Throughout our development and growth, the vast majority of the population is acquiring a set of knowledge and skills thanks to which we are going to forge our identity, our way of seeing the world and the way we interact with it. We are learning how to carry out tasks that allow us to survive autonomously and independently.
However, there are people who for some reason have lost or have not sufficiently developed the necessary skills to carry out day-to-day activities completely autonomously. These people may need some type of supervision, help or support in the different day-to-day tasks, an aid that can be provided in many cases by different types of social and health institutions.
This requires professionals capable of responding to the needs of this sector of the population, making training in social and health care for dependent persons in social institutions necessary . This is the subject that will be discussed throughout this article.
What is social and health care for dependents?
In order to understand the type of care that should be offered from social institutions to dependent persons, first it is necessary to take into account what the concept of dependent person refers to .
We consider a person to be dependent when he or she is in a situation or state of generally permanent characteristics in which for some reason this person has lost or seen reduced his or her faculties or capacities to lead a totally autonomous life , or when he or she has not been able to develop these capacities completely to levels that allow him or her to act independently and adapt to environmental and social demands.
Dependency implies the need for attention, support or supervision by other people (or resources) outside the subject himself in order to be able to carry out day-to-day activities or to maintain as autonomous a performance as possible.
Although in general, when we speak of dependency we tend to think of people with intellectual disabilities or some type of neurodegenerative disease, the truth is that the concept of dependent person also includes those subjects who have some degree of physical or sensory disability or whose vital activity is highly interfered with by the presence of some type of psychiatric problem.
In addition, the elderly or those in frail health requiring continuous care are also included.
In some cases the person is in a situation of legal incapacity and may be guardianshipd by a relative or foundation, although it is not necessary to be legally incapacitated to have some degree of dependency .
Thus, social and health support or care is not something that only implies an action at a cognitive level but a comprehensive care, which may include different types of actions depending on the needs, difficulties and / or potential of the subject. It is important to note that the intention of this type of service is not only to alleviate possible deficits but also to maximize and optimize the strengths of the individual , as well as his or her quality of life.
It should also be taken into account that when we speak of social health care in social institutions we are referring to care that is offered in an organization or structure dedicated to the service and search for the welfare of users, and whose action can be carried out in multiple environments.
Types of social institutions for people with some kind of dependency
With regard to the type of resource or social or healthcare institution offered to dependent persons, we can find different categories with different objectives and types of treatment or support offered . In this sense, some of the most common are the following.
1. Service for the prevention of situations of dependence
These are devices whose main purpose is to try to prevent or limit the possibility or worsening of situations of dependence in a population at risk, the most obvious example being that of people with a congenital disability or the elderly. Thus, this type of device works with a population that either does not yet have a dependency situation, or seeks to ensure that this does not limit more than the person’s autonomy is already doing.
2. Hospitals and Day Centres
Probably the best known types of social health services or institutions, day centres and day hospitals have as their main objective to provide complete and comprehensive care to users in order to increase or maintain their level of autonomy, social and community participation, capacity for self-management and in general their quality of life.
Its biopsychosocial work usually includes the application of rehabilitation measures, restoration or compensation of functions, guidance and counselling for the user, facilitation and training of social and family bonding without requiring an income, favouring healthy habits, controlling the situation and providing support to both the end user and his environment.
3. Residential Care Centers
This last type of center, also highly known, is dedicated to offer a social-sanitary attention also integral but in people who are admitted or located in the same service, in which they live (either in a permanent or temporary way).
In these centres, the users carry out different types of activities, workshops or therapies (depending on the case) that allow them to improve and/or preserve their autonomy and/or capacities, favour their bonding and socialisation. An example of this type of service can be found in the Llar Residencia, in Catalonia (Residential Home, in Spanish).
4. Other types of service
While the three above are some of the most common, there are also many other types of care services for dependents. Among these, we may find the tele-assistance service or home help .
Likewise, and at a more integral level of health care, we can find various services within the public health portfolio, such as units of high psychiatric dependence or admission to acute or sub-acute units, neuropsychiatry or psychogeriatrics.
Degree of dependency and activities from which they are analysed
It should be borne in mind that in order to offer quality social and health care to dependent people it is first necessary to know what their needs are and to what degree they are dependent.
In this sense, it will be necessary for a professional with the appropriate training to be able to assess the subject , for which he/she will use one or several questionnaires and the observation of the subject as well as the characteristics and reports of his/her life situation and environment. With this, a score will be obtained in the Dependency Assessment Barometer that will serve to determine the type or degree of dependency of the person in question.
The type of activities that are analyzed are usually the basic activities of daily life: nutrition, hygiene, sleep, sphincter control, mobility and movement, household tasks, ability to maintain health status, ability to make decisions. It is also taken into account whether external help or guidance is needed, for example, to carry out these actions.
Based on the scale we have seen, we can get three types of dependency: Grade I or moderate in which the subject needs some help to be autonomous, Grade II or severe in which although it does not need a permanent caregiver but requires help several times a day to perform certain basic activities and Grade III or great dependency in which the subject needs a caregiver, supervision or continued assistance in their day to day.
Another factor to be taken into account is that the care of a dependent person requires the collaboration of different professionals from different health and social branches .
The specific type of professionals that each person will need may vary according to the case, but broadly speaking we can find doctors (from any branch, be it neurology, phoniatrics, cardiology, endocrinology, immunology…), nurses, psychologists, assistants, physiotherapists, speech therapists, occupational therapists, social workers, educators, teachers and pedagogues (and not only in the case of children) and in some cases even lawyers.
All of them shall coordinate their actions to offer an integral care that takes into account the needs, potentialities and difficulties of the dependent person in order to improve his/her quality of life as much as possible.
Social and health intervention
Although the different professionals involved will work focusing on their specialty in order to help the subject, we can roughly determine the general nature of the main work that has the socio-health care of dependent people in social institutions.
The action of the professionals is aimed at the development and implementation of programmes aimed at providing assistance that allows the subject to carry out the basic activities with which he has difficulties, the rehabilitation or compensation of systems, capacities and functions, the incorporation of the subject into social participation and to link up with other people, and education and psycho-education aimed at both the subject and his environment in order to face possible difficulties and improve the subject’s standard of living and autonomy.
This action includes the approach of therapies and activities aimed at cognitive stimulation, cognitive restructuring of distorted beliefs, the use of occupational therapy to improve functionality in basic activities, health promotion and damage prevention, adherence to treatments if any, stress or emotion management or improvement of social participation through various activities and training, among many others.
All of this always preserving an ethical line in which dignity, confidentiality and respect for the capacities and independence of the subject prevails, while generating a warm and comfortable atmosphere and seeking the maximum benefit for the subject and avoiding, as far as possible, any harm produced by the assistance action itself.
- Institute of Training and Social Studies (IFES). Territorial Management of Andalusia. (2010). Social and health care for dependent people in social institutions. Training Module 1. Support in the organization of interventions in the institutional field. Training Unit 1. Support in the Reception and Welcoming in Institutions for Dependent People. Andalusia, Spain.