About education and training in home care

Equipment and hands are not enough
It goes without saying that it is not possible to achieve any quality of services for the elderly and people of determination in home care and the implementation of daily assistance tasks for them unless you have professional and highly qualified care providers who can play their role with flexibility, independence and confidence. There will be no point in professional home care providers without tools, devices and equipment that facilitate their work in carrying out their role. But all of this is based on a fundamental principle of advanced home care, which is continuous professional education and training to qualify a generation of home care providers who can carry out the daily tasks assigned to them with clear standards. Therefore, it is imperative that we put our experience and capabilities into creating high quality educational and training content for everyone who wants to build a professional home care team. I do not know exactly why you have not established a school, institute or academy, you name it, to educate, train and qualify professional home care providers in our Arab region until now. I don't think finance is the obstacle so much as the prevailing culture.

The list of education and training programs should be varied to cover everything that may affect the daily lives of the elderly and people of determination. In our understanding, the importance of education and training is equal in movement, activation, medicine, food, mental health, methods of dealing and rehabilitation, as they all constitute elements that raise the quality of life of the elderly and people of determination. The principle of generous care for the elderly and people of determination is not based on providing products, equipment and home care providers only, but this concept goes beyond how to link all these elements together to make decent care a tangible daily matter, not just a slogan that we raise. For all of this, we must constantly develop education and training programs that serve the principle of dignified care for the elderly and people of determination, and based on a solid foundation of the understanding that the “sixteenth area” and the “physical or mental challenge area” are not the beginning of “serving” the elderly and people of determination, but rather an area to create Spaces for movement and activity, enabling them to do their day-to-day chores “with the help” of home caregivers and to enhance their physical and mental capacities so they can do it themselves. They do not need "servants" but professional helpers.

Contrasting standards
Private home care providers play an important role in providing home care providers who provide what they can within their educational and training capabilities and skills acquired from experience, individually or according to the will of the service provider and controlled by the factors of supply, demand and profit and loss. It may come to mind that this is sufficient to provide decent home care for the elderly and people of determination, as long as the cadres and available hands are cadres of doctors, nurses and physiotherapists. The answer may be shocking to some, but it is clear: These are not professional home care providers. Being a professional home care provider who can provide dignified care for the elderly and people of determination requires much more than a degree in a medical or therapeutic profession. A well-established concept in professional home care requires communication skills, community knowledge, psychological conditions, rehabilitation, workplace culture, creative methodology, professional documentation, health promotion and preventive care. These professional skills are taught in accordance with academic curricula and appropriate and effective practical training that enables the professional home care provider to provide preventive, effective and participatory care services with care recipients.
So far, there is no health or social authority in our Arab region, as far as I know, that sets clear standards for the quality and quality of services provided by the mobile home care teams that it sponsors, or the private companies providing home care services that they also sponsor. Therefore, we are faced with a dilemma of double standards in which the gray area expands, which devours a lot of the quality and efficiency of the services provided, and thus reduces the quality of life of the elderly and people of determination. It is necessary to develop a package of unified educational and training standards that meet the conditions of decent care for the elderly and people of determination. For this purpose, education and training that are permitted by home care departments must be in all their forms, and with their knowledge and within their controls, is the only standard for the quality and quality of home care services.

Costly effects of lack of professionalism
An Ernst & Young study published in 2016 estimated the number of “holding beds” by long-term rehabilitative and intensive care patients (mostly the elderly) to eat up 20% of the number of hospital beds in the health sector in the Gulf Cooperation Council countries, not to mention “ “Detained beds” by elderly patients with short stays who are sent to hospitals for treatment due to emergency health symptoms. On the economic front, having professional home care providers and providing integrated home care will reduce the number of older people being sent to hospitals and long-term stays that are fueling the “retained family” phenomenon due to the lack of qualified professional care in their homes. On the other hand, large numbers of elderly people who have completed their hospitalization are sent home to continue treatment at home, but due to the lack of qualified home care, the elderly are sent back to hospitals again to start an endless cycle of transfers between hospital and home. The sector most affected in this process is the health sector, due to the high costs of occupying beds in hospitals for long periods of time due to elderly cases that do not require hospital stays. In addition to the effect of family occupancy by a group can be treated from home. As for the role of generous care for elderly patients in this cycle, we do not see an effect.
These costs can be reduced, and thus a lot of medical beds can be made available to those in need. I believe that the Covid-19 crisis has clearly shown us the importance of having the capabilities in hospitals to maintain their capacity, as well as the importance of a professional home care system capable of providing advanced home care that relieves stress or Completely remove it from the shoulders of hospitals.

