tag:theconversation.com,2011:/ca/topics/community-services-11003/articlesCommunity services – The Conversation2023-09-26T21:10:43Ztag:theconversation.com,2011:article/2128672023-09-26T21:10:43Z2023-09-26T21:10:43ZAre seniors being pressured into retirement homes by lack of community services?<figure><img src="https://images.theconversation.com/files/549798/original/file-20230922-29-uw9xz2.jpg?ixlib=rb-1.1.0&rect=715%2C169%2C7881%2C5254&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Retirement homes might seem like less of a lifestyle choice and more like relocation imposed upon older adults by fragmented and under-resourced primary and community care services.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/are-seniors-being-pressured-into-retirement-homes-by-lack-of-community-services" width="100%" height="400"></iframe>
<p>Ads for retirement homes often feature an older couple relaxing in comfortable surroundings, playing a board game or enjoying a meal with friends. They look well — and young for their age — with broad smiles and perfect silver hair. </p>
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<a href="https://images.theconversation.com/files/550125/original/file-20230925-26-eb6i3b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Collage of three photo of healthy, smiling older adults." src="https://images.theconversation.com/files/550125/original/file-20230925-26-eb6i3b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/550125/original/file-20230925-26-eb6i3b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=488&fit=crop&dpr=1 600w, https://images.theconversation.com/files/550125/original/file-20230925-26-eb6i3b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=488&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/550125/original/file-20230925-26-eb6i3b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=488&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/550125/original/file-20230925-26-eb6i3b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=613&fit=crop&dpr=1 754w, https://images.theconversation.com/files/550125/original/file-20230925-26-eb6i3b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=613&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/550125/original/file-20230925-26-eb6i3b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=613&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Ads for retirement homes seem to offer a worry-free lifestyle choice. Above: stock images seen in marketing materials for retirement homes in Canada.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>These ads offer worry-free, active retirement living at its fullest, complete with delicious and nutritious food. It looks like a wonderful lifestyle choice. </p>
<p>But is it really a lifestyle choice? Or, is it imposed upon older adults by fragmented and under-resourced primary and community care services?</p>
<h2>Assisted living</h2>
<p>In Canada, retirement homes (also known by other names like assisted living) are increasingly for-profit living facilities for older adults. They offer a variable range of services paid for by residents. Across Canada, <a href="https://www.comfortlife.ca/retirement-community-resources/retirement-cost">monthly fees range from $1,600 to over $6,000 for spaces ranging from 300 to 600 square feet</a>. </p>
<p>In Ontario, <a href="https://www.cmhc-schl.gc.ca/blog/2021/2021-seniors-housing-survey-learn-more-insights">where monthly fees for retirement homes average almost $4,000</a>, at least two services must be provided, such as meals and medication administration, with additional services often available at extra cost. </p>
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<img alt="Two older women sitting at a table while a young man wearing an ID badge talks to them" src="https://images.theconversation.com/files/549801/original/file-20230922-24-ripe1o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/549801/original/file-20230922-24-ripe1o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/549801/original/file-20230922-24-ripe1o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/549801/original/file-20230922-24-ripe1o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/549801/original/file-20230922-24-ripe1o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/549801/original/file-20230922-24-ripe1o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/549801/original/file-20230922-24-ripe1o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">In Ontario, retirement homes must provide at least two services, such as meals and medication administration.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Some homes (for extra fees) offer services geared towards people with cognitive impairment, and others provide nursing and personal care to those who require physical support. Yet, these privately paid services are often not enough. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5344365/">A 2017 study</a> in the Hamilton Niagara Haldimand Brant region of Ontario showed that up to 40 per cent of retirement home residents receive publicly funded home care services, in addition to those purchased from the home. In almost one-third of these cases, retirement home residents or their caregivers said they would be better off living elsewhere, such as in long-term care (LTC) homes, where they can receive 24-hour access to nursing and personal support services. </p>
<p>In Ontario, <a href="https://www.closingthegap.ca/long-term-care-homes-vs-retirement-homes-vs-home-care-in-ontario/">retirement homes are almost exclusively private facilities</a> offering accommodations and some paid care services for less frail seniors, and they operate under less stringent regulations by the <a href="https://www.ontario.ca/page/ministry-seniors-accessibility">Ministry for Seniors and Accessibility</a>. </p>
<p>In contrast, LTC homes provide 24/7 nursing care for more dependent individuals and are regulated and subsidized by the <a href="https://www.ontario.ca/page/ministry-long-term-care">Ministry of Long-Term Care</a>. Retirement homes typically feature private suites or apartments, whereas LTC homes have more institutional and less private accommodations.</p>
<p><a href="https://doi.org/10.1017/S0714980820000045">A recent review of research</a> showed that the opportunity for greater social interaction in retirement homes is an important consideration for some, and consistent anecdotal reports suggest that many residents have a boost in health and well-being after moving into a retirement home. </p>
<p>However, the primary drivers of relocation are concerns over age-associated decline in health, coupled with uncertainty over being able to access services — such as assistance with property upkeep, medications or personal care — in their current home.</p>
<h2>Unmet health-care needs</h2>
<p>We still have a limited picture about <a href="https://doi.org/10.1017/s0714980813000159">what happens when someone moves into a retirement home</a>. In contrast to the LTC sector, for which we have relatively rich information sources at the national level, there is almost no information on retirement home residents. </p>
