Social work with the elderly in the UNITED STATES

In the United States, the implementation of the principle of independence of the elderly is carried out through a system of non-stationary types of social assistance provided by public or private organizations, as well as through cash payments to the elderly for their independent acquisition of certain social services. There are a significant number of different funds in the country, providing, in particular, payment for medical care, the provision of cheap housing, food, transport services, etc. Social services at home are characterized by a large number of services provided, including home delivery of dinners, bathing, provision of vehicles, therapeutic exercises. Services for the elderly include the repair of apartments, the provision of a telephone for temporary use, the organization of cultural events, leisure and entertainment.

In the United States, there is also a clear trend towards creating conditions for the residence of elderly citizens at home. Its implementation is carried out through a system of non-stationary types of social assistance provided by public or private organizations, as well as through cash payments to the elderly for the independent acquisition of certain social services. There are a significant number of different funds in the country, providing, in particular, payment for medical care, the provision of cheap housing, food, transport services, etc. Systems of payment of benefits to families for the organization of care for the elderly at home are becoming increasingly common.

Home care services are professional assistance through home visits to patients who have an increased risk of morbidity or damage, disease, impaired function, to terminal patients and all those who need short- and long-term care of professional workers.

Home care services include:

• • visits of staff to the house;
• • infusion therapy at home;
• • Supply of medical equipment to the home;
• •hospice;
• • services of patronage workers.

Home assistance includes a wide range of support services, such as home food delivery, local transportation, financial assistance, daytime programmes at health or social facilities.

In the U.S., professional home care services are provided by certified Home Care Agencies, which can be private or non-commercial. Funding for their activities is carried out by two federal programs - Medicare and Medicaid. Agencies implement medical and rehabilitation programs, including qualified care, physiotherapy, speech and occupational therapy, consultations of social workers, psychologists, nutritionists, etc.

In recent years, home care services have established a method of working as a team of specialists or an interdisciplinary team. In recent years, home care services have established a method of working as a team of specialists or an interdisciplinary team. Requirements addressed to an interdisciplinary team working from home:

• • integration and coordination of professionals;
• • overcoming communication barriers in the use of professional terms;
• • identification of the leader, "mediator" and "moderator" in the team;
• • recognition and respect for professional abilities;
• • Taking into account the problems of the professional hierarchy;
• • respect for differences in qualifications and consideration of the interests of team members.

The practice of working as a team in a home care system is associated with the risk of conflict, competition and poorer coordination. The development of home care is associated with a decrease in the use of care homes and other similar institutions.

The main systems for providing the most important services to older persons and older persons have been called "formal" and "informal". Formal services include public, charitable, private institutions and agencies, while informal services include family members, friends and neighbours. A characteristic feature of the provision of formal services in developed Western countries and the United States is that they are provided at the place of residence of the elderly and the elderly.

In the United States in the 70s. subsidies were allocated for the implementation of research programs for the elderly, including the organization of day care centers. The point of the experiment was to find cheaper alternatives to home care.

In recent decades, much effort has been made in America to increase the number of day-care centres and link them into a single network of services within the community.

Currently, in addition to day care centers, in foreign countries there are institutions that offer not only temporary, but permanent residence.

Noteworthy are family-type shelters for the elderly and elderly people living outside the family in the United States. They have become very common. They can be of various shapes, but the common features in them are as follows:

• 1. assistance is provided by a private person who provides his house, but is not a relative;
• 2. for a certain fee, an elderly person is provided with a room, assistance in overcoming difficulties, protection, provision of medicines;
• 3. the shelter should be small to create a warm family atmosphere;
• 4. Supervision and control of the guardianship is carried out by professionals from the staff of the agency that manages this program of care for the elderly. Of the listed elements, only the first remains unchanged, the rest vary. For example, in one shelter there may be 2 old people, and in another - 10. There are no strict criteria for the selection of caregivers. In some states, there are no high requirements for staff training, while others, on the contrary, pay great attention to staff training.

The frequency of follow-up visits by full-time employees is also different. Some programs offer weekly monitoring, others - monthly.