Should we start now?
Simply yes. Administrators in home care departments cannot delay any longer to build a generation of professionally trained home caregivers who are able to entrust the home care tasks of the elderly and people of determination and manage their skills in an unconventional way that gives them more space to make daily decisions related to the affairs of movement, activation and nutrition for the elderly Old people and people of determination in their homes. Home care providers have clear standards in the quality and quality of services they provide. It is no longer sufficient to simply keep home care mobile and provide simple services such as recording blood pressure data and making sure that the elderly are still alive.

Mijbel Al-Swait
Founder & Chief executive officer
Nordic Home Care Solutions

About rehabilitation in home care

Experience indicates that the entire field of rehabilitation is much broader than rehabilitation for people with brain damage. Rehabilitation of people with brain damage will remain an obvious target group because they are in dire need of rehabilitation. But in this article it will be useful to talk about rehabilitation in relation to the elderly and other groups of people who They receive home care. In the White Paper on Rehabilitation prepared by the Marseillesburg Center in 2004 'rehabilitation' is defined as a process of purposeful cooperation between the individual, relatives and professionals and with a fixed schedule.

The purpose is that an individual who has or is at risk of significant limitations on his physical and/or social functioning will be enabled to lead an independent and meaningful life. Rehabilitation is based on the individual's entire life situation and decisions consist of a coordinated, coherent and knowledge-based effort.
However it must be emphasized that there is no consensus on what rehabilitation is and there are no basic books on the subject where one can find quick and ready-made solutions. The concept is constantly evolving and so it is imperative that our understanding is constantly updated and that we stay abreast of developments in this field.

Rehabilitation after discharge from hospital

Discharge of the person in need of rehabilitation from hospital means that the home care service must be able to continue the rehabilitation that began in the hospital. So far the target groups of health and social workers in home care have not been directly covered by what might be called a 'rehabilitation team' as at present the tasks are handled mainly by therapists, nurses and sometimes home caregivers. With the outsourcing of rehabilitation work to hospitals, the need for home care providers to be involved in rehabilitation work increases. This requires increased competencies. There is a need for a multidisciplinary effort by all parties and a better effort is required, with the person under rehabilitation at the center of the effort.

With the increasing need for this effort among others there is the requirement of home care provider collaboration skills. The process of 'rehabilitation' should be carried out by the home caregiver and the person undergoing rehabilitation as a continuous process from the hospital down to the outreach (the party that continues the home rehabilitation), which, as a general rule, is of course the home caregiver. The Rehabilitation as a Way of Work curriculum must enable staff to work in accordance with the core values ​​and elements of rehabilitation, and the home care provider must be able to understand individual rehabilitation plans so that they can act accordingly. In addition, the home care provider should be able to help prevent restrictions on the functioning of the person undergoing physical, mental and social rehabilitation, in order to lead an independent and meaningful life. The home care provider must also be able to assist the person undergoing rehabilitation with advice and guidance, and therefore must know the legislation regarding rehabilitation.

Rehabilitation as a modus operandi for home care providers

Work functions in the social and health sphere are constantly evolving. Under hospital care, working conditions are changing as patients are hospitalized for a shorter period, treatment is more intense, and outpatient efforts are increased. This means that the caregiver/employee has a shorter contact with the patient. The hospital is obligated to prepare a rehabilitation plan, which must be implemented through cooperation between the two responsible parties, which are here the hospital and the Department of Elderly Care.
A hospital must provide specialized rehabilitation services, but a significant portion of rehabilitation and all health promotion activities are often transferred to aged care facilities. This means that home care must be able to continue the rehabilitation that began in the hospital.

With different aged care departments outsourcing the task of rehabilitation, the need for home care providers to be involved in rehabilitation work is increasing. This requires increased competencies. For example, some home care providers must be able to participate in the preparation of rehabilitation plans and not only implement them, work with the person under rehabilitation to achieve established goals but also participate in the review of the plan and contribute to a coordinated and comprehensive effort. A multidisciplinary effort is needed by all parties to make a better effort with the person being rehabilitated at the center of the effort.