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<img alt="A woman in a white coat with a stethoscope and clipboard stands and talks to an older woman in a chair" src="https://images.theconversation.com/files/549799/original/file-20230922-17-vel5bj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/549799/original/file-20230922-17-vel5bj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/549799/original/file-20230922-17-vel5bj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/549799/original/file-20230922-17-vel5bj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/549799/original/file-20230922-17-vel5bj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/549799/original/file-20230922-17-vel5bj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/549799/original/file-20230922-17-vel5bj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The role of primary care medical providers is not regulated in retirement homes in Ontario.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>What we do know paints a mixed picture. For example, retirement home residents living with dementia, and who can afford specialized memory care services, <a href="https://doi.org/10.1016/j.jamda.2021.07.002">are less likely to move to a LTC home</a>. In contrast, retirement home residents <a href="https://doi.org/10.1503/cmaj.211883">receive far fewer primary care visits</a> than those in LTC homes, and are more likely to visit the <a href="https://doi.org/10.1016/j.jamda.2023.06.024">emergency department</a>, <a href="https://doi.org/10.1016/j.jamda.2015.01.079">be hospitalized</a> and experience prolonged hospital stays.</p>
<p>Clearly, the service and health-care needs of retirement home residents are not being met, nor were these being met in the community, compelling the move to a retirement home in the first place. </p>
<p>In Canada, under-resourcing of home- and community-care sectors imposes limits on where an older person can reside as their health declines, though more choices are available to those living in larger cities and able to pay for expensive private home care. Canada spends <a href="https://www.oecd.org/health/long-term-care.htm">substantially less per capita on home and community-care than the OECD average</a>. </p>
<p>Despite evidence that the medical needs of retirement home residents have been growing more complex, the role of primary care medical providers is <a href="https://doi.org/10.1016/j.jamda.2021.12.012">not regulated</a>, nor is there much incentive to practice in these settings. Retirement homes look like <a href="https://doi.org/10.1503/cmaj.211883">primary care deserts</a>, with residents often having no meaningful access to their previous primary care provider due to mobility limitations in transportation to off-site clinic locations. </p>
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Read more:
<a href="https://theconversation.com/preventing-delirium-protects-seniors-in-hospital-but-could-also-ease-overcrowding-and-emergency-room-backlogs-189220">Preventing delirium protects seniors in hospital, but could also ease overcrowding and emergency room backlogs</a>
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<p>Retirement home residents are more likely to be hospitalized and experience accelerated functional and cognitive decline without access to co-ordinated, senior-friendly primary care. Reliance on the limited access to community-based primary care clinics is inadequate because outside primary care providers often can’t know the environment or staff in the retirement home. </p>
<p>Common issues, like falls, can go unaddressed given that there is no one on site to do a sufficiently thorough medical falls risk assessment. Dehydration related delirium (confusion) that could be addressed on site can instead lead to hospital admission and premature institutional care. </p>
<h2>Designed for institutionalization</h2>
<p>Our health-care system <a href="http://nationalseniorsstrategy.ca/wp-content/uploads/2020/09/NSS_2020_Third_Edition.pdf">seems designed to foster premature institutionalization</a>. The retirement home sector attempts to fill a care and service gap in the community, but is progressively less able to do so as resident care needs become more complex and exceed what they can afford out of pocket.</p>
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<img alt="A nurse taking a man's blood pressure on a sofa" src="https://images.theconversation.com/files/549800/original/file-20230922-21-pyv5pf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/549800/original/file-20230922-21-pyv5pf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/549800/original/file-20230922-21-pyv5pf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/549800/original/file-20230922-21-pyv5pf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/549800/original/file-20230922-21-pyv5pf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/549800/original/file-20230922-21-pyv5pf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/549800/original/file-20230922-21-pyv5pf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The solution requires that publicly funded and integrated home and community services be made more accessible to older people regardless of where they choose to live.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>The solution requires that publicly funded and integrated home and community services be <a href="http://nationalseniorsstrategy.ca/wp-content/uploads/2020/09/NSS_2020_Third_Edition.pdf">made accessible to older people regardless of where they chose to live</a>, whether in a retirement home or in the private residence where they have lived for years. </p>
<p>Specific attention is required for community dwelling older people with cognitive difficulties, many of whom could continue aging in place with minimal assistance for nutrition, medication management and surveillance of chronic medical conditions. </p>
<p>Interprofessional primary care (teams that include multiple health professionals such as doctors, nurse practitioners, dietitians and social workers) <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10198684/">would have greater capacity to support older people with complex health issues</a>. Such teams must be made available to prevent hospitalization and its often disabling consequences. </p>
<p>Since many residents have limited capacity to travel to office visits, providing on-site access to primary care in retirement homes is simply fulfilling the promise of the Canada Health Act that reasonable access to insured health services is provided to all Canadians. </p>
<p>More home care and better access to robust primary care services will better meet the needs of older adults in the community, optimize their health and independence, and reduce the huge <a href="https://doi.org/10.1503/cmaj.230719">strain on our hospitals</a> and caregivers. They will also allow older people greater choice over — and ability to afford — whatever lifestyle they prefer.</p><img src="https://counter.theconversation.com/content/212867/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>George A Heckman receives funding from the Schlegel Research Chair in Geriatric Medicine. The Schlegel Chair endowment was a charitable donation to the University of Waterloo, and there is no personal obligation to the donor. </span></em></p><p class="fine-print"><em><span>Andrew Costa receives funding from the Canadian Institutes of Health Research and the Public Health Agency of Canada for related research. He is the Schlegel Chair in Clinical Epidemiology & Aging and Canada Research Chair in Integrated Care for Seniors at McMaster University. The Schlegel Chair endowment was a charitable donation to McMaster, and there is no personal obligation to the donor. He is Research Director of St. Joseph’s Health System's Centre for Integrated Care (Hamilton).