors being psychological, biological, and social. The clinical manifestation of adaptive failure in higher age is geriatric maladaptation syndrome. It is a manifestation of adaptive failure typical of a higher age and is based on chronic stress, usually a psychosocial stressor. Stress is the state of organism that is unable to adapt anymore and respond appropriately.131 The risk factors for geriatric maladaptation syndrome are biological or psychosocial factors. Biological risks include: a severe disease, incontinence, immobility or high blood pressure. The added biological risks are: alcohol, smoking, obesity, lack of physical effort, hypertension. Psychological risks are: a mental disorder, confusion, a passive attitude to life, a submissive type of personality. Social risks: a change of residence, a change of lifestyle, the threat of institutionalization, loss of a partner, life in isolation,
130
HEGYI, L. Klinické a sociálne aspekty ošetrovania starších ľudí. Trnava : Slovak Academic Press, 2001, p. 46. 131 Porov. HEGYI, L. Vybrané kapitoly zo sociálnej gerontológie a geriatrie. Bratislava : IVZ, 1996, p. 16.
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loneliness, loss of self-sufficiency, threat of dependence, a low income, a collapse of valid values, loss of the programmeme.132 ,,Geriatric maladaptation syndrome is a typical disease of people of higher age with a pronounced health-social character. It reduces the quality of life. It affects morbidity and mortality and increases the cost of caring for the elderly. The prevention consists of eliminating risk factors, early diagnosis and treatment of the present diseases, mental health concerns and depression treatment. The treatment, causal therapy is not possible because we cannot influence adaptive mechanisms.“133 The actual adaptation to the institutional stay takes place in three phases. The first phase is the expectation phase, it is time to decide and apply for the stay. The second phase is the actual adaptation that follows immediately after being admitted to the social care facility and takes about half a year. Both phases are marked by a stress response, a serious threat to life and health. These complications represent the clinical picture of adaptive failure. The third successive phase which is the result of the subsiding stress response and the psychosocial sphere passes until the acceptance of residence with manifestations of active adaptation.134 A clinical unit expressing an adaptive abnormality disorder in seniors of higher age is a geriatric maladaptation syndrome which is a symptom of adaptive failure that is typical of seniors of higher age and is based on chronic stress. Geriatric maladaptation syndrome is an 132
Porov. HEGYI, L. Vybrané kapitoly zo sociálnej gerontológie a geriatrie. Bratislava : IVZ, 1996, p. 16. 133 HEGYI, L. Vybrané kapitoly zo sociálnej gerontológie a geriatrie. Bratislava : IVZ, 1996, p. 17. 134 Porov. KRIŠKOVÁ, A. Profesionálne opatrovateľstvo. Martin : Osveta, 2010, p. 162.
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extraordinary danger to an older person who passes from home to longterm institutionalized care.135
3.1 Senior citizens before admission to social care facilities If an elderly person leaves home, such a loss is accompanied by a deep shock as well as a different long crisis. The biggest problem is to get out of this crisis and it is therefore necessary for this new situation to be taken with a certain level of balance. It is very important to be able to live fully again, even though the new life will seem poorer compared to the past. This period of sadness is a process in which a person has to cope with various life losses. Sometimes a person is settling very fast, sometimes it takes several years to settle.136 ,,According to Kubler-Rossová, we know the types of attitudes and survival among those in crisis. These attitudes include: Shock, denial Protest, revolt and anger Sadness, tingling, depression Admission and adaptation: A person who had the ability to express emotions begins to regain the loss and the pain slowly subsides. There is a taste for life again. They again feel joy from contact with other people, from new activities. They accept the fact that they spend the rest of their lives in a retirement home. They reconcile with getting old. However, accepting this fact does not mean to resign. But it is about adapting to the new situation. A person is being set up in a new 135
Porov. BARTOŠOVIČ, I. Seniori v domove dôchodcov. Bratislava : Charitas, 2006, p. 50-51. 136 Porov. MARCINKOVÁ, D. - HROZENSKÁ, M. - VAŇO, I. Vybrané kapitoly z gerontológie. Nitra : FSV a Z UKF, 2005, p. 98.
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life situation that allows him or her to live by presence, to plan the future, and to use the enriching experiences of the past.“137 A good survival of old age also depends on the ability to reassess the personal situation of seniors, to sensibly orientate in it, to identify with their new roles, boundaries, possibilities, to cope with their situation internally and then to plan other goals according to the conditions in which they find themselves. Some situations of seniors cannot be changed, but the attitude to them can change. Aging as an inevitable process does not happen from day to day. It comes gradually and thus gives persons the chance to prepare for it for a longer time. But in their youth, people were less aware of the fact that old age does not affect only others, but once we find ourselves in this period of life. If we look at old age from the point of view of an agitated life, then it is no wonder that the process of our own aging causes in us a sense of irritability, frustration or dissatisfaction. Each of us, to some extent, in our own creation at every stage of our life, by each action and by each idea, pre-portrays the form of our own aging process.138 We often hear the phrase that man is as old as he or she feels. According to most psychologists, old age behaviour begins when people are aware of an appealing physical and mental performance that begins to decline initially slightly but with an increasing age faster to the point in which they realize that they are no longer capable of doing their job and it is time to leave for the younger. The retirement day, or the expulsion from professional life, is a significant milestone. This
137
PICHAUD, C. - THAREAUOVÁ, I. Soužití se staršími lidmi. Praha : Portál, 1998, p. 33. 138 ČORNANIČOVÁ, R. Obohacovanie života starších ľudí edukačnými aktivitami II. Bratislava : Národné osvetové centrum, 2000, p. 42-48.
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important milestone could be the point in which old age begins from a social point of view.139 Old age survival depends largely on the psychic and physical availability of seniors, from their readiness to the final stage of their life, from the environment in which they will survive old age. Every person can prepare for old age already in the period of full life and work activity. People who have an idea of where, how, and with whom they want to spend their autumn years, respond more positively to the changes brought by this period, they are happier, more balanced, easier to live the livelihoods of life. What plays an important role in this period is a healthy family environment filled with respect, understanding and mutual love. A harmonious family environment affects the life of seniors positively. It influences psychological, physical and social balance.140 Older people represent a rapidly aging human population. Professionals from different professions are therefore concerned with the issue of aging human population. Gerontologists and psychologists are looking for the ways to improve the quality of life of the elderly, their health and well-being. Successful aging is not just a matter of good health which also enables older people to maintain mental and physical performance. An important role is played primarily by the socalled adaptive competence as a component of intelligent and creative
139
ČORNANIČOVÁ, R. Obohacovanie života starších ľudí edukačnými aktivitami II. Bratislava : Národné osvetové centrum, 2000, p. 113-118. 140 ČORNANIČOVÁ, R. Obohacovanie života starších ľudí edukačnými aktivitami II. Bratislava : Národné osvetové centrum, 2000, p. 106-108.