Family-type homes for the elderly serve mainly three categories of the population: the mentally ill, the mentally retarded, the old and the sick. Such institutions are a cross between a public orphanage and a family. They are intended for those who cannot live independently. Their advantages over state shelters are that they create a warm family atmosphere, there is the possibility of individual care, the opportunity to communicate and maintain relations with the family. They also have lower cost of services than specialized state shelters.

Issues of social support for the elderly in the United States are systematically dealt with by specialized public associations. They advocate the need to increase allocations for the elderly, seek to increase social security benefits, reduce the cost of medical care and housing for the elderly. There are dozens of nationwide organizations of older Americans in the country, among which the largest are: the American Association of Retired Persons, the National Alliance of Senior Citizens, the Gray Panthers and others.

An important aspect of the activities of these organizations is the lobbying of legislative decisions at various levels of government, the requirement for state authorities to improve the work of medical institutions, the conduct of broad nationwide campaigns aimed at increasing the attention of the federal government to solving the problems of older citizens. Significant assistance to associative organizations in their noble cause is provided by US government agencies, establishing and financing special grants. At the congressional level, federal grant programs are approved.

Programs and projects for needy older people operating in the United States:

• • services for the protection of the elderly (since the 60s of the XX century exists in every state).
• • Elderly Pensioner Volunteer Program.
• • Foster program of elderly "parents".
• • Retirement Service Corps.
• • Day care centres for the elderly (in each city).
• • Project for the care of the homes of the elderly (home renovation services).
• • nutrition programs, "food on wheels".
• • Nursing home with legal services.
• • phone number of social and psychological assistance.
• • Special programs to reduce federal taxes.
• • Program "Special prices for transport".
• • Community selection programme.
• • intergenerational programs, hospice programs 

It should be noted that there are organizations abroad with which NASR coordinates international efforts in social work with older persons. For example, with the International Federation of older persons, the American Association for International Ageing.

The Association organizes and coordinates several national programs and projects for the needy elderly, the activities of national social services.

Their main content:

• 1. Services for the protection of the elderly. According to the U.S. State Department, every year hundreds of thousands of elderly Americans are abused and left unattended in their families. These people can not help themselves in satisfying the most ordinary human needs: food, sleep, self-care, etc. Purposefully take care of such people in the United States began in the 50s of the last century. In the 60s, studies were conducted and projects and programs were organized to protect the elderly. In 1968, the results of work with the elderly in 20 communities, whose experience is recommended for distribution throughout the country, were summarized. Currently, every state has elderly protection services, which are funded under Section 3 of the Americans of The Elderly Act of 1965 and Section 20 of the Social Services Act. The technology of their work is as follows. The Service receives information about cases of violence against the elderly and investigates it. This information is confidential. If the service believes that a case violates state violence law, a social worker is dispatched to investigate the case (within 24 hours in urgent cases). The client is provided with all services of a crisis nature. If a case of violence is not proven, the client is provided with the full range of social and health services that the community can provide and needs. An elderly person can refuse these services. Separately, cases are considered when a person is incapacitated, and the decision is made by the court.
• 2. The Senior Retired Volunteer Program (EPA) provided by the National and Community Service Corporation is in keeping with the interests and skills of Americans ages 55 and older who are interested in addressing a community issue. Program volunteers choose how and where they can benefit the community, for a total of 40 hours per week. The program provides an opportunity to realize themselves to all the elderly who wish to do so.
• 3. Foster program for elderly parents. This federal program was created in 1965 and offers elderly people over 60 years of age who have a limited budget the opportunity to provide help and support to children requiring special care. These are children living far from their parents, young mothers, AIDS victims, juvenile delinquents, victims of violence and homelessness with special or exceptional needs. Such elderly people, volunteers are trained and help children 4 hours a day, 20 hours a week.
• 4. The Retirement Care Corps was established in 1993 and unites more than a million Americans who provide assistance to the elderly. The scope of his activities includes three programs - foster families, a senior companion and an elderly pensioner. Older companions are seniors over the age of 60 who work with older seniors who need help or want to live independently in their own homes or communities. According to the National and Community Service Corporation Regulation, senior companions "assist clients in meeting their natural needs: they provide and provide companionship for the elderly in isolation, assist in the performance of simple household chores, the movement and transportation of the elderly, and communication with them." Elders, companions serve the elderly, the disabled and the terminally ill.
• 5. Day care centres for senior citizens. Every city in the United States has such a center. As a rule, they are located in an old or modern beautiful building and are a public or private institution. Both specialists and volunteers work in them. The centres are financed by municipal or private social services. The center is managed by a board of directors and trustees. Professional workers provide some medical services: fluorography, pressure measurement, which belong to the sphere of activity of medical personnel and hospitals. Social workers organize events for sports art therapy, massage, etc. Entertainment programs are organized by local organizations, these are concerts, trips to historical sites, performances and seasonal events, for example, preparation for Christmas. Many cities, often smaller, organize joint events where participants living in relative isolation are given the opportunity to socialize with peers from other communities. The most interesting centers in terms of organizing activities turn into clubs for the elderly and work on the principle of clubs: admission to club membership, maintaining the image of the club, club attributes (clothes, hats, badges and signs, etc.). Such clubs are called clubs of the "golden age".
• 6. Projects for the care of elderly homes, home repair services. Many elderly people living separately from their families need the help of construction specialists and repairmen who help them keep their homes in order. The projects provide the elderly with certain benefits in the organization of care for their homes.
• 7. Nutrition programs, food on wheels. The National Nutrition Programme was established in 1972 under the 1965 Act, articles 3 and 6 thereof. Under this law, states must provide meals to the elderly through its organization in centers for the elderly or churches, delivery of food home (food on wheels). The U.S. Department of State for the Elderly, which oversees these programs, provides assistance to low-income seniors, those who live alone and from the so-called risk group.

