FSC CARE OF THE ELDERLY PROJECTS BACAU TOWN AND COUNTY

This is a report by our long serving Director of Programmes, Julia Smyth, who retired a few years ago but in late 2013 kindly agreed to visit the projects in Romania - most of which she had set up - and report on their progress.

  • HOME CARE OF THE ELDERLY BACAU TOWN
  • HOME CARE OF THE ELDERLY IN REMOTE VILLAGES
  • DAY CENTRE FOR THE ELDERLY BACAU (Dr Stefan Ciobanu Centre)

History

FSC first started Home Care of the Elderly 16 years ago in 1997 as a result of seeing so many ill, old people at home when they were working in the Mobile Health Centre and its subsequent programmes in the villages of Bacau county. Family had very often moved away to find work leaving the elderly ill isolated and unable to cope with the difficulties of everyday life: fetching water and wood apart from the effects of illness and old age. Pensions are tiny (£30 - £50 a month) and in the villages, heating and cooking methods are primitive, there are usually no local shops and no convenience foods.

The need is acute and presumably widespread throughout Romania. There appears to be no precedent or funding in place for providing for the elderly sick at home. FSC copied and developed a Home Care model from a community support charity in Bucharest and Dr Stefan Ciobanu developed this model and training.

The need continues to grow as the state concentrates on secondary care in hospitals. In Bacau town the mayor has decided to build a large new hospital behind the present one but FSC have to fight for any funding for home care. FSC have developed these services to an impressive level with the help of RFFR funding and various grants over the years and now with some state funding.

From 2 locations in 1997 FSC now provide home care, nursing, social support and much more in 12 villages, in Bacau town and a very busy Day Centre with an overall total of over 870 beneficiaries.

  • Their focus has been on providing an example of excellent nursing and social care to the elderly, at home, providing training and employment for local women and involving local authorities with the aim of raising awareness of and state funding for this huge problem.
  • State funding is at the discretion of local mayors. In Bacau the mayor spends a fortune on sports events, building a huge new Orthodox Cathedral, pop concerts, roads and infrastructure. There appear to be no set-aside funds for social care and services. He gives scholarships to bright students: Gabi’s daughter has received one of these which as Gabi remarked "We didn’t need it - there is no means assessment of these grants which are dished out randomly"
  • When FSC have been applying for funds for the care of the elderly at home, the Bacau mayor has remarked to FSC "The poor have no vote", "What’s the point? Old people die anyway" and "I am helping the poor myself" – he distributes food tokens with his picture on and goodie bags, again with his picture on, at Christmas.
  • That such discretion in funding is the accepted system seems incredible and is a major part of the problem. The other factor must be the 40 year + gap in the awareness and development of basic health and social services. There just seems to be no plan whatsoever in place.

Training, accreditation and funding

FSC are an accredited training organisation for Home Care of the Elderly. In 2003 they became contracted by the Health Insurance and Health Care Providers in Bacau City.

FSC have trained other teams of carers in Roman, Racacuini, Podu Turcului, Vrancea and in many villages in Bacau County. They have also trained the staff at the recently opened Milly Centre in Buhusi.

Funding in the villages (carers’ wages) are negotiated with each mayor and funded under Law 34. Funding in Bacau town is a constant fight with the Mayor. FSC did not know about funding for 2013 until 1st January 2013 and the funds for 2012 were not paid until April 2013 and they still have not heard from the Mayor about funding for next year.

Current services

  • Bacau town: home care and nursing to 140 elderly sick
  • Rural villages: home care and nursing to 520 elderly sick in 11 villages
  • Day Centre:81 beneficiaries
  • Physiotherapy, speech therapy and rehabilitation at the Day Centre 41 beneficiaries
  • Publication of the newspaper "The Voice of the Seniors"
  • Pre-discharge hospital assessments by one of the FSC nurses based at Bacau Hospital
  • Supplies of food and incontinence materials
  • Collaboration with the Community Transport Project

The work and services are very complex and are outlined in great detail in FSC’s quarterly reports. Activities and statistics are available on the attached graphs.

My visit

I made five home visits in Bacau and five in the rural villages. The home situation of many, especially in the villages is pitiable and this when the weather was very good. For many patients the daily visit of the carer is the only help they get and I dread to think how they manage with heating, toileting and eating for the rest of the day and in the depths of winter. In many village houses there was very little food around. Of the 10 people I visited with the FSC team, 6 were in tears about their situation and their loneliness.

   
   

 

 

This lovely lady of 86 looks after her husband (right) who is bedridden and cannot move his legs. She has help from the FSC carers every day.

Nevertheless, she was cheerful and joked "What am I to do? Beat my old age with my stick?"

 
 
   

This lady is recovering well from a mild stroke but was in tears because the hospital had sent her home with 10 lots of different pills which cost her over 400lei (£80). Her pension for the month (slip in photo) was 255lei (£51) and she is on the medicines long term so how can she possibly live and take the medicines?