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behaviour. Prerequisite of successful aging is in creative attitude to mental and physical activities.141 We consider healthy aging as a complex whole consisting of several components. These include in particular proper nutrition and physical activity, lifestyle, a good ability to adapt to changed conditions, influences of the external environment as well as genetic factors.142 ,,The aging process is a natural, continuous biological process in which there are changes in the organism depending on the action of many external and internal factors. With age, the ability to adapt to ongoing changes is falling, which can lead to a psychosocial and biological adaptation failure. The specificities of adaptation in higher age are characterized in particular by the changed response of the organism to stress. The change occurs mainly due to characteristic factors of higher age: altered functional status of the organism, a failure of adaptive mechanisms, polymorbidity with more complications, a change of living conditions in old age. These factors altering the adaptive response of an older person cause under certain conditions, in the presence of risk factors of adaptation failure, a clinical manifestation of adaptation failure: geriatric maladaptation syndrome.“143
141
ČORNANIČOVÁ, R. Obohacovanie života starších ľudí edukačnými aktivitami II. Bratislava : Národné osvetové centrum, 2000, p. 27-30. 142 ČORNANIČOVÁ, R. Obohacovanie života starších ľudí edukačnými aktivitami II. Bratislava : Národné osvetové centrum, 2000, p. 101-103. 143 ČORNANIČOVÁ, R. Obohacovanie života starších ľudí edukačnými aktivitami. Bratislava : Národné osvetové centrum, 1994, p. 35-39.
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Many older people go into retirement unprepared, they cannot find any meaningful activity, many of them cannot accept their difficulties and illnesses, they lose energy, resist and are apathetic. Accepting an illness and difficulty does not mean to admit defeat, but it is a manifestation of adapting to new conditions. It is a manifestation of adaptation and an attempt to achieve the highest quality of life under changed conditions. As a result, the society needs to ensure a healthy lifestyle and healthy living conditions for the elderly.144 ,,The risks of adaptive failure are of a psychosocial and biological nature. The social risks include: loss of self-sufficiency or threat of dependence,
loss of a partner,
loneliness or life in isolation, a low income, the need for institutional care, a change of the environment, a change of lifestyle, a collapse of valid values, loss of the programmeme. The psychological risks include: states of confusion, a mental disorder, passive attitude toward life, a submissive type of personality. The most serious biological risks include:
144
ČORNANIČOVÁ, R. Obohacovanie života starších ľudí edukačnými aktivitami II. Bratislava : Národné osvetové centrum, 1994, p. 218-221.
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high age, presence of a serious disease.145 One of many risks in the senior´s life is also adaptation to the institutional form of life. Seniors often become stressed and it is said that stressors can be undesirable and unpleasant but also vice versa. 146 Stress according to Rheinwaldová means any pressure that forces us to adapt. Distress means pressure that has already exceeded the limits of our adaptability and thus causes harmful reactions, then leads to physical and mental disorders and illnesses.147 Distress should be acceptable and well-processed because it is associated with unsatisfying vital needs. It brings with it a negative survival and negative feelings such as fear and anxiety. It deprives the organism of an important energy, depresses, tires out, and is the cause of various pathological changes in psychic and the activity of an individual organism. Negative emotions exhaust a person and make the entire adaptation process more difficult. Therefore, positive eustress should be searched correctly and deliberately because it is connected with meeting vital needs, generating positive emotions and experiences such as vitality, happiness, health, joy, and thus contributes to overall psychological well-being and is an important aid to the process of adapting seniors to social care facilities.148 From the point of view of the length of stay of a senior citizen in a social care facility, an initial adaptation stage can be set apart in
145
ČORNANIČOVÁ, R. Obohacovanie života starších ľudí edukačnými aktivitami. Bratislava : Národné osvetové centrum, 1994, p. 35-39. 146 CUNGI, CH. Jak zvládat strep. Praha : Portál, 2001, p. 15. 147 RHEINWALDOVÁ, E. Novodoba péče o seniory. Praha : Grada, 1999, p. 85. 148 KUFFOVÁ, J. 2009. Adaptácia v živote klienta v zariadeniach sociálnych služieb. In Štvrtá medzinárodná konferencia FSV a Z UKF. Nitra, 2009, p. 395.
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which seniors are introduced to the new environment, the staff, the roommates, the atmosphere of the facility and its habits. At this stage, the caregiver´s role is to monitor the senior´s feelings, his or her orientation in the new space, the possible health risks arising in connection with the new unusual environment. Great attention is paid to building the senior citizen´s relationships to the roommates, helping to create the atmosphere of interest, understanding and mutual assistance and supporting conflict-free situations. It is a difficult stage and a good result or output is watching seniors´ interests in activities and their gradual integrating into them. At the stage after adaptation to a social care facility, a client´s biography can be used to explore their active interests, wishes, abilities and skills. A good result is the active participation of seniors and the design of integration activities for the future.149 Older people at a certain age have problems with selfsufficiency. Their dependence on others is increasing, especially in disease. It is not easy to learn to take on the role of a dependent person. Asking for help and accepting this role is considered by older people to be humiliating and degrading.150
3.2 Senior citizens in social care facilities Institutional stay represents risks that are, apart from the state of health, the type of disability or the age of the incoming individual, conditioned by an unfavourable situation, by the previous way of life, by mastering a new life programme with resonating ideas of dependence, helplessness, authorities, rights and obligations brought by 149 150
KRIŠKOVÁ, A. Profesionálne opatrovateľstvo. Martin : Osveta, 2010, p. 161. HAŠKOVCOVÁ, H. Fenomén stáři. Praha : Panorama, 1990, p. 99.