The Nursing Care Home with legal services is interesting in the sense that nurses who have undergone special gerontological training also provide legal services related to the calculation of payment for treatment, settling the case with inheritance and others. A distinctive feature of the American model of social work is the decentralization of the social assistance system. And this means that the real organizational activities to ensure social federal programs are carried out directly at the state and municipal levels.

It is here, in cooperation with public self-government bodies, that numerous associative organizations carry out the main work. State governments, for example, make a supplement to the federal old-age pension, and local governments set discounts on public transport for the elderly and disabled, which, as a rule, are 50% of the ticket price.

Like other countries, the U.S. also has problems with social security for the elderly. For example, almost a third of nursing homes do not meet the necessary safety and quality standards. One reason for this is that many nursing homes are privately owned. Therefore, the state is forced to license and inspect their activities. Another problem is that older Americans (12% of the population) account for a third of all national health care spending. At the same time, more than 30 million citizens at a younger age do not have health insurance.

Most care homes in the U.S. are relatively small, with an average of 80 beds. About 75% of them are private, commercial, about 15% are private non-profit, funded by ethnic, religious and charitable organizations. Medical and social assistance to the elderly at the community (microdistrict) level is provided by such types of services as home care, day care centers, mental health centers, elderly centers, hospices.

In addition to the usual day care centers for the elderly in the United States, a network of special paid centers designed to provide social and medical care to disabled pensioners, in particular, those suffering from serious diseases of the nervous system, is rapidly developing. Persons visiting such centers are provided with dietary nutrition, receive physiotherapeutic procedures, are engaged in therapeutic gymnastics, occupational therapy, and a speech therapist is at their service.

Much attention is paid to the organization of leisure - excursions, dances, gentle sports games, conversations or debates on various topics are organized with the involvement of doctors, psychiatrists, sex therapists, a beauty salon works. In addition, important importance is attached, and the possibility of freeing relatives of disabled people from the need for constant care for them, in the coming years about ten thousand centers of this type can be created in the country.

in the work of Western public and state structures of social assistance, considerable emphasis is placed on volunteer work in the community. Community refers to a community of people living in one territory (in a small town or one area of a big city). It is understood that people who are part of the same community are in contact with each other, ready to help each other and make joint decisions about the life of the community.

It is on the community that the activities of Day Care Centres are designed. In these day centers there are lunch clubs, workshops, services of medical staff, teachers for further education can be provided. Day centres are generally located close to the accommodation of serviced persons and in areas with good transport links. They are visited by residents of the area - the community. And the volunteers working at the center tend to live in the area as well. There are close social ties between residents of all ages of the same district.

Analyzing the foreign experience of organizing inpatient care for the elderly, it can be concluded that the most cost-effective was the functioning of day hospitals, long-term hospitals for the elderly, nursing homes, etc.