Two of the drugs had severe heart-slowing effects which I felt was of real concern with no monitoring – discussed with Elena (coordinator) who will follow-up

 

Meetings with Mayors and Home Carers

I saw three mayors and while making it clear that I had no authority to advise I congratulated them all on the success of their visit to the Ministry of Works in Bucharest with the NGO forum which had helped to secure funding under Law 34 for 2014 and stressed the importance of lobbying and campaigning for state funding of these vital services. As mentioned in a previous report, I found the mayors more engaged and receptive than when I was last in Romania.

We had meetings with all of the carers of two communas when I listened to their stories. They are very dedicated teams and were pleased to be able to help the beneficiaries whose needs were so great. Their main problems were reported as:

 
  • Long distances travelled to patients on foot - one patient was an 8km round trip. I asked about bicycles but they didn’t think they were suitable for the roads (the councils have added a layer of small rocks to the surfaces to reduce skidding).
  • Not enough time to do all they would like to for patients
  • Not enough incontinence pads which led to real compromises and discomfort for patients
  • Low wages
 

My visit to the Day Centre ‘Dr Stefan Ciobanu (opened 2002)

The Day Centre was a vibrant hive of activity on the day we visited. There were over 50 people seated at five tables engaged in all sorts of handicrafts, painting and sewing. We were treated to a wonderful choral recital of traditional Romanian songs and helpers and beneficiaries were busy making lunch (pizza) for everyone including the beneficiaries.

The atmosphere was joyous and very busy. The residents I chatted to were clearly thrilled to be part of this happy gathering and many wanted to relate their stories. Most were widowed and said how lonely they had been until they came to the centre. One glamorous lady asked if I spoke French and told me "Je veux vous raconter mon histoire d’amour"!

In the treatment room next door there was a constant stream of patients arriving and leaving for physiotherapy, speech therapy and rehabilitation following strokes etc.

Two of the Coordinators are part of the IMPART team who split their time between the Day Centre and the IMPART training programmes. (Throughout FSC’s history they have demonstrated great flexibility in moving staff between projects as the demands of their work change.)

Physio/treatment room
 

Beneficiaries who also volunteer

 
 
 

After lunch, I said a few words about Dr Stefan Ciobanu and how his ethos, caring and dedication live on at the Day Centre named after him. We lit a candle in his memory. Many remembered him and were touched.

CONCLUSIONS AND RECOMMENDATIONS

Fantastic projects serving the most needy elderly in society. The standard of the services given is very high but in many cases not enough time is possible to allocate to each patient. There are always more patients on the waiting list. FSC’s Day Centre is far superior to any I have ever worked in or visited in the UK. Combining rehabilitation services with so many other activities is a very high standard facility.

The monitoring and referrals processes work well with an FSC nurse representative assessing patients on discharge from hospital in Bacau. In spite of the difficulties and the fact that I was on something of a whistle-stop tour of the villages, I felt that staff morale was remarkably good.

Transport

All of FSC’s rural projects are necessarily dependent on vehicles all of which have been provided by grants with the exception of one RFFR Land Rover which is still running and used by the maintenance man. The two vehicles used in the rural areas have high mileage (well over 100,000 miles). They are unlikely to be able to afford new vehicles from their own reserves.

Incontinence

FSC CoE PAMPERS COSTS
Item Amount used pm Unit cost Total Lei Total GBP
Venixe large  1,020.00  1.98  2,019.60 403.92
Veixe medium  465.00  1.66  771.90 154.38
Venixe blanket  200.00  0.80  160.00 32.00
Totals  1,685.00    2,951.50 £590.30

FSC spend nearly £600 per month on incontinence pads and still this is not enough. They obtain the pads from a company who are one of their supporters and get a discount so I doubt they could improve on the cost.

Some patients may benefit from having a commode and trying to maintain some bladder control. This was discussed with FSC staff.

Funding and rural poverty: the main problems

Insecurity of funding is a major nightmare for FSC particularly with Bacau City Council. There is no formal funding in place for social and medical services in the community, other than the dispensaries and GP’s. Most accredited service providers in Romania are NGO’s, many of whom have gone out of business because of funding problems. The cost of living has risen sharply since EU accession but pensions have not risen. Far from improving, rural poverty is a worsening problem. The lack of a proper funding strategy and reliance on the Mayor’s discretion is staggering. The population is ageing. 15% of the population is over 65 years of age and this is set to double by 2030.

Lobbying and campaigning

This seems to be the best chance but a lot has already been tried. (Please see ‘Civil Society in Romania’ in Gabi Achihai’s Organisational Report) The EU says that provision of health and social services is Romania’s own problem and the government tells them they have it sorted. Everyone’s main focus appears to be on "sorting out the economy first" which may take years or forever.

Recommendations

  • I did wonder if an approach to Procter and Gamble about Pampers would be worth a try.
  • Approach Channel 4 "Dispatches" to see if they would be interested in a follow-up programme (to their 1994 programme which featured the Mobile Health Centre) which could highlight the lack of government concern for funding these essential services
  • FSC and the NGO Forum will continue to lobby. I wondered if there was any possibility of any lobbying at EU level

 

Julia Smyth
30 October 2013

 

Also check out these related reports by our partners FSC on Bacau / Urban Care for the Elderly and Rural Care for the Elderly