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this differentiated social environment associated with close contacts to people with similar situations and problems. 151 ,,The actual adaptation to institutional stay takes place according to Hegyi in three phases: 1. Expectation phase - represents the time period from the decision and application to the retirement home 2. Adaptation itself phase - comes immediately after being admitted to the retirement home and lasts for an average of six months 3. Subsiding stress response phase.“152 ,,The first two phases are marked by ongoing stress response with possible organ complications to psychic decompensation. During this period, the health and life of the individual are seriously endangered. These complications represent geriatric maladaptation syndrome. The third phase in the psychosocial sphere goes into accepting the stay in the retirement home with manifestations of active and positive adaptation. In case of an adverse development, adaptation stress can be overcome in the first six months of the stay in the retirement home, but with a transition to resignation with social disintegration
of
personality,
psychological
disorders,
suicidal
tendencies or organ failure indicating a prolonged form of adaptation failure, the culmination of which may be also a total body failure and death.“153 At the stage of a long-term residence in a social care facility, the caregiver focuses on the use of resources, the identification of reserves 151
LABÁT, V. Rezidenciálna starostlivosť. Bratislava : OZ SP, 2004, p. 87. HEGYI, L. Zlyhanie adaptácie vo vyššom veku. In. MARCINKOVÁ, D. HROZENSKÁ, M. - VAŇO, I. Vybrané kapitoly z gerontológie. Nitra : FSV a Z UKF, 2005, p. 99. 153 MARCINKOVÁ, D. - HROZENSKÁ, M. - VAŇO, I. Vybrané kapitoly z gerontológie. Nitra : FSV a Z UKF, 2005, p. 100. 152
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that a senior citizen has, but also on the use of resources from the surroundings. Students in primary or secondary schools located near social care facilities represent a resource that can be systematically and purposefully integrated into the plan of activities, e. g. a brief informal visit to the senior citizen. An interest in his or her daily activities can be a welcome diversion. On the other hand, students can form feelings of respect and humanity and both students as well as seniors improve the quality of life and manage the prevention of undesirable stereotypes. A good result is then the good orientation of seniors in the social events.154 Individual adapt with the help of their own adaptive mechanisms. They can be adapted in an appropriate and active way. They seek ways and means of overcoming adaptive difficulties, forming and growing relationships, verifying their possibilities, even with the help of an institution that is able to adequately saturate their needs and create prerequisites for providing support by the staff and other residents. They conform to the required rules and standards of the environment. If they show up defiance, protests, complaints or outrage of others, it can be an inappropriate adaptive response or a personality trait with which they respond to stressful situations. ,,Adaptation of each new resident requires a special, individual approach, observation and influence from the whole staff. In the first phase after admission to a retirement home it is necessary to avoid a passive and depressed attitude toward life while avoiding geriatric maladaptation syndrome. A differentiated approach to new residents must be based on the knowledge of their characteristics, habits and
154
KRIŠKOVÁ, A. Profesionálne opatrovateľstvo. Martin : Osveta, 2010, p. 162.
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interests. It is necessary to develop individual adaptive education programmes for every newly admitted person.“155 ,,Based on the research results from the past, there were identified three types of adaptation in social care facilities: a good adaptation - the residents of the facility are active and engage in all activities from the first days of their stay in the facility. They immediately form relationships with the staff and the roommates. They are satisfied, optimistic, enjoy meals, actively move around the facility and its surroundings and express interest in the events in and outside the facility, an appropriate adaptation - the residents of the facility do not show an active interest in the surroundings, but do not render it negative. The staff challenges are passively stacked and filled without interest. They do not engage in a conversation with the roommates, but they listen to the conversation. The meals are taken without taste and their mood is mostly pessimistic, a poor adaptation - the residents are not interested in the new environment, do not cooperate with the staff, are apathetic, depressed, complacent, accept meals only with compulsion, sit incarnate and refuse to perform any activity. With a good adaptation, the adaptation time does not exceed 6 weeks, while it lasts for 4-6 months with an appropriate adaptation and up to 12 months in case of a poor adaptation. The ability to adapt in old 155
MARCINKOVÁ, D. - HROZENSKÁ, M. - VAŇO, I. Vybrané kapitoly z gerontológie. Nitra : FSV a Z UKF, 2005, p. 100.
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people is conditioned by age changes as well as changes in physical and mental health, mobility and self-sufficiency.” 156 ,,According to Nováková and Šejvlová, the following main characteristics are typical of a good adaption: seniors work well with the staff, seniors are friendly to co-residents, seniors move around without a challenge, seniors are peaceful and balanced, seniors engage in the events of the retirement home, they have their own hobbies, they perform functions in the social organizations. Decreased and inadequate adaptation is characterized by the deterioration or absence of these characteristics.” 157 A specific area of socially oriented counselling is gerontological counselling providing specialized services to clients of higher age groups in the area of health, as well as in the social, psychological or legal areas.158 Gerontological counselling is based on the knowledge of gerontology, gerontopedagogy, mental hygiene of old age and aging with a supportive discipline that provides insights into the field of psychological counselling being gerontopsychology. Its main task is to delay aging and to seek ways to maintain as long as possible man´s mental liveliness, to compensate for the losses that are necessary, to 156
MARCINKOVÁ, D. - HROZENSKÁ, M. - VAŇO, I. Vybrané kapitoly z gerontológie. Nitra : FSV a Z UKF, 2005, p. 100-101. 157 NOVÁKOVÁ, H. - ŠEJVLOVÁ, J. K metodice sledování adaptace starších lidí umísteních do domova duchodcu. In. HROZENSKÁ, M. a kol. Sociálna práca so staršími ľuďmi a jej teoreticko-praktické východiská. Martin : Osveta, 2008, p. 85. 158 TOKÁROVÁ, A. a kol. Sociálna práca. Prešov : FF PU Akcent Print, 2003, p. 518.
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strengthen the ability of man to adapt to changes in one´s own organism, to strengthen man´s ability to adapt to changes in the surrounding world, to identify the means for extending the period during which a person is useful to their surroundings, their family and society.159 An important role is played by the memories and interviews of seniors with their loved ones about the events that took place in the past, thus giving the elderly a sense of security, assurance and love. The opposite of this is the need for seniors to adapt to new events, new things and new incentives, so that they do not become rigid in their attitudes and thus do not block the process of adaptation that is taking place inside of them.160 Current scientific evidence proves that aging already begins after thirty years of life, that aging is an individual process and that each person has their own aging rate that is influenced by the external influences and conditions of existence. Knowing to prolong active aging lies primarily in the art of knowing not to shorten it. Major factors in the life of the elderly include movement that contributes to the slowing down of aging processes, to happy social life, self-care and relocation.161 Relationships between residents of social care facilities are more neighbourhood than family relations. The people who live there are dependent on the services of others, the contact with the public is
159
TOKÁROVÁ, A. a kol. Sociálna práca. Prešov : FF PU Akcent Print, 2003, p. 519. 160 HROZENSKÁ, M. a kol. Sociálna práca so staršími ľuďmi a jej teoretickopraktické východiská. Martin : Osveta, 2008, p. 21. 161 LABUDOVÁ, J. 1994. Edukatívne formy v telesnej kultúre starších a ich pohybová aktivita. In. ČORNANIČOVÁ, R. Obohacovanie života starších ľudí edukačnými aktivitami. Bratislava : Národné osvetové centrum, 1994, p. 53-58.
