Home Services as a Better Alternative for the Elderly Living in Residential Instituciones MSc

This is a qualitative stydy which aims to present the experiences of older pople living in residential institutions in Tirana. The results are based on the analysis of eight interviews with elderly people that live in residential institutions and experts/serviles providers for the elderly. Participants in the study were intentionally chosen. For data collection were used semi-structured interviews, which were designed at the end of literature review process. At the end of interviews transcription process, for data analysis was used contrast method, that helped in indetification of categories and themes building. The study found out that services provizions has to be extended to the specific situation of elderly. Home-care services are more desired for the elderly, while long-term care services are considered as the last alternative to be taken as solution. Because older pople prefer to stay in their homes, where they know their friends or neighbors and can associate memories with each object around them. Elderly appreciate also the impact of day centers in strengthening the role of the family as primary care institution. This research can be used by policymakers and private sector to improve and expand the variety of services for elderly. This study may also encurage initiative of others researchers for depth studies in this area.


Introduction
The increase of the demographic perspective of elders in our country is makeing more evident the begining of "aging population" fact.In condictions where the role of family as a basical institution of care on elders is becoming less, the request of them to have residential care has grown.The residential care isn't consider as the best alternative from the elders, but as the only alternative which is offered.The increase of requestes from elders to be part of residential services hasn't been in parallel with the increase of institutions capaciteties to offer this service.In group focuses and in interviews realized during the phd studies has been note that the beneficiaries are with different heteregeneous characteristics accoriding to the geneders,ages, and even the health state.Some of them have expressed that if will offered serivces like home visits, they will not consider as an alternative the residential services.The residential service it keeps them away from their family enviroment but even persons which are in age groups 60-70 years old and are in a good health state compared with elders (over 75-85 years old) which needs medical assistanc continuously, they think it might be more intergratetiv for them to live in their houses where can benefits part time social assistanc.

Study's purpose
In focus of this study are the elders which are living in residential instituions, how they experience the living in this institutions.

Researches questions
-Which are the perceptions and thoughts of elders about residential services?-Which are the feeling that they have for living in residential institutions of social care?-What kind of social care services should be offerd for the elders who lives alone?

Literature Review
Even though the Defend Social Sistem has been extended with offering community services for elders in just some main cities, this haven't effect in the reduction of elder's number which ask residential services.
In this way should be identifing services which might "go" there where the elder is, so it can be avoided the oposite.In other developed countries for example Franc, the residential services it seems as a good alternative for the elders that need a contiuous medical care, meanwhile has been increase the number of elders which take the home services 1.The majority of elders prefers to stay on their houses, where they know their neighborns and can connect memories with each part of the furnitures and with the objects around them, instead of going in a residential institution.
In Franc "ageing in your place" is the term used more currently, where the elders it might offered home services for cleaning, shopping, cooking.This help it might come from family members, relatives, or neighborns, or even members of religion communities.
Another help for the elders that choose to live in their homes it might come from the Local Agencies for Elders, where the elders can call for needed helps.
In USA to be more close of elders needs, which are in a status and choose to live alone it is created a webbsite care.com, in this webbsite it can easly contact with trained persons which offers home services for elders.
This service it might be easly applied even in our country 1 .The service of home assistance for elders which lives alone it offers assistance for daily activitetes like washing/place cleaning and cloths or other personal objects of elders, food, help in paying the monthly bills of water and elctricity, friends visistis, ect.It doesn't needs proffesional care.It can be managed and supported even from civil actores of society.
• Home medical assitance for elders that do not need full time health care but suffered from a chronical sickness.This service it might be offered partly from the National Social Service(national budget) and different NBO that might operate in the country.• Extended the network of community services empowering the family.The daily care for the elders it offeres health services, social services like social activities, physicals, religions, creative, and supportive services for the elders with function damages for a prearranged time of day, less than 24 h.In this way the families of the elders thay can fellow without interruption their activies during the day.In the italian country seems more worthful spreading the monetary beneficials for the informal care offers for the elders rather rising a stable insurance system of infromal care 1 .In Italy the community services for elders, but even the home visits or personal assitenc services in home are appreciate like the most desirabled from the elders, meanwhile the residential service is seemed like the last altrenative for the care of the elders with specifiques needs 2 .
Meanwhile in Canada home services are appreciate with a low cost campered with the residential service 1 .In this way should kept in mind the desire of elders to stay in home and the nation budget request to offer services with low cost, the home services are evaluated like the most righteousness and accpetabled .
Exist great changes in using longterm care services in Germany, depended from the social status, ethnicity and gender.Those with a high social status mostly they use home services offered from them private institutions, meanwhile those who are with a low social status they use money comenstation 1 .Even though in Germany always is getting enlarge the network of private services offers for elders, where the most favorite service is home service 2 .
The theory of Empower and Juristy is one of the theories that can effect in increasing the participation of individuals and communities in taking decision for cases that are sensible for them and touchs directly their lives.Juristy wants to present the interest of unpower groups of individuals which effects the proggress of social structures.The empower is focused in incresaing the abilities of individuals to take decisions related with the services that touchs them, growing the selfconfidence to effect individuals or social structures.The thoery of empower and juristy it will empower the elders to ask, convicible, services that they consider more fittable and right for them.This theory will help to increase the knowledges of the elders for the capcities and the rights they have to effect in the structure of social services.According to Lee, Mullender and Eard the Theory of Empower is evaluated for the practical use in empowering of individuals or groups following different social causes, meanwhile Schneider and Lester are focused at role of the Theory of Juristy on proggressing of indiviual situations or groups following differernt socila causes 1 .