The work tasks and competencies of home caregivers will be very different depending on the scale of the complexity, the organization of work and the place of employment. Basically organizing the rehabilitation file is a big challenge and it is still not clear in most places for example what tasks the health centers should deal with and what professional groups they should deal with.

Preventive rehabilitation

Preventive rehabilitation efforts should be viewed as primary prevention that enables healthy, able-bodied older adults to maintain health, resilience, functional ability, social network, and activities. This effort is made in daily assistance, care and nursing work in the form of information and guidance in any contact/communication with the elderly and those with special needs
Skills development for home caregivers should also focus on secondary prevention, which aims to detect health problems at an early stage. Therefore, an increased ability to notice these problems in any contact with the elderly or those with special needs would be essential for early intervention.

Mijbel Al-Swait
Founder & Chief executive officer
Nordic Home Care Solutions

About gender in family home care, why do women bear responsibility in most cases?

Human societies have made qualitative leaps in terms of civil and social rights and work related to empowering women and benefiting from their productive capacity outside the home, and their influential presence on the ground in workplaces and production equations has become evident, leaving no room for mere imagining that the labor community can dispense with them. Only a few remain in some fields that women did not enter for one reason or another, although it is also worth noting the concentration of this presence in specific areas more than others. Among the most important of these areas is the field of home care, and here we do not differentiate between professional home care or family care, which is based on distributing tasks to family members by agreement or coercion.

The collective concept of the caregiver

The Arab and Islamic culture, which emphasizes the status of care for parents and the weakest in need of help, and raises the status of caregivers for these groups, plays an influential role in consolidating the culture of primary care that starts from the nucleus of the family in our Arab region, and therefore this role automatically falls on family members. This early home care often takes on a culturally gender biased turn in which women play the lead and full-time roles, as well as a production role from the workplace they are joining. When I compare (I don't like comparisons in general) and my personal experience in the Scandinavian home care job market with our experiences in the Gulf home care labor market, with regard to gender distribution, I see a great similarity in which women are equally the norm for home care, and men are the exception.

In an attempt to change this situation, I remember that we participated in a campaign funded by an EU Commission body in 2004 in which we worked to attract the male component to work within the Danish home care market. What drew us during our field campaigns and in the questionnaires that we distributed is that most men of different age groups answered one of our questions about what do you think that working in home care is a field of work for men, women or joint work? The overwhelming majority of the responses were in favor of the fact that this field of work is primarily women's.

Here, it became clear to me that this gender concept in home care is a broader human concept in societies and is based on the formation of women primarily as a being characterized by passion, tenderness and giving. In the end, the campaign achieved tangible success in enrolling a good number of men and young people in home care in Denmark, in addition to the rest of the societal campaigns that lifted the veil from the stereotypical concept in this very important field.

Women and double effort

That home care, regardless of the category it receives, whether it is from elderly parents or family members with special needs, is a responsibility entrusted to the rule of the collective emotional or cultural sense of women, or to be seen from above a community tower for home care as a field of work dedicated to women, It is something that must be seriously reconsidered. A woman, whether she is a worker, a student, or a housewife, has a dual responsibility to provide an exceptional effort of physical and psychological care for people, even if the care is optional on her part. We are now at a crossroads where we see firsthand that the profiling of this vital field is of no benefit to us at the professional or family levels, in terms of the obvious lack of trained hands working in this field, and the attempt to bridge the gap in creating a required gender parity and polarizing a male effort that can make a difference.

On the other hand, alleviating the pressure caused by stereotyped care for women, and here we stress more on the woman who “looks after” one of her loved ones in addition to her work as a full-time employee in her workplace, which often makes her give up some of her rights in marriage, study, or even work if she do not work. Here we do not generalize the idea that all women who provide care to one of their family members are necessarily compelled or harmed by not being given equal opportunities to bear care without the rest of the male family members, but many of what I witnessed from the testimonies of some women prompted me to dedicate an article to this topic.

What can we do?

The horizon looks bleak when we look at the reality of family home care. From the first sight, we can clearly see that demolishing a strong wall of rooted culture could be an impossible task that even Tom Cruise would not be able to accomplish, but honestly, it is not that impossible if we change Only the priority of our task from "demolition" of the fence to "opening a hatch" in the wall of the fence. Perhaps we can start from finding some solutions if the family members are motivated on the same level and on an equal principle.