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very small. The world previously culturally and socially highly differentiated has narrowed down on the elderly, the home residents and the workers of the facility. With regard to the difficulty of the features of institutional life, there are also several degrees of adaptation of the residents of social care facilities: adapting to external behaviour - to adopt the daily regime, to comply with the rules of the home order and the desirable forms of behaviour. Seniors are still connected with emotional relationships with the people from outside where they came from and those in the home are new or strange. internal adaptation, when seniors are used to the people in the home, are able to come up with them, link with emotions, are interested in them, but in the spirit are still at home, are sad about the people and values that they left behind. adaptation continues, links to the people and the outside world are weak, and the bond to people and values in the home is strengthened, but the first bond still prevails. finally, rooting and domestication is already taking place, the bond to home, the environment and the people becomes so strong that seniors do not want to go away, they no longer miss the people from outside the facility. Of course, seniors are very happy to see those people when they come, and also enjoy visiting their native home, but then seniors like to return to the social care facility, because they feel there at home. This occurs in seniors who are long-term residents, who have nobody outside or to whom none of their closest relatives behaved badly and 69
who found in the social care facility understanding and friends who they do not want to lose.162 After relocating to social care facilities we can observe in the elderly typical anxiety reactions, aggravation of health problems, a lack of appetite, sleepiness, attenuation of behaviour, unwillingness to communicate with the environment, increased frequency of death, which suggests that their adaptation is very difficult.163 A long-term stay in a social care facility is a serious interference with the fate of seniors that will often permanently affect their next life and may also have a meaning of a life sentence. By moving to a social care facility, seniors leave their home and habitual lifestyle. Changing the environment, changing the diet, their daily routine or the social climate with their relationships and problems can result in a loss of feeling of assurance and security. Seniors face a serious question about how to handle and adapt to their new situation, how to create acceptable co-existence conditions or how to organize free time, because the degree of adaptation of seniors to the new conditions will influence their next life. During adaptation, seniors fight with multiple stressors at once. On the one hand, it is the departure to the social care facility, the unknown environment and the unknown situation. It takes time for seniors to develop the necessary way of adaptation and managing loneliness. If seniors accept the state and fight only with what can be changed and do not have a strategy of struggle, they seek a help from outside that will replace the lacking resources of their forces and possibilities, they will identify and avoid those factors that are
162
ŠTEFKO, A. Dôstojnosť človeka v starobe, chorobe a zomieraní. Trnava : Dobrá kniha, 2003, p. 104. 163 MATOUŠEK, O. Ústavní péče. Praha : Slon, 1995, p. 73.
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increasing the burden (excessive sticking to the self- attitudes that I will never get used to it) and will discover the things what they are and not what they perceive at the moment and get rid of them (better awareness of the benefits of living in a social care facility), they would not survive in the home environment.164 It is important to cultivate a way that strengthens resilience (to change the ranks of values, to change the previous lifestyle), to learn to look for existing resources and to actively use them (enjoyment from work, the pleasure of trying to create an acceptable form of existence, the joy of some activities). If seniors do not accept the situation they fight with, even if it is invariable, or they accept it passively, even if something can be done with the existing state. The adaptation of seniors in social care facilities is an individual matter.165 The adaptation process is being entered by numerous factors of different weight and ratio such as the number of children and their visits, the type of previous work, the place of housing, departure for a weekend, but also the characteristics of personality such as communicativeness, religiosity and openness. Other factors include information about the facility, social and health care, social climate, possibility and willingness to implement different activities and social life. 166
164
KUFFOVÁ, J. 2009. Adaptácia v živote klienta v zariadeniach sociálnych služieb. In. Štvrtá medzinárodná konferencia FSVaZ UKF. Nitra, 2009, p. 395. 165 KUFFOVÁ, J. 2009. Adaptácia v živote klienta v zariadeniach sociálnych služieb. In. Štvrtá medzinárodná konferencia FSVaZ UKF. Nitra, 2009, p. 396. 166 BARTOŠOVIČ, I. Seniori v domove dôchodcov. Bratislava : Charitas, 2006, p. 160.
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Placement in social care facilities is a major change in life and lifestyle, so the focus of the entire adaptation process must always be on seniors and not on the interests of the social care facility.167 Adaptability of seniors depends on their psychological and physical condition, their motivation for admission, the readiness for a new
situation,
the
awareness
of
the
facility,
willingness,
involuntariness, the attitude towards living together, their ability and willingness to adapt. If seniors have opted voluntarily for a stay in a social care facility or if circumstances have been imposed, the situation could not be resolved otherwise and their attitude to living together is not negative, the adaptation is proceeding in a gradual and positive direction. The mood of seniors is balanced and their behaviour is balanced and peaceful. Seniors do not feel any signs of violence and are active, express interest in the surroundings and the roommates, cooperate with the staff, build new friendships, participate in the events of the social care facility, accept meals and go to group events, adaption takes a short time.168 More complex types of personality and distinctive individuals with a positive attitude towards such type of living together are adapting for a longer time. Activities and cooperation with the staff and the environment are only at the challenge level. Seniors are sometimes subject
to
sadness,
nervousness,
depression,
irritation,
their
psychological well-being is unbalanced, approach to meals is influenced by mood, they do not have hobbies, they neither care about
167
MATOUŠEK, O. Sociální péče v praxi. Praha : Portál, 2005, p. 352. KUFFOVÁ, J. 2009. Adaptácia v živote klienta v zariadeniach sociálnych služieb. In. Štvrtá medzinárodná konferencia FSVaZ UKF. Nitra, 2009, p. 395. 168
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the activities in the facility nor do they refuse them, they need stimulus from outside, from their family, the staff or the community.169 Involuntarily placed or explicitly dissatisfied seniors, either because of a negative attitude towards such type of living together or the sense of committing violence on their person, show signs of negative adaptation. The mood of seniors is aggressive, apathetic or depressed. Seniors do not show any signs of activity, do not cooperate with the environment or the staff, reject their relatives, do not have any hobbies, refuse meals, invoke conflicts and do not participate in the events of the facility. If they do not get help in a short time, distress will endanger their biological and social existence, which can cause the process of adaptation to end with a disease, a complete social isolation or death. In the best case, seniors may be treated or returned to the family. More intensive care should be given to senior citizens especially in the first days weeks of staying in the facility and to seniors who need it for a longer time, sometimes up to one year of stay.170 The first days of the senior citizen´s stay in social care facilities place great demands on the moral qualities of the staff and their expertise, assume a high level of moral awareness and responsibility of the people looking after this risk group. An employee who cannot adapt to seniors and their real needs can hardly cope with stress arising from the senior´s placement in social care facilities. Consequences of adaptation failure can be stopped or prevented by early diagnosis, clarification and finding of its cause, a long-term observation, monitoring, correct infiltration at the point of crisis and 169
KUFFOVÁ, J. 2009. Adaptácia v živote klienta v zariadeniach sociálnych služieb. In. Štvrtá medzinárodná konferencia FSVaZ UKF. Nitra, 2009, p. 396. 170 KUFFOVÁ, J. 2009. Adaptácia v živote klienta v zariadeniach sociálnych služieb. In. Štvrtá medzinárodná konferencia FSV a Z UKF. Nitra, 2009, p. 397.