Methodology
The revision of studies realized in different countries, like those very developed(USA, Canada, France, Germany, Italy) and on countries more close to our culture(Bulgary) has been served as a first instrument used for the collections of datas, determining clearly the study field and the researcher questions.The second method of collecting datas it was used the half structure interview,all the participations in study were choosed in a purpose way.

The participations on study
In this study were realized 8 interviews.Were involved 6 elders which are living in the House of Elders in Tirana, three of them were females and three males.Also it was realized an interview with a social worker of the institution and another interview with the specialist for elders of the National Social Services.
4 ladies and 4 gentelmens That are living in residential institutions Age above 60 Persons with different proffesions The participations were choosed attentively It was determined the age above 60 for elders that will be interviewed according to VKM number 425 for filling the files of being part of residential national institutions the age is one of the clear determind criterion 1 .

The procedure of data's collecting
An interview lasted 15-20 minutes.All the interviewers were opened and didn't hesitate to answered and to share the experiences and their feelings.For collecting information was used the method of noting down during the interview.

The method of data's collecting
The basical instrument of collecting datas was used the half structure interview.All the interviewers were cleared preliminarily according to the purpose of this study and the nature of refered questions.
Some of the questions included in this half structure interview were: What do you think for the typology of soacial services that are offered to elders in our country?Which one of the services for elders that you might know even as an concept will evaluate like the most adaptable or likable for elders?How could you describe your feelings according to the residential service?

The method of data analysies
In the end of the whole procces of collacting datas, next step was the trascription of all interviews.In the end of the whole transcripted interviews and thier coding was used the method of contrast comperment whcih helped in the categorically of datas, identifycation of categories, creating topics of combining possible relations between identify categories.

Data's Analyzes and Interpretation
The results of datas in this study will be appeared in three main topics:

Attitudes about Services Offered in Our Country for Elders
The elders emphasized that services offered are limitted, do not offeres services that can improve their lives in home.They emphasize if they will have an oppurtiunity to choose, may desire to live in their family environment.Fifth of interviewed elders tolds that during the time of filling the right necessary files to be part of residential service, have been intersted at National Social Services officies in their cities, for other services that might be offered to elders that do not have family supports or do not have famiy/relatives and have choosed to live alone in their homes.The Specialist by National Social Service when was asked about the variegation of services typologies that are offered to elders, was expressed that have emphasized incompletetions in extension and typology.According to him it is very necessary to extend the typology of social services for elders considering as a prime service offered the home services.This it will bring a low cost for the nation budget.
Meanwhile the social worker by Home of Elders in Tirana shows that the typology of social services for elders it's very limitted.She expressed that might be in total three or four daily centres for elders in all country and even the public sector and private one are focused in offering residential service for elders.
o Well i don't know very good the words that are used but do not have very much services about us the elders.o The public sector and even the private one offeres more residential services , in the whole country it might be three or four daily centres.Could not talk about services because only the residential service is offered(social worker)