</span></em></p>Publicly funded primary and home care should be accessible to all older adults, regardless of where they live.George A Heckman, Schlegel Research Chair in Geriatric Medicine, Associate Professor, University of WaterlooAndrew Costa, Associate Professor | Schlegel Chair in Clinical Epidemiology & Aging | Canada Research Chair in Integrated Care for Seniors, McMaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1772462022-04-07T16:41:57Z2022-04-07T16:41:57ZFaster diagnosis of frailty in seniors aging at home is key to helping them stay independent<figure><img src="https://images.theconversation.com/files/456640/original/file-20220406-22-skjmyw.jpg?ixlib=rb-1.1.0&rect=201%2C100%2C6045%2C4365&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Frailty is a state of reduced physical function for seniors living independently in the community. It can affect endurance, balance, cognition or social engagement.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>In the next 10 years, the number of Canadians living with frailty will grow to <a href="https://www.cfn-nce.ca/frailty-matters/">more than two million</a>. Frailty matters because it not only affects seniors’ ability to function, but also puts their health at risk.</p>
<p><a href="https://www.cfn-nce.ca/frailty-matters/what-is-frailty/">Frailty</a> is a state of reduced physical function for seniors living independently in the community. It looks different for different individuals and can affect endurance, balance, cognition or social engagement. Often frailty assessment is limited to in-office assessments by physicians. If it could be assessed in other settings, it may provide opportunities to respond to seniors’ needs for services faster and with less burden on the health-care system.</p>
<p>As nurse practitioners, we led a quality improvement project to expand identification and response to frailty for seniors living in the community. The project also engaged social work staff and others working in seniors’ services in Edmonton to assess older adults for frailty, performing these assessments at a seniors’ centre in the community. </p>
<p>Our goal was to confirm that frailty screening could be effective without medical professionals’ involvement, and to test a new method to identify and prevent functional decline. </p>
<h2>Enabling frailty assessment</h2>
<p>Unfortunately — or, looking back now, maybe serendipitously — the project began at the same time as the onset of the COVID-19 pandemic and the team had to pivot quickly to ensure continuation and success. The pandemic forced the team to think about frailty assessment in totally different ways and to develop an innovative approach to assess and respond to frailty virtually. </p>
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<img alt="A woman with gray hair smiling while holding a telephone to her ear." src="https://images.theconversation.com/files/456642/original/file-20220406-12-ovb2w1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/456642/original/file-20220406-12-ovb2w1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/456642/original/file-20220406-12-ovb2w1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/456642/original/file-20220406-12-ovb2w1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/456642/original/file-20220406-12-ovb2w1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/456642/original/file-20220406-12-ovb2w1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/456642/original/file-20220406-12-ovb2w1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Virtual assessment used questions over the phone to assess frailty.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>We needed to find a way to continue this important work despite limited face-to-face interactions. </p>
<p>Originally, the plan was to have primary care providers use a pre-existing tool, the <a href="https://www.dal.ca/sites/gmr/our-tools/clinical-frailty-scale.html">Clinical Frailty Scale</a> (CFS) developed at Dalhousie University, to assess frailty during in-person appointments at a community-based seniors’ organization in downtown Edmonton. Since in-person visits were limited, our team identified an alternative approach that involved interviewing seniors by telephone and having them provide a self-assessment of their frailty level. </p>
<p>Permission was obtained from Dalhousie to adapt the Clinical Frailty Scale to a Virtual Frailty Screening tool. Seniors responded well to the process and, after a few tweaks, we pivoted to a new and improved virtual version of <a href="https://doi.org/10.1177/21501327211034807">Building Resilience and Responding to Seniors Frailty, known as DRAGONFLY</a>.</p>
<h2>Providing support in the community</h2>
<p>Virtual Frailty Screening scores ranged from zero to nine and were divided into three categories: mild frailty (scores of one to three), moderate frailty (four to six) and severe frailty (seven to nine). Interestingly, it was the moderately frail seniors who required the most support. Those who were experiencing mild frailty didn’t require active intervention and those experiencing severe frailty were well supported. It was those seniors in the moderate category who required intensive intervention. </p>
<p>The DRAGONFLY team’s response focused on providing both social and clinical supports for care in community. The most common social supports included financial assistance, housing support, transportation, home services, legal referrals and completion of medical paperwork. More specifically, assisting seniors with paperwork to access funds or adequate housing. </p>
<p>Other seniors required more practical resources, such as a connection to a driving service for medical appointments or assistance with grocery delivery during the pandemic. </p>
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<img alt="A man with gray hair holding a pen while a younger woman smiles beside him" src="https://images.theconversation.com/files/456643/original/file-20220406-7184-39dzm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/456643/original/file-20220406-7184-39dzm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/456643/original/file-20220406-7184-39dzm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/456643/original/file-20220406-7184-39dzm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/456643/original/file-20220406-7184-39dzm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/456643/original/file-20220406-7184-39dzm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/456643/original/file-20220406-7184-39dzm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The most common social supports included financial assistance, housing support, transportation, home services, legal referrals and completion of medical paperwork.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Social connections were very important. Seniors were referred to recreation programming to enhance engagement with peers, connections with other seniors from specific newcomer communities, caregiver support, psychosocial support groups and virtual communities. Well-being supports included use of multicultural navigators to help newcomers acclimatize to their new homes, LGBTQ2S connections, medical translation and counselling for those who struggle with hoarding behaviours. </p>
<p>The most common clinical supports included connecting to a new primary care provider, help finding allied health providers such as physiotherapists or pharmacists, primary care network program registration, facilitating pharmacy reviews, connecting with drop-in mental health counselling and health navigation. </p>