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prevention. Respect for the elderly also involves the confidence that the senior citizen is strong enough to knowingly deal with and overcome the difficult situation. Such an approach will create the conditions for an increased quality of life for the elderly and a chance to overcome an inadequate difficult situation and will serve to gain a lost inner balance due to strong stress.171 An individual plan to assess the health and psychological state of seniors, their self-estimation and needs, setting goals to improve the state of the art (psychotherapy, activities, family contacts adjustment, rehabilitation, nutrition, improvement of relationships), time for achieving goals, tasks for the team members, a regular evaluation of the progress of achieving goals, of making changes and of active participation of seniors to improve their situation.172 A helpful and active approach of the staff can help seniors to reconcile with the situation, so social work as one of the forms of social assistance in adapting seniors must be done in a good way, based on mutual relationships and trust between the senior citizen and the social worker. Social work must not forget the importance of individual phases, where the role of the first phase is to avoid the passive and depressive position of seniors to life, to differentiate each senior citizen according to their characteristics, interests, lifestyle, and then to develop an individual adaptation and educational plan.173
171
KUFFOVÁ, J. 2009. Adaptácia v živote klienta v zariadeniach sociálnych služieb. In. Štvrtá medzinárodná konferencia FSV a Z UKF. Nitra, 2009, p. 397- 398. 172 MATOUŠEK, O. Sociální péče v praxi. Praha : Portál, 2005, p. 352. 173 HROZENSKÁ, M. Sociálna práca so staršími ľuďmi a jej teoreticko-praktické východiská. Martin : Osveta, 2008, p. 181.
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Satisfying needs in the adaptation process They represent an important space for a social worker who knows the clients with whom he or she works, but also their unfavourable situation. Maslow´s hierarchy of needs is grouped into five categories according to the degree of urgency of their satisfaction. According to Maslow, the highest level is self-actualization, but also life satisfaction, spiritual needs and morality. They are followed by recognition, selfesteem, success, respect, intimacy, dignity, activity, self-sufficiency, competence and education. On the third level there is love, fellowship, friendship, belonging and standing in a certain group. On the second level there is access to resources, assurance and moral security, selfsufficiency, care, health and orientation in life. Physiological needs such as breathing, excretion, regulation of body temperature, water, sleep, food, sexual intercourse, pain, even though they have been ranked at the lowest level as a category, they are the first priority of satisfying because people spend most of their time seeking to satisfy them. If they are not satisfied, other needs also cannot be satisfied. For the disabled, the sick senior citizens, it is vital to satisfy their physiological needs not only during the adaptation process. Particular attention should be paid to pain that reduces the quality of life, limits daily life activities, causes conflicting situations, causes depression, reduces the chance of normal adaptation and socialization. It also raises the need for other types of care.174 Psychological needs can also be compensated by physiological needs. For example, „a person who feels unloved interprets this emotional deficiency as a physiological need 174
BARTOŠOVIČ, I. Seniori v domove dôchodcov. Bratislava : Charitas, 2006, p. 123.
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and overeats.“175 When identifying needs, the social worker may not omit this fact because it can point out that the individual is experiencing the crisis. Complications during adaptation can also be caused by damage to the sensory organs, which can cause anxiety, fear and isolation.176 Equally important is the satisfaction of psychological needs. The need for assurance and security also includes adequate economic security. A lack of financial means raises fears of the future. Loss of physical security is associated with loss of self-sufficiency, leading to isolation. The need for love and compassion is the most natural need of man. Furthermore, other needs include the need for autonomy, recognition, seriousness, appreciation and self-sufficiency. In the social care facility, support for autonomy can also be undertaken by the caring staff by motivating an individual to carry out various day-to-day activities for his or her benefit, but also for leisure and therapeutic activities, which can also prevent adaptive crises. 177 The need for self-realization is associated with the feeling of recognition, which is important for a satisfying life, based on the search for an adequate way of life that brings satisfaction. Needs are the basis for individual development, formulation of activities, ways, methods of work, expected results and planning of interventions in social care facilities.
175
KOZOŇ, A. a) Psychológia osobnosti v socializácii. 1. vyd. Trenčín : SpoSolnE, 2009, p. 92. 176 KLEVETOVÁ, D. - DLABALOVÁ, I. Motivační prvky při práci se seniory. Praha : Grada, 2008, p. 174. 177 KOZOŇ, A. b) Sociálna práca s rizikovým klientom. 1. vyd. Trenčín : SpoSolnE, 2009, s .22.
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3.3 Activities contributing to adaptation to social care facilities, findings and recommendations ,,In accordance with the Short Dictionary of the Slovak language, activity is understood to be an increased action; to activate = to encourage, to encourage more activity; to state, to operate.“178 It is very important for seniors to spend leisure time meaningfully as they are a group of people who have enough free time but who use it very inefficiently for their benefit. People who prepare activities for seniors to spend their free time must include the part of the day that seniors use according to their interests for self-education, culture,
recreation,
entertainment,
interest
activities,
volunteer
education, voluntary socially beneficial activities and time losses associated with these activities. 179 Individual activation and integration is understood as the coordination of caregivers and seniors in professional practices aimed at achieving the optimal level of mental and physical activities in the elderly, taking into account their life experiences, current possibilities and abilities to create conditions for quality and dignified everyday life in their natural environment. The natural environment of the senior citizen can be an apartment, a family house or a social care facility. The procedures are focused on engaging in activities that make every day life more pleasant and enriching and that have a preventive character, e. g. exercising fine motor skills in hands, exercising memory, attention, thinking, and at the same time preventing boredom, monotony, 178
KRIŠKOVÁ, A. Profesionálne opatrovateľstvo. Martin : Osveta, 2010, p. 156. BURSOVÁ, J. Adaptácia seniorov na starobu a nové sociokultúrne podmienky v domovoch sociálnych služieb. In. Nové aspekty v sociálnej práci I. Zborník príspevkov z medzinárodnej vedeckej konferencie konanej na Teologickom inštitúte v Spišskom Podhradí v apríli 2009. Ružomberok : VERBUM, 2010, p. 167. 179
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lacklustre routine institutional life, isolation or inactivity. They are focused on an individual, a couple, a group, partners, partnership associations and its essence is the positive life experience of seniors, optimism, humour and expectation of nice moments.180 With aging process and old age there are associated a number of problems related to adapting a person to new changed living conditions, and also the adaptation process to change depends on the type of person and on the overall ability of a person to adapt to aging and old age. 181 Spending time with prayers, singing and listening to religious songs, reading the Bible, mediating participation in the holy mass transmitted by the radio, blessings of the Holy Father from the Vatican and other kinds of religious rites are some of the most important activities that are part of an individual plan for seniors in social care facilities.182 An important role is naturally played by the environment in which seniors are located. Experts believe that reconciliation with aging and old age is easier for seniors living in the countryside or in their own family because they are more burdened by duties, care for grandchildren, their household or garden than for seniors living in the city.183
180
KRIŠKOVÁ, A. Profesionálne opatrovateľstvo. Martin : Osveta, 2010, p. 156. BURSOVÁ, J. Adaptácia seniorov na starobu a nové sociokultúrne podmienky v domovoch sociálnych služieb. In. Nové aspekty v sociálnej práci I. Zborník príspevkov z medzinárodnej vedeckej konferencie konanej na Teologickom inštitúte v Spišskom Podhradí v apríli 2009. Ružomberok : VERBUM, 2010, p. 164. 182 KRIŠKOVÁ, A. Profesionálne opatrovateľstvo. Martin : Osveta, 2010, p. 166. 183 BURSOVÁ, J. Adaptácia seniorov na starobu a nové sociokultúrne podmienky v domovoch sociálnych služieb. In. Nové aspekty v sociálnej práci I. Zborník príspevkov z medzinárodnej vedeckej konferencie konanej na Teologickom inštitúte v Spišskom Podhradí v apríli 2009. Ružomberok : VERBUM, 2010, p. 165. 181
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When working with seniors in social care facilities, it is also important to select appropriate activities: cognitive therapy (memory training, orientation, training of basic skills), physical exercise in the group, individual physiotherapy, basal stimulation, interest activities, listening to music, artwork, handicraft, group therapy focused on memory training, helping to improve and enhance the environment of the social care facility, reminiscence therapy, social games, cultural and theatrical events. Social activities also have side effects. Seniors improve the ability on which the activity is focused while at the same time gaining better control over their body or memory and thereby improving their mood. Many activities are carried out in a group, with the senior citizen being acquainted with other home residents, seeing that other people have similar problems and gaining confidence in the helping staff. Programmes are always selected for a particular group of senior citizens. The activities are voluntary; the programme is formed in cooperation with the elderly and their family members. The family can provide us with valuable information about the senior´s hobbies in the past.184
184
VENGLÁŘOVÁ, M. Problematické situace v péči o seniory. Praha : Grada Publishing, 2007, p. 47.