Services of home care & Residential services
Home services are evaluated from elders like the mos desirable and intergratetiv because it can enalbe againg in environments where have pass their lives, close to objects or furnitures that are valour for them.Home services makes possible for them to meet their neighborns, friends, for the morning habits, example drinking coffe, reading newspapers or walking.
The social worker tolds that most of elders they pass their day talking about their homes, clothes,personal objects, morning coffe and converstations with friends or neighborns.Obviously this shows their desire to live by their family environment.
The specialist nearby National Socials Services talked about the advantages of home services not only for reliefing the elders lives but even for minimizing the costs that will bring to nation budget the application of those services.Also he emphasized that even the residential service for elders it would improved more because the number of the beneficiaries will be reduces.
Almost all of elders emphasized that home services will make them happy, even though one of interviewed elders showed that even if exsist the home services again he would choose to stay in institution becuase it doesn't has a home and his childrens don't want him to live with them.The old ladies staies home because they be concerned for the home meanwhile males tolds more about walking and the routine that have created with their friends.
All the time i listen the elders telling each other for their homes, furniture, friends and their neighborns.It sad when you see that during all the time, days pass trying to creat the life they had.The service it is offered to improve the conditions where they are not to remove the joy.Indeed i could say that the residential service it a necessary affliction, but for them who do not have home or relatives and are in an old age and not in a good health condiction.(Social worker) o Home services despite that are very desirable from elders, brings even a reducer cost than residential services.Because it is not offered home services it is growing more and more day by day the request for residential services, this is making that institutions are extanded their capacities.But all of this has a cost.So, if every town hall or commune will enable part time home services where should offer social assistance but even medical it would be alright.This is not hard to be realized but it needs time and a good institutional cordination, certainly .(Specialsitnearby SHSSH) Thank Lord we don't have health problems but it will be good to have a nurse in home to measure blood preasure or to help with the medications or like our friends says to do one day on and one day off to do for in our home.Becuase i have a big house, and it can be humided and damage my clothes.My furnitures are new.I'm not here because of pleasure.
There i know all in the neighbornhood, i have pass my life there.Drinkin coffe at my home because i was alone, staying there comfortable, talking, this is what we old laydes wants.(oldlady)

Daily/ comunity services
Almost all the elders evaluates very important even the daily services or comunity nearby their locality.Those services offeres different activities like parties, discussing environments, games(dominoes,pool), reading news papers, eating, for example having a tea or coffe or eating lunch.According to them these services are very desirable not only form the elders that are living alone but even from those how are living with their families.In this way they will pass a long time in the center and will not occlude their families that can have an active social life.Accordin to the social worker, daily centers offers necessary services for comunity and relief the life of the elders family, so in this way it increas the integration of elders in social life.
Meanwhile the specialist of National Social Service emphasized that daily centers will effect directly in reducing the number of beneficiaries in residential centers because it will offered services nearby elders house.Daily centers are I think that opning daily centers in every city or comune of the country it will be easier for the family to take care of elders.
The major part of day elders can pass it in the centre and for their family it would be easier to follow their activites.Daily centres remove from them a big burden and avoids the conflicts.(socialworker)

Conclusion
Social services that are offered to elders are very limitted according to the typology.Residential service is evaluated from elders like less desirabled but it still be the main service and only alternative for elders that lives alone and in different social situtations.From this study also it results that that elders see the residential service as a necessary affliction where staying home is impossible for them because of the absence of the necessary services.Also social workers of residential service have emphasize the importance of home service as an alternative that may intergrate elders in society without dispatch them from the their friends and family.Residential services is estimated as a good alternative for elders above of 80 years old or which might be not in a good healthy state.
According to the study home services are considered from elders, but even from social workers for elders, as a good alternative.It can enalbe ageing in environments where they have pass their life, close to their objects or furnitures which are very important for them.Home services enalbe to elders to meet their friends and neighborns for the morning habits for example drinking caffe, reading newspaper or walking.
Extanding comunity services or daily centers will affects directly in reducing the requests of the elders to be part of residential services and will help in strengthing the family as a main institution of care for elders.
From datas analyzies the elders evaluates very important the daily services nearby of their place.Daily centres offeres different activites like celebretaing holidays, environment for disscusing, games (pool, dominou), reading newspapers,consuming food for example, drinking tea and cafe, or eating lunch.According to the results of the study the elders see those services very desirable not only for whom are living alone but even for whom lives with their families.In this way they will pass a major part of time in center and wont occlude their families that might have an active social life.

Further Proposals
This study gives its contribution in identifing the most desirabled social services, most adapted and integrated for the elders.The discoveries of the study might be interested for further and studies according to social services for elders.This study it might determined the initiatives of public sector and private one for offering integrated services for elders.
It seems they don't can make it short and close us in insitiution.I have a house and i would like to live there, there are my neighborns, my place.It will be very good if persons came homve for some hours to help or to measure my blood presson.I asked at the place where i filled the files before of coming here but they said to me that doesn't have this kind of services.(theelder) male elders rather than females.Almost all the male elders appreciated a lot the efficacy of those centers.oIf would have centers to pass our day it will be good.For example, my son and daughter in low are the whole day working and their child is in kindgarden till 5 o'clock.I decided to come here because i caused to them argues, my daughter in low camed late from work and the time flies taking care of baby.I was occluding them, i couldn't help them, i was just staying all the time.I hearded about this kind of center in Kamez,they come to pick you up from home.That's good because i can not walk, there was so nice, playing dominou with friends, drinking caffe with other elders and eating.(theelder) o I am convinced that it will have daily centers almost in every city or comune, it will be reduced the number of elders that are part of residential services.Not all the elders needs 24 hour service.Daily centers offers differens activites for holidays but even for ordinary days.In this way the elders wouldn't feel alone and those who lives with their familys it wont occlude them.(Specialist of National Social Service)