<p>Putting these in place and following up with seniors via phone on a regular basis demonstrated improvement in their resilience. We saw a significant decrease in their support needs and gaps over a 12-month period. </p>
<h2>Frailty in the community</h2>
<p>Assessing and responding to frailty in the community has never been so important. The pandemic highlighted the inherent <a href="https://theconversation.com/after-covid-19s-tragic-toll-canada-must-improve-quality-of-life-in-long-term-care-homes-139763">risks of congregate living</a> and the importance of maintaining older adults living in their communities as long as possible. Independent living contributes to <a href="https://theconversation.com/enabling-better-aging-the-4-things-seniors-need-and-the-4-things-that-need-to-change-151191">greater health for seniors</a> and also helps to keep <a href="https://www.cma.ca/news-releases-and-statements/new-study-cost-and-demand-elder-care-double-next-10-years">health-care costs lower</a>. </p>
<p>We already know that seniors who are socially engaged are <a href="https://doi.org/10.1186/s12889-019-7841-7">not only happier, but healthier</a>. Thinking about and implementing new ways of identifying frailty and including social services as a major sector in this work represents a new way to integrate our health and social spheres, rooting wellness in our communities, not in our clinics.</p>
<p>Our program made an important difference to over 100 seniors during a very challenging time for them. In the face of social distancing and limited face-to-face services, DRAGONFLY continued to assess frailty in seniors in the community and allowed us to respond to functional needs in a meaningful way. </p>
<p>This project is coming to an end, but we are currently working with <a href="https://drivehappiness.ca">other organizations</a> that serve seniors and hope to apply the lessons of DRAGONFLY to build capacity to assess and respond to frailty, preventing its progression.</p><img src="https://counter.theconversation.com/content/177246/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tammy O'Rourke receives funding from Healthcare Excellence Canada.</span></em></p><p class="fine-print"><em><span>Anne Summach is affiliated with the Nurse Practitioner Association of Alberta.</span></em></p>Frailty — the physical limitations of seniors living in the community — needs to be assessed before it can be addressed with social and health support. Virtual assessments can speed up this process.Tammy O'Rourke, Assistant Professor, Faculty of Health Disciplines, Athabasca UniversityAnne Summach, Assistant Teaching Professor, Nurse Practitioner Program, Faculty of Nursing, University of AlbertaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1523732021-01-31T14:00:17Z2021-01-31T14:00:17ZOlder caregivers struggling with extra burdens of home care during COVID-19<figure><img src="https://images.theconversation.com/files/381412/original/file-20210129-20114-1jei23h.jpg?ixlib=rb-1.1.0&rect=46%2C0%2C952%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Older caregivers report unprecedented and unrelenting levels of responsibility, stress and isolation due to COVID-19 and pandemic-related protocols.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Ninety-three per cent of older Canadians (age 65+) <a href="https://www.canada.ca/en/employment-social-development/corporate/seniors/forum/report-seniors-housing-needs.html#h2.3">live in the community</a>, and <a href="https://www150.statcan.gc.ca/n1/pub/75-006-x/2020001/article/00007-eng.htm">one in four provides care</a> for family or friends with long-term health conditions or disabilities. <a href="https://doi.org/10.1177/1471301219834423">Challenging circumstances are not a new phenomenon for these caregivers</a>, but COVID-19 has complicated and amplified their situations. </p>
<p>Older caregivers report struggling with increased levels of responsibility, stress and isolation due to COVID-19 and pandemic-related protocols. A survey conducted by the Ontario Caregiver Organization have found <a href="https://ontariocaregiver.ca/spotlight-report/">54 per cent of family caregivers have found it harder</a> to manage their caregiving responsibilities since the pandemic began.</p>
<p>Early in the pandemic, there was some recognition of the <a href="https://www.thestar.com/opinion/contributors/2020/03/31/family-caregivers-will-be-key-during-the-covid-19-pandemic.html">potential challenges that family caregivers were likely to face</a>. However, the main focus was on controlling community spread of the virus and on institutional settings such as hospitals and long-term care residences. </p>
<h2>Greater burden on caregivers</h2>
<p>Long-term care residences, populated almost exclusively by older adults, have experienced immense loss as a result of COVID-19, yet most older adults who depend on care rely on family and friends. Without informal caregivers <a href="https://www.carerscanada.ca/carer-facts/">providing the majority of care in the community</a>, these older adults would no longer be able to reside safely in their homes.</p>
<p>Widespread public health efforts to limit COVID-19 spread have led to drastic <a href="https://theconversation.com/covid-19-has-isolated-disabled-people-from-family-love-sex-142262">reductions or closure of community-based services</a> that were intended to protect and support vulnerable older adults. As a result, caregivers cannot access community supports such as: home care services, day programs, respite services and caregiver support groups. Community-based organizations that frequently offer programs suitable for caregivers and their care recipients have been forced to cancel or severely reduce program offerings. </p>
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<strong>
Read more:
<a href="https://theconversation.com/after-covid-19s-tragic-toll-canada-must-improve-quality-of-life-in-long-term-care-homes-139763">After COVID-19's tragic toll, Canada must improve quality of life in long-term care homes</a>
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<p>Caregivers have also lost the assistance of friends and family because of restrictions on the number of social contacts beyond immediate households. As a result, these caregivers have become entirely responsible for the care provision of their often highly vulnerable care recipients, in addition to running a household and caring for themselves. This greater burden of care in combination, with increasing social isolation and loss of time for respite and self-care, has placed caregivers at undue risk for declining health.</p>
<h2>The need for collective community action</h2>
<figure class="align-center ">
<img alt="A woman caregiver feeding an older man" src="https://images.theconversation.com/files/381414/original/file-20210129-20155-2d15u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/381414/original/file-20210129-20155-2d15u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/381414/original/file-20210129-20155-2d15u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/381414/original/file-20210129-20155-2d15u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/381414/original/file-20210129-20155-2d15u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/381414/original/file-20210129-20155-2d15u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/381414/original/file-20210129-20155-2d15u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Social distancing and restrictions during COVID-19 have resulted in many caregivers losing the assistance of friends and family beyond their immediate households, leaving them more isolated and with greater responsibilities.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>As health researchers in nursing and rehabilitation sciences, we are <a href="https://doi.org/10.1017/S0714980820000203">seeking to understand how best to support older adults</a> and their caregivers in managing their health and well-being. <a href="https://doi.org/10.1177%2F2235042X20981190">Our research suggests that communities can play an important role in supporting this invisible caregiver workforce</a> so that they do not become further burdened by this pandemic.</p>