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,,An integral part of every educational process are educational methods without which it would not be possible to fulfil the goals of the education of senior citizens. .“185 A suitable activation programme includes: Reflecting the course of the day and the activities, we focus on how seniors spent the day, what they ate, who they met and so on. We then complement the information properly, we do not confront. Memory support activities. We ask for news in the newspaper or on the radio, for the plot of the film they saw. We include activities that require cognitive functions. Here are appropriate social games. Together with seniors, we plan the tasks that they can handle over the day and in the evening we sum up whether and how the tasks have been accomplished. We will always appreciate the effort of seniors. We use everyday activities to train, let seniors prepare things for their hygiene and for dining.186 Educational activities or programmes should be varied and their implementation should be within some components of education. A social care facility should offer its clients the opportunity to choose from a wide range of interest activities. moral education of seniors: activities of moral, philosophical, religious and world-conscious character, aesthetic education of seniors: activities of cultural artistic and aesthetic character, 185
HATÁR, C. Inštitucionálna edukatívna starostlivosť o seniorov v Slovenskej republike. Nitra : PF UKF, 2005, p. 77. 186 VENGLÁŘOVÁ, M. Problematické situace v péči o seniory. Praha : Grada Publishing, 2007, p. 48.
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ecological and environmental education of seniors: activities of natural and naturalist character, work and polytechnic education of seniors: activities of work
and
technical
and
information
technology
character, physical and health education of seniors: activities of physical education, sports health and tourism, intellectual education of seniors: activities of socialscientific,
linguistic,
cognitive
and
knowledge
character.“187 Younger generations wait for experiences and knowledge of the elderly and they would even be lost without them. The history of human activity is a continuous chain. It is a generational relay in which the ,,torches” of the experienced are passed to the less experienced. The claim that inactivity can have pronounced negative consequences for the aging and elderly is true. Inactivity at an advanced age can be a ,,trigger mechanism” for an unsustainable decline process that, if started, can be difficult to hold. Inactivity leads to a reduction in overall morale, which often leads to depression and sometimes to a collapse of the personality psyche. Life-long activity, whether psychological or physical, can slow down functional aging.188 The following types of educational activities are offered to achieve the objectives of moral education in seniors: spiritual exercises
187
HATÁR, C. Inštitucionálna edukatívna starostlivosť o seniorov v Slovenskej republike. Nitra : PF UKF, 2005, p. 82. 188 BURSOVÁ, J. 2010. Adaptácia seniorov na starobu a nové sociokultúrne podmienky v domovoch sociálnych služieb. In. Nové aspekty v sociálnej práci I. Zborník príspevkov z medzinárodnej vedeckej konferencie konanej na Teologickom inštitúte v Spišskom Podhradí v apríli 2009. Ružomberok : VERBUM, 2010, p. 169.
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and seminars, pastoral activities, participation in worship, pilgrimage tours, reading of religious and philosophical literature, self-advocacy training, assertiveness and empathy training, philosophical discussions, preparation
of
proposals
for
solving
moral
problems
and
sociopathological phenomena in the society. Spirituality has a serious significance in the lives of seniors because many seniors find hope and a sense of their being in God, in the spiritual sphere. That is why we consider representation of religious activities in social care facilities and retirement homes to be beneficial and relevant.189 The purpose of the activities of aesthetic educational and cultural artistic character is to teach seniors to perceive the beauty around them and to bring them to the very creation of aesthetic values. In social care facilities, these activities could be featured under the interest clubs such as amateur theatre, visiting theatre performances and games, joint reading of excerpts from literary works, singing in the choir, singing, individual playing a musical instrument, various concerts in social care facilities, or retirement homes, outdoor concerts, singing in churches, social dance classes, dance folklore, gymnastics, light athletics, modelling, amateur film, amateur photography, art, visiting exhibitions and galleries.190 Seniors in social care facilities can work in nature conservation and environmental services where they can use some nature-oriented activities such as walking in nature or in a forest, instructional walkways, working in the garden or the park as part of the facility,
189
HATÁR, C. Inštitucionálna edukatívna starostlivosť o seniorov v Slovenskej republike. Nitra : PF UKF, 2005, p. 82. 190 HATÁR, C. Inštitucionálna edukatívna starostlivosť o seniorov v Slovenskej republike. Nitra : PF UKF, 2005, p. 84.
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watching nature television programmes, visiting protected natural sites and flower care. An elderly person who was used to working outside often feels useless inferior and can therefore make a good use of activities such as manual work, repairing broken objects or instruments, woodcarving, working with clay. The priority mission of health and physical education of seniors is, among other things, the formation of a positive attitude to movement and sport and the formation of a proper lifestyle maintaining the intellect of seniors in certain vitality, and thanks to physical activities ensures a relatively good physical condition and physiological vitality of the older person. Here we can mention activities such as morning joint exercises, nutrition classes, walks, meditation exercises, hiking, healing and rehabilitation education or professional training with doctors. In order to develop the intellectual personality of seniors in social care facilities, seniors can use activities such as social evenings linked to the discussion of current issues that are affecting seniors, informative lectures by experts on selected topics that seniors are interested in, rhetorical exercises aimed at developing communication skills and social competencies, memory training, reading of professional books and periodical press, competitions to test knowledge, quizzes, playing social games, participation of seniors in joint meetings, sessions and trips together with children. Through such activities, it would be possible to re-mobilize the inner strengths of
83
seniors and their personal potential in order to re-engage in the active survival of old age in social care facilities.191 It is very important to realize that programmes should be targeted by the interests and the requirements of senior citizens. This means, above all, the provision of social and cultural events, group trips, excursions, tours with cultural and cognitive themes, arranging of dance performances as well as educational programmes or riddle competitions, which serve to preserve the quality of life, promote the self-confidence of the elderly and prevent loneliness in the period of aging and old age. In creating a quality programme, it is therefore important at least once a year, preferably every quarter a year, to continually evaluate the activities offered in the social care facility and respect the wishes of senior citizens.192 Seniors also need to encourage their interest in incoming visits and to prepare small refreshment for visitors. Activities concentrate on preparing the space to receive visitors as well as on preparing seniors to receive visitors. These are also activities that help to develop selfrespect, awareness of their own abilities, resources, participation in social life and quality of everyday life.193 An important factor is the cooperation with the city council and the founders of social care facilities in order to provide or support social, cultural and sporting events for senior citizens. The most common leisure-time activities currently include nature, hiking, gardening, lighter physical activities, travel, but in most cases these
191
HATÁR, C. Inštitucionálna edukatívna starostlivosť o seniorov v Slovenskej republike. Nitra : PF UKF, 2005, p. 93. 192 BALOGOVÁ, B. - ŽUMÁROVÁ, M. Medzigeneračné mosty. Košice : Menta Media, 2010, p. 28. 193 KRIŠKOVÁ, A. Profesionálne opatrovateľstvo. Martin : Osveta, 2010, p. 166.