Some physical incentives for caregivers, along with providing the necessary training and education in a modern and practical way, can have a decisive effect in changing some of these patterns. In addition to this, providing smart equipment and advanced digital solutions inside and outside the home for the elderly and people with special needs, and enabling their families to follow up, check on them and help them in modern ways that make it easy and even enjoyable for male caregivers of the family to choose to provide care on their own instead of the sister, mother, daughter or the wife.

Finally, the process of change does not always go in a straight line, we may encounter many zigzag lines, but in the end we will reach the desired result only if we continue to walk, and we have a clear map towards the goal.

Mijbel Al-Swait
Founder & Chief executive officer
Nordic Home Care Solutions

About assessing the environment in home care. 

The population of the Emirate of Dubai is living longer, and there are more elderly people with chronic diseases and disabilities. Shorter hospital stays and increased outpatient treatment mean more health and social tasks, more complex care, and more processes for home care recipients across cross-cutting sectors such as the Community Development Authority، Dubai Health Authority, the private sector and other societal sectors. This demographic development places great demands on the entirety of Dubai's health and care efforts, including the effort to assess the elderly's surroundings, ensuring the design and delivery of appropriate assistance and support to citizens.

Therefore, the Environmental Assessment for the Elderly and People of Determination project can contribute to the development of important data on current needs and for evidence-based analysis to help develop future home care plans in the Emirate of Dubai.

With the assessment of the surrounding environment, we will enhance the focus on the different needs of the assessment recipients, and through the high quality of the assessment process, we ensure that the correct efforts and the most coherent process are directed to the people who need the most services and supplies. This applies to both those who have significantly lost part of their physical/mental function and those who, through extensive and professional assessment and the rehabilitation process, can become more self-sufficient and independent – ​​ensuring that both groups have a higher quality of life as a result. The ambition of the Environmental Assessment Project is to support standardization of the service level, as well as better interaction/integration between the constant and changing needs of the assessment recipient in their surroundings.

Various applications

The data collected from assessments of the surrounding environment for the elderly and people of determination gives ample opportunities for home care departments, for example, to have a variety of practical applications, ranging from knowing the degree of movement and physical activity of people, to tracking their diet, to analyzing sleep patterns and quality. The data can also be used to develop proactive solutions in digital care based on preventive services that raise the quality of life in the surrounding environment and reduce the risk of possible injuries, as we see in cases of multiple falls in the elderly, for example, or in order to create a safe environment for accessibility that allows people with special needs to control completely independent of their surrounding environment.

The practical applications that can help the elderly and people of determination create an surrounding environment suitable for their current daily needs, and at the same time predict their future needs, in fact provide a double benefit in terms of providing what citizens need and also saving a lot of dirhams in the budgets of the departments concerned with the care The elderly and people with special needs.

What will evaluations provide?

Among the interesting outputs that assessments of the surrounding environment can contribute to shaping, lies the possibility of designing an integrated map of the needs of the most harmful people or “most degraded” states from the physical and psychological aspect, whose stated abilities can deteriorate more dramatically than others who need help for various reasons . Anticipating physical or cognitive decline in people with dementia or Alzheimer's disease and establishing services that slow down the pace of this decline is driving more control over health and home care delivery resources critically.
Within that we can benefit by:

1. Knowing, arranging and designing care services for the elderly and people of determination.
2. Better identification of the type of challenges surrounding the environment for people of determination.
3. Anticipating the volume and quality of services that must be provided in the next five years.
4. Develop an interactive database of physical and mental challenges for the elderly and people of determination.

At work together

The surrounding environment assessment processes are characterized by their comprehensive size, which helps the concerned departments in drawing an integrated and clear picture of their services and operations in the short, medium and long term. However, this is not easy or affordable because it requires experienced professional human resources and the ability to put the different pieces on the board in a consistent manner.

The aim of environmental assessments is not statistics, it is not the numbers themselves that are what should be obtained. Beyond the numbers is knowing how to analyze this data to design current services that are more suitable for those who deserve it. No less important is the proactive and preventive planning in designing these services for the future, which we do not have much to prevent from attacking us, and we must be more than ready. Yes, assessments of the surrounding environment are not a luxury or a statistic, it is the future of decent care for the elderly and people with special needs.

Mijbel Al-Swait
Founder & Chief executive officer
Nordic Home Care Solutions