<p>Neighbourhoods and communities can play an important role in supporting this invisible caregiver workforce to reduce additional burdens experienced during the pandemic. The collective mobilization of the community and its members can provide assistance to caregivers in two ways: </p>
<ol>
<li>Through facilitating their access to formal supports </li>
<li>By using creative approaches to provide informal support that respect public health protocols and mandates </li>
</ol>
<p>For example, public libraries could loan tablets and Wi-Fi hotspot devices as part of their services, <a href="https://www.brantfordlibrary.ca/en/technology-and-creativity/technology-and-maker-kits-laptop-wifi-and-tablet-loans.aspx?_mid_=17759">as seen in some communities</a>. That would enable older caregivers, who are often on fixed incomes, to benefit from digital connectivity. </p>
<p>Individual community members can volunteer their time to remotely assist caregivers with their digital literacy so that they can recover lost social connections with family and friends via networking sites such as Facebook, or through platforms like FaceTime and Skype. </p>
<p>Fostering caregivers’ online capabilities would also enable them to take advantage of newly adapted online formal supports for their care recipient, such as <a href="https://alzheimerlondon.ca/virtual-social-rec/">online therapeutic recreation programs</a>.</p>
<h2>Closing service gaps</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/381415/original/file-20210129-20114-rdjv0q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman taking a man's blood pressure" src="https://images.theconversation.com/files/381415/original/file-20210129-20114-rdjv0q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/381415/original/file-20210129-20114-rdjv0q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/381415/original/file-20210129-20114-rdjv0q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/381415/original/file-20210129-20114-rdjv0q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/381415/original/file-20210129-20114-rdjv0q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/381415/original/file-20210129-20114-rdjv0q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/381415/original/file-20210129-20114-rdjv0q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">In a survey conducted by the Ontario Caregiver Organization, more than half of family caregivers reported finding it harder to manage their caregiving responsibilities since the pandemic began.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Compassionate efforts of community members, including individuals and local businesses, can lessen gaps left by loss or reduction of services due to COVID-19. For example, community members can reach out to caregivers and older adults in their neighbourhoods to help with tasks such as going to the grocery store or pharmacy, and provide respite for caregivers by providing virtual or phone visits to the older adults the caregivers are supporting. </p>
<p>A <a href="https://www.redcross.ca/how-we-help/current-emergency-responses/covid-19-%E2%80%93-novel-coronavirus/information-for-community-organizations-affected-by-covid-19/granting-program/emergency-community-support-fund/round-1">number of community support organizations</a> have taken measures to reduce program sizes or offer physically distanced visits in client homes. Communities could work together to ensure that caregivers are aware of these initiatives, <a href="http://www.oacao.org/programs/seniors-centre-without-walls/">such as Seniors’ Centres Without Walls</a>, and support them in accessing them.</p>
<p>Collective action by communities can include advocating for prioritized COVID-19 vaccination for informal caregivers, especially those who are older adults, and their family members. Early and timely access to vaccines for these vulnerable community members would enable the reinstatement of multiple caregiver supports. Caregivers should be recognized as essential workers as they are instrumental in keeping those most vulnerable in our communities safe at home. </p>
<p>When addressing older adult caregiver needs, there must be careful, measured evaluation of the risks and benefits of COVID-19 physical-distancing and other protective measures. Collectively, we have a responsibility to ensure that we don’t further isolate caregivers for fear of COVID-19 transmission, subsequently placing them at grave risk of health decline due to prolonged caregiver burden.</p><img src="https://counter.theconversation.com/content/152373/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anna Garnett has received funding as a co-applicant from the following organizations:
Society for Social Sciences and Humanities - Partnership Engage Grant 2020-2021
Canadian Institute for Health Research - Team Grant 2013-2018</span></em></p><p class="fine-print"><em><span>Melissa Northwood has received funding from Canadian Institutes for Health Research, Mitacs Accelerate, and the Regional Geriatric Program (affiliated with McMaster University. She is a member of the Registered Nurses Association of Ontario. </span></em></p><p class="fine-print"><em><span>Ruheena Sangrar has received funding from the Labarge Optimal Aging Fund (McMaster Institute for Research on Aging at McMaster University). She is a member of the Canadian Association of Occupational Therapists.</span></em></p>Older adults who are caregivers to someone with a health condition or disability report severe and unrelenting levels of stress and isolation during COVID-19 due to pandemic-related protocols.Anna Garnett, Assistant Professor, Arthur Labatt Family School of School of Nursing, Faculty of Health Sciences, Western UniversityMelissa Northwood, Assistant Professor, School of Nursing, McMaster UniversityRuheena Sangrar, Postdoctoral Research Associate, Centre on Aging, University of ManitobaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1068932019-01-07T10:20:46Z2019-01-07T10:20:46ZKnife crime: children are not the problem, they are part of the solution<p>Within the first few hours of 2019, <a href="https://www.bbc.co.uk/news/uk-england-london-46728460">two people in London</a> had been stabbed to death. This came just after the Metropolitan Police revealed <a href="https://www.independent.co.uk/news/uk/crime/london-crime-stabbings-murders-shootings-violence-met-police-crime-figures-total-a8705986.html">134 people</a> had been killed in the capital in 2018, with just over half the victims of knife crime.</p>
<p>The spate of knife crimes in London has whipped the media and politicians into a frenzy. Knife crime is now described as <a href="https://www.theguardian.com/uk-news/2018/oct/21/trauma-doctors-knife-crime-epidemic-nhs-hospitals">an “epidemic”</a> that’s spiralling out of control. Its impact on victims and communities is horrifying and the police and courts are seemingly powerless to address it. </p>