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activities are mostly geared towards self-sufficient or partially selfsufficient people. Group activities are also preferred. However, individual activities have a minimum of opportunities.194 In general, organized activities, in particular group activities, are carried out in the premises designated for this purpose: a social room, a rehabilitation room, a chapel or a workshop. However, many activities are carried out in the client´s room, especially if for poor health it is not possible to transfer senior citizens to other social rooms. Social care facilities usually have single, double, triple and sometimes multi-bed rooms.
However,
each
arrangement
has
its
advantages
and
disadvantages when compiling and implementing an individual plan of activities and integration. A single-bed room provides privacy, personalized daytime imagery, concentration without disturbing influences, the possibility of individual arrangement of items of personal need and items related to religion, religious creeds such as crosses, candles or sacred images. Multi-bed rooms in turn allow senior citizens to play games, to have fun in a couple, a trio, to create cooperative relationships, support, understanding, talking, memories, but there are also conflicts, quarrels, scams and misunderstandings.195 Finally, good health and self-sufficiency in day-to-day operations are the most important values for elderly people of higher age regardless of the environment in which they are found, whether family or institutional. In the context of the empirical research and based on the demographics of the current state of the increasing number of senior
194
BALOGOVÁ, B. - ŽUMÁROVÁ, M. Medzigeneračné mosty. Košice : Menta Media, 2010, p. 62. 195 KRIŠKOVÁ, A. Profesionálne opatrovateľstvo. Martin : Osveta, 2010, p. 162.
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citizens, we have identified how senior citizens depend on social care facilities and how adaptation is taking place. We consider it important to develop a senior personality and assist seniors in the adaptation process in order to adapt more easily to social care facilities and to adapt to life in social care facilities without any major problems so that the elderly could spend their autumn years in love, respect and understanding. This issue is current because it will sooner or later touch us too as we all will once become senior citizens. 500 residents in social care facilities participated in the quantitative research and 10 respondents participated in the qualitative research. We found out how participants can adapt to changes in living conditions and the environment, what reasons they had for admission, whether they liked their facilities, what the care there was, whether they were missing something, how they felt and what problems or worries they had. By applying the exploration method, we determined, processed and evaluated the information based on the questionnaire. However, personal visits to social care facilities were essential in processing and implementing the research. The questionnaire was aimed at identifying the adaptation of senior citizens to new socio-cultural conditions, to the changed environment, to the changed living conditions, to the new roommates and to a regular daily regime. Other areas of our interest covered circumstances of moving senior citizens from a familiar environment of their own family and friends or if admission to the facility was their own decision or the decision of another person, what reasons or causes they had for moving to a social care facility and so on. We were also
86
interested in how the elderly managed to adapt to the new changed environment. A questionnaire belongs to the ,,simplest methods“ of capturing public opinions. It respects the anonymity of the respondents, the time perspective, allowing for quick answers to questionnaire information. The questionnaire we used contained 18 questions and the interview contained 6 questions regarding the adaptation of senior citizens. The responses of the participants are shown on a continuous basis and the most important findings include: „A very well-known proverb says that an older tree that has deep roots is hard to replant” and so are older persons who are accustomed to their house and their own familiar environment in which they lived all their lives. Nevertheless, we have come to the conclusion that elderly people who have been prepared to change the environment, have more often thought of such an alternative to the survival of old age in some kind of facility, whether for their health, mobility, or for not burdening their children, did not consider admission to a social care facility to be a big shock or a great change. They did not look for negatives at the facility, but they have highlighted the positives that they are among people with similar fates, they are not alone. The residents who were not prepared for such a change and suddenly widowed, did not have anybody to care for and their health status significantly worsened, tolerated harder to leave for a social care facility, harder to adapt, did not communicate, were reserved, refused the staff support and were angry at their relatives. Most elderly people would like to spend their autumn years in their family circles, with their children, their grandchildren, in their environment, and therefore would prefer social care in their home or 87
terrain form of social services in their natural environment so that they do not have to adapt to regular daily routine or to the roommates, they want to have the freedom to spend free time their own way. The most important factors affecting the decision to move to a social care facility are in most cases health reasons (inability to perform basic domestic life, constant need for help, general health). Other reasons included social factors (non-insurance by another person, inability of the family to take care of the senior citizens). Other crisis factors and reasons for moving to a social care facility were a sudden failure of self-sufficiency and loneliness of the person after the loss of their life partner that provided the needs. Based on the findings, we recommend: -
facilitating the adaptation of the elderly by new approaches,
-
keeping the senior citizen in the family as long as possible,
-
if it is not possible to keep the senior citizen in the home environment, look for a good facility,
-
placing the senior citizen in a social care facility as close as possible to the senior´s original residence,
-
facilitating and promoting a healthy lifestyle,
-
preserving the dignity of the elderly and the sick as well as their right to freely decide their own destiny,
-
taking into account all the needs of senior citizens, not ignoring the personal needs of the elderly,
-
respecting
the
elderly,
expression
of
human
understanding, acceptance of the inner life of the elderly, tolerance, 88
-
helping senior citizens to lead an active, full-fledged and independent life according to their abilities,
-
creating an environment in which seniors feel that their t their values, habits or spiritual conviction are respected,
-
supporting projects that will help the elderly to better adapt,
-
providing more sports, cultural and other events for better
acquaintance
with
senior
citizens,
strengthening friendships, developing relationships that lead to better adaptation to a new life, -
involving relatives in co-operation after senior citizens move to social care facilities.