<p>The typical perpetrator, allegedly, is young and working class, part dangerous, part feckless. This new breed of violent child offender seemingly cannot control themselves, and can barely be controlled by others. The result is a society that feels impotent and is growing fearful of its children. </p>
<p>But in reality, the UK is witnessing the construction of a moral panic about knife crime: the problem is politically constructed, its causes falsely identified, and the “solution” ineffectively articulated.</p>
<p><a href="https://bmjopen.bmj.com/content/8/10/e023114">Research</a> into knife crime, and government <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/698009/serious-violence-strategy.pdf">strategies</a> aimed at tackling it typically adopt an “epidemiological” approach that treats knife crime as an individual pathology or disease which requires medical treatment. Alternative approaches focused on public health <a href="https://theconversation.com/knife-crime-important-new-findings-could-help-us-understand-why-people-carry-weapons-101755">centre on the causes</a> of knife crime – such as exposure to psychological and social risk factors from family, peers, or at school. </p>
<p>Either way, knife crime is committed by a broken child in need of fixing. But both these approaches are counter-productive and harmful. </p>
<h2>Toxic environments</h2>
<p>To counteract the moral panic and identify appropriate solutions to children carrying and using knives, society urgently needs to bring the issue into its proper perspective. Knife crime is a complex social problem. It is a symptom of the toxic environments that adults create around children, who then become both perpetrators and victims. These toxic environments <a href="https://policy.bristoluniversitypress.co.uk/positive-youth-justice">can leave children</a> disaffected, fearful and vengeful. They are scared and provoked into carrying knives, joining gangs and committing violent acts. </p>
<p>It is no coincidence, therefore, that the <a href="https://www.theguardian.com/commentisfree/2018/nov/16/austerity-british-state-children-special-needs-mental-health">vast majority of knife crime</a> takes place in neighbourhoods suffering from huge social disadvantage and disinvestment. </p>
<p>Children pass through many different environments in their daily lives relating to their families, education, neighbourhood, employment and recreation. Environments become toxic, harmful and can cause crime when children’s relationships and experiences fail to meet their basic needs, in particular, their <a href="https://beta.gov.wales/sites/default/files/publications/2018-02/direction-and-guidance-extending-entitlement-support-for-11-to-25-year-olds-in-wales.pdf">right</a> to be protected, nurtured and enabled to achieve positive outcomes. </p>
<p>Work with children living in toxic environments often focuses exclusively on preventing negative behaviours and their effects, such as crime, substance use and school exclusion, protecting adults, and controlling children’s behaviours, choices and opportunities. Such efforts treat children as little adults with adult capacities, development and foresight – contrary to evidence indicating that this is <a href="https://www.routledge.com/Youth-Justice-A-Critical-Introduction/Case/p/book/9781138233256">patently untrue</a>. </p>
<p>Toxic environments are not created by children – who are the victims in these environments – but by politicians and by the politics of austerity. Local council estates have been <a href="https://www.onlondon.co.uk/karen-buck-money-has-been-saved-by-reducing-services-that-keep-young-people-away-from-violence-it-has-not-been-cost-free/">hollowed out</a> by a decade of austerity which has ripped away funding for basic services for young people. </p>
<p>Let’s be clear, austerity is a deliberate political choice, it is not inevitable – but it has consequences. Austerity abrogates the responsibility to care for, to nurture and to lead children into positive lifestyles, shifting this responsibility to criminal gangs and drug dealers. </p>
<h2>Children first</h2>
<p>Responses to knife crime must be focused on the child and the adult environments that shape them. And they must involve partnerships between a variety of children’s services, such as youth offending teams and youth work, and other relevant organisations such as police, schools, and housing authorities.</p>
<p>These partnerships should prioritise positive behaviours and outcomes. Children need access to services, guidance and opportunities that build their strengths, capacities and aspirations, and develop their pro-social relationships with adults. Our own research indicates that this approach <a href="https://policy.bristoluniversitypress.co.uk/positive-youth-justice">increases children’s achievements and successes</a>, while decreasing negative behaviours and outcomes. </p>
<p>Children must be diverted away from toxic environments such as the youth justice system, into positive, nurturing ones. These environments should provide appropriate education, social care that meets children’s needs, effective youth services and training and employment opportunities. This is an approach that <a href="https://journals.sagepub.com/doi/full/10.1177/1473225414563154">we’ve proven</a> can improve children’s lives and their chances at school, finding work, and relationships with professionals, while reducing criminal and antisocial outcomes. </p>
<p>Engaging with children is sustainable and productive. Imposing interventions on children is short-term and destructive. It can make a bad situation worse. </p>
<p>Knife crime is a social problem – its causes, not its symptoms, must be treated, and austerity is one of its causes. The UK needs to refill local communities with positive services and activities for young people. Children are part of the solution to knife crime, not part of the problem.</p><img src="https://counter.theconversation.com/content/106893/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Knife crime is a symptom of the toxic environments that adults create around children.Stephen Case, Professor of Criminology, Loughborough UniversityKevin Haines, Professor, Institute of Criminology and Public Safety, University of Trinidad and TobagoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/827582017-09-08T04:46:39Z2017-09-08T04:46:39ZExtreme weather makes homelessness even worse. Here’s how we can help<figure><img src="https://images.theconversation.com/files/182715/original/file-20170821-17179-1t2r3bt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">When this is home, bad weather can make a bad situation much worse.</span> <span class="attribution"><span class="source">Karen McIntyre</span>, <span class="license">Author provided</span></span></figcaption></figure><p>The <a href="https://theconversation.com/flooding-from-hurricane-harvey-causes-a-host-of-public-health-concerns-83134">images of Hurricane Harvey in Texas</a> have shown how extreme weather can rob people of their homes. But what about those who have no home to begin with, or whose living situation is already precarious?</p>
<p>Almost one-third of people who have been homeless have suffered extra trauma because of extreme weather, according to our research involving 163 homeless services in Australia and New Zealand. </p>
<p>What’s more, 19% of people in our study cited extreme weather as a factor in their clients becoming homeless in the first place.</p>
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Read more:
<a href="https://theconversation.com/staying-safe-in-a-hotter-australia-might-depend-on-your-income-11804">Staying safe in a hotter Australia might depend on your income</a>
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<p>Our <a href="http://www.redcross.org.au/files/Building_the_disaster_resilience_of_the_homeless.pdf">study</a>, carried out on behalf of the Australian Attorney-General’s Department and published by the Australian Red Cross, featured surveys, interviews and focus groups involving people with experience of homelessness. We also talked to workers with homeless services and members of the emergency services.</p>
<p>We found that 39% of people who have experienced homelessness lose their home during severe weather.</p>
<iframe src="https://datawrapper.dwcdn.net/u5qSL/1/" scrolling="no" frameborder="0" allowtransparency="true" allowfullscreen="allowfullscreen" webkitallowfullscreen="webkitallowfullscreen" mozallowfullscreen="mozallowfullscreen" oallowfullscreen="oallowfullscreen" msallowfullscreen="msallowfullscreen" width="100%" height="307"></iframe>
<h2>Vulnerable situations</h2>
<p>In media coverage of weather disasters, both overseas and <a href="https://theconversation.com/au/topics/cyclone-debbie-37279">in Australia</a>, we often hear about how many homes have been damaged. But for those vulnerable to homelessness, the definition of “home” is much broader than this.</p>
<p>Our research focused on people who are already homeless or at risk of homelessness. This broad group includes rough sleepers, people who are couch-surfing or living in vulnerable situations such as temporary caravans, and those escaping domestic violence. </p>
<p>Compared with those who own or officially rent their home, and have access to financial security in the form of income or insurance, these people are especially susceptible to extreme weather. The problem is compounded by the fact that people in vulnerable living situations are also more likely to be suffering problems such as social isolation, mental illness, substance abuse or unemployment.</p>
<p>People in our study said they had lost tents, caravans, temporary structures such as shipping containers and cardboard shelters, and blankets and sleeping bags in open-air areas such as parks. This “loss of shelter” for the homeless community also includes losing a previously safe sleeping area to mud and water – until the area dries out it can’t be used for sleeping.</p>
<p>Less obvious, but critically important for people’s well-being, are the impacts of losing your shelter. During extreme weather, people are more likely to seek shelter in the lee of buildings like churches or public toilets to stay dry. This provides temporary shelter, but increases the risk that they will be moved on, or that they will face aggression and violence.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/182726/original/file-20170821-27201-58fmtm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/182726/original/file-20170821-27201-58fmtm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/182726/original/file-20170821-27201-58fmtm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/182726/original/file-20170821-27201-58fmtm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/182726/original/file-20170821-27201-58fmtm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/182726/original/file-20170821-27201-58fmtm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=565&fit=crop&dpr=1 754w, https://images.theconversation.com/files/182726/original/file-20170821-27201-58fmtm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=565&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/182726/original/file-20170821-27201-58fmtm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=565&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">No match for a storm.</span>
<span class="attribution"><span class="source">Joao</span>, <span class="license">Author provided</span></span>
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<p>For 19% of people in our survey, experiencing a natural disaster was a factor that helped to tip them over into homelessness. One example is this man’s experience after a bushfire, as related to us by a homelessness service provider:</p>
<blockquote>
<p>We had one fellow who was living as a caretaker on a farm. This was [230km away] … [He lost his accommodation because of the bushfires] and because there wasn’t the capability of providing homelessness services for him [there] he walked down to Adelaide and stayed down at the park for a few days until the police here connected him with us.</p>
</blockquote>
<p>Besides losing shelter, extreme weather can also trigger mental health issues or worsen existing conditions. Community services working with people experiencing homelessness report that 30% of their clients had experienced mental trauma from an extreme weather event.</p>
<p>These impacts on shelter and mental health illustrate the hardship that extreme weather can bring to people who lack the money or resources to find shelter in a storm.</p>
<h2>How communities can help</h2>
<p>Providing suitable shelter is crucial. A lack of affordable long-term accommodation, and of short-term options such as drop-in centres with laundries and showers, was the biggest risk factor for people experiencing homelessness during severe weather. In 25% of the extreme weather events we studied, there was no publicly available shelter for people who are homeless.</p>
<p>Access to weather information and warnings is important too. Our research showed that 50% of people experiencing homelessness did not receive any warning of the coming events, and 45% had no access to information about what to do in the event of extreme weather. For those who did receive information and warnings, this was most often through the outreach services provided by community homelessness agencies. </p>
<p>This vital capability can be expanded, for example by providing staff with equipment such as four-wheel drive vehicles in rural and remote areas. This would help not only with disseminating emergency warnings, but also with distributing items such as bottled water, and helping people without transport to reach shelters and hospitals.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/cyclone-debbie-we-can-design-cities-to-withstand-these-natural-disasters-75287">Cyclone Debbie: we can design cities to withstand these natural disasters</a>
</strong>
</em>
</p>
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<p>However, homeless services themselves are also highly vulnerable to the impacts of natural disasters. <a href="https://www.nccarf.edu.au/publications/extreme-weather-climate-change-community-sector">Recent research in Australia</a> found that 25% of community organisations could not recover if their infrastructure was damaged by extreme weather. Extreme weather can damage crucial infrastructure such as shelters and computer networks; it forces staff to work harder to meet the demand for shelter, bedding, food and emergency supplies; and it makes reaching people more difficult in cases where roads are cut off or mobile phone towers have been damaged. As one agency put it: “extreme weather stretches our already disproportionate response to need”. </p>
<p>Without access to housing, to weather information and warnings, to protective items or homeless services, extreme weather deepens the cycle of homelessness, as this service provider in Southeast Queensland described:</p>
<blockquote>