89
Conclusion Serious situations in the life of a senior citizen include a stay in a social care facility that puts high demands on the individual´s adaptation to a new way of life. This process can be made much easier for a senior citizen by a social worker. Adaptation is also characterized as a process of adapting an individual to biological, psychological, social and working conditions. A person has also developed a wide range of adaptive skills developed on the basis of their own knowledge. A well-adapted individual responds to the load either very weakly or in no way. Social services are a very important factor in the life of senior citizens whose altered health conditions, poor satisfaction of their needs or problematic life situations make them use these services. Social care provided will enable them to live their lives in dignity, with not all senior citizens being able to accept this situation, and their adaptation skills are not big enough to make relocation to a social care facility a viable situation. Then they are dependent on the care and assistance of professionals including social workers who, through appropriate methods, procedures and ways, help senior citizens to pass that life span without negative consequences. At present, social care facilities seek to adapt as closely as possible the living conditions of the elderly to the normal living conditions the older person used to be living so that the facilities could meet their own life and aging habits expectations. We have been thinking many times about what can be a dream of a person who has lived a full life. Their dream is surely to survive the most beautiful old
90
age in a circle of their beloved ones, being loved and not alone, even when there are problems or bad health. An individual should take responsibility for their own aging and constantly re-evaluate their attitude to old age if possible. Of course, we realize that there are many senior citizens with dementia and mental illnesses that were not able to collaborate on our research.
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ANNEX No.1 Adaptation work plan Diagnostics and adequate interest of seniority will affect not only the adaptation process, but also the entire stay in the social care facility, so at each stage of the stay, it is necessary to meet the needs in the first place, while the objectives of the work are important. An adaptation plan is set up with the admission of the senior citizen in the social care facility. It is a social worker who can help the senior citizen in the process of adaptation. When designing a plan, the social worker works on the basis of an interview with the senior citizens to help them with the adaptation process. On the basis of diagnostics and the interview, we will get in touch. The social worker provides seniors with basic information about the facility, its structure, regime, home order, co-operation rules and activities that are organized in the facility. The social worker observes the behaviour of the client and the communication during the interview. The social worker gets all the information about the client, finds out what their expectations are about the facility, looks at their adaptability, their hobbies and expectations about the future. He or she finds out about their satisfaction and needs. He or she detects the reasons for their admission, the social environment, their family background and creates space for proper communication based on appropriate behaviour. The social worker tries to get the client acquainted to the residents of the facility in order to make friends. The individual plan includes planning strategies and achieving the objectives of working 101
with the recipient of social services. Chosen interventions should suit and not interfere with the mission of the facility.196 Therefore, the objectives must be real, concrete and achievable and based on the clients´ needs, on the assessment of their health situation, selfsufficiency and the steps we decided to take, which should lead to situation improvement or problem solving, to improvement of the actual state.197 From the planning process, it is clear who will be involved in the implementation of the activities. It can be based on a social contract. If it is not possible to obtain consent for the contract due to the unfavourable health of the resident, the individual plan will be developed by the social worker. If the resident has at least a partially preserved ability to understand, they will be explained the individual steps of the plan and will be created the same conditions as others. Act of the National Council of the Slovak Republic No. 448/2008 on Social Services, as amended, states that if the recipient of social services is a natural person with a severe disability or relying on the assistance of another natural person, the implementation of social rehabilitation is part of the individual development plan. The individual plan has an impact on the quality of life of the resident, so support and guidance to independence, a balanced attitude to all areas of their lives must be guided by the plan in a way that is effective. It should meet the requirements of active cooperation not only with the resident but also with the whole social network,
196
LABÁT, V. Rezidenciálna starostlivosť. Bratislava : OZ SP, 2004, p. MATOUŠEK, O. - KOLÁČKOVÁ J. - KODYMOVÁ P. Sociální práce v praxi. 1. vyd. Praha : Portál. 2005. 224p. 197
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objectivity in mapping their life situation. The individual plan is to be understood as a legal document, its complexity should include all the needs of the resident. When implementing an adaptation and individual plan, it also depends on how much time social workers will devote to creating the programme and working with the client´s family, which greatly affects the adaptation process.198 The success of the intervention also depends on the motivation and professionalism of the social worker.
198
NOVOSAD, L. 2000. Základy špeciálního poradenstva. Praha : Portál, 2000, p. 152. Act No. 448/2008 Coll. on Social Services and on the amendment of Act No. 455/1991 Coll. on Trade Licensing as amended and modified
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ANNEX No. 2
CASE REPORT History of the case - family, personal and social anamnesis A.K, a 58-year-old loving, good and caring mother. She accepted her husband´s first-married children. Father dominant, the hierarchy in the family strictly adhered to. Her childhood was quite good and balanced. She was talkative, understanding, loving and singing beautifully. She worked as a worker all her life. She got married young, but the marriage ended in divorce for her spouse´s pathological behaviour. In the marriage, three sons were born who supported her. After the divorce she lived alone in a flat where there was still open fire in the kitchen. When her eyes worsened, she needed more help, so she initially addressed the caregiver. After she had lost her sight to eighty percent, the nursing service was already inadequate, and the independent life was more or less impossible. She did not want to burden the sons because they had their own families and work, so she decided to move to a social care facility. The admission was voluntary, no trauma. She kept her contacts with her relatives. Diagnostics and adaptation Medical history: practical blindness, cholecystiosis. After the review, she was included in the fifth degree of social dependence on social services, a severe disability. Emotional manifestations on the admission and during the period of the first months of adaptation: peaceful, sensitive, empathetic, loving, balanced, with a sense of humour, active, open to the environment.
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Behaviour: reliable, active, welcoming, friendly to others, helping others with advice, willingness or a service. After initial misunderstandings, she found a decent roommate, later found a partner in the facility and got married for the second time. She was adapted without problems and independently. A social worker was being sought for psychological support, helping to deal with an inappropriate roommate, engaging actively in the life of the facility. Social worker intervention
Diagnostics of major adaptation problems: an inappropriate roommate, lack of activity. Objectives: She set them herself, using the support of the social worker - adaptation, a good roommate, self-realization. Activities, methods and procedures: an interview, psychic support, activation, therapies, memory training, compensation. Since the beginning of her stay, she has been relatively well integrated into the life of the facility. Complicated fate did not negatively affect her behaviour and survival. She showed interest in various forms of activities and therapies. She was an active member of the Residents´ Committee, actively taking part in dance and singing events. She liked going to memory trainings. She took it as a challenge to do something, to develop, to gain new experiences, to learn something new, to be in the community. She offered the social worker to help him or her work with her. She strengthened her ability to push, her self-confidence increased so much that she began to act publicly. Conclusions: Adapted up to half a year. She was completely satisfied when she found herself an adequate roommate with her own
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initiative. She internally accepted her stay in the facility and found her home there after re-marriage. The case report was processed on the basis of an interview with the client, whereby we examined the adaptation process in social care facilities.
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Adaptation of Senior Citizens to Conditions in Social Care Facilities
©Janka Bursová, Zuzana Budayová, Number of copies: 200 pieces
Issued by: 2017
Publishing House Uczelnia Warszawska im. Marii Skłodowskiej - Curie Warszawa
Number of pages : 107
ISBN 978-83-937651-6-4
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