<p>The largest event to hit was the flood event of January 2013 which impacted over 30 tenancies we managed as well as hundreds elsewhere in the town. Hundreds of homeless people were also affected as common areas for sleeping outside were near the river or in low-lying areas affected by the flood. This event immediately impacted the customers and continued to have impact over 18 months later with countless numbers still couchsurfing or living in overcrowded situations as a result of loss of housing or camping areas.</p>
</blockquote>
<p>Homeless services can prepare by stockpiling items such as weatherproof swags, protective clothing and shoes, mobile phone chargers, cash cards, food and water. Homeless services can also use online emergency planning and preparedness tools like ACOSS’s Resilient Community Organisations <a href="http://resilience.acoss.org.au/the-six-steps">Six Steps to Resilience</a>. </p>
<p>But unless the situation improves, those least fortunate can find that they are living with the aftermath of events such as cyclones long after most people have cleaned up and moved on.</p>
<hr>
<p><em>This article was coauthored by John Richardson, National Resilience Adviser at <a href="http://www.redcross.org.au/">Australian Red Cross</a>.</em></p><img src="https://counter.theconversation.com/content/82758/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Danielle Every has received funding from the Attorney General's National Emergency Management Program, the Bushfire and Natural Hazards CRC, the Victorian SES, and SAFECOM.</span></em></p>Extreme weather is hard enough for those with a home. But imagine losing everything you own in a storm - that’s the experience of many homeless people forced to live out in the open during wild weather.Danielle Every, Senior Research Fellow in social vulnerability and disasters, CQUniversity AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/587902016-05-09T03:20:51Z2016-05-09T03:20:51ZBuild in good services from day one for healthier communities: lessons from Selandra Rise<figure><img src="https://images.theconversation.com/files/121314/original/image-20160505-1305-3dflqk.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many things go into making a healthy community, so the earlier services and infrastructure become available, the better.</span> <span class="attribution"><span class="source">Cecily Maller</span>, <span class="license">Author provided</span></span></figcaption></figure><p>Building new residential communities is no mean feat. Building healthy new communities is an even greater challenge. Released today by VicHealth, our <a href="https://www.vichealth.vic.gov.au/search/selandra-rise">five-year study</a> into the creation of one such community, <a href="http://cur.org.au/project/selandra-rise-researching-planning-for-health-and-wellbeing/">Selandra Rise</a> in Melbourne’s south-east growth corridor, points to the need for providing good services and integrated planning early on.</p>
<p>In most Australian cities new communities are usually set on greenfield sites. These have limited pre-existing infrastructure and services. Aside from housing and connections to water and electricity networks, at the bare minimum communities need parks, schools, shops, health services, public transport and roads. </p>
<p>Although the models and timing of the delivery of services and infrastructure vary, housing is usually delivered long before such essential services. For this reason early residents in new communities are often called “pioneers”. </p>
<p>Debates continue about the timing and delivery of public infrastructure in new communities. At the heart of the issue are two conflicting viewpoints. </p>
<p>The economic rationalist view requires a big enough population to ensure viability of services such as public transport or shops before these are delivered. In contrast, a health promotion perspective calls for health-enabling facilities, infrastructure and services from day one. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/121442/original/image-20160505-19848-cbegf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/121442/original/image-20160505-19848-cbegf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/121442/original/image-20160505-19848-cbegf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=777&fit=crop&dpr=1 600w, https://images.theconversation.com/files/121442/original/image-20160505-19848-cbegf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=777&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/121442/original/image-20160505-19848-cbegf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=777&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/121442/original/image-20160505-19848-cbegf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=977&fit=crop&dpr=1 754w, https://images.theconversation.com/files/121442/original/image-20160505-19848-cbegf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=977&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/121442/original/image-20160505-19848-cbegf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=977&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A new community can be designed in ways that promote healthier ‘active transport’.</span>
<span class="attribution"><span class="source">Cecily Maller</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Major life changes such as moving house create an opportunity to intervene in unhealthy lifestyles and encourage new residents to adopt healthier travel practices, or “active transport”. Examples include walking, cycling and taking public transport. However, the lack of infrastructure and services in the early years can force residents of new communities into car dependency.</p>
<h2>Long-term returns on early investment</h2>
<p>Taking a longer-term view and considering broader economic impacts, the health promotion perspective makes more sense. That’s because having healthier communities reduces the cost of the burden of disease. </p>
<p>Recent work on obesity by Pricewaterhouse Coopers estimates the potential cost savings. A <a href="http://www.pwc.com.au/obesity">2015 study</a> found that if no action is taken, obesity and its health impacts are estimated to cost the Australian economy A$87.7 billion from 2015-2025. Over the same timeframe, it shows interventions to target obesity would provide a benefit of $2.1 billion. </p>
<p>Unfortunately, this report did not include environmental interventions such as active transport. Filling this gap, a <a href="http://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/how-the-world-could-better-fight-obesity">2014 report by the McKinsey Global Institute</a> argues interventions to “reset” default lifestyle patterns – without relying on conscious choices by individuals – will play a vital role in improving population health. This, in turn, will cost-effectively reduce health-care costs and improve productivity. </p>
<p>An example is designing urban environments that promote physical activity. As others have pointed out, such interventions involve sectors beyond health – such as finance, transportation and urban planning. These sectors will “<a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3417037/">arguably have the greatest influence in creating environments conducive to obesity prevention</a>”, as well as reducing other negative health outcomes of sedentary lifestyles. </p>
<h2>What did the project set out to do?</h2>
<p>Early delivery of health-enabling infrastructure and services requires long-term planning, co-operation and partnerships among multiple government and non-government partners. </p>
<p>As a new community, the <a href="https://www.planning.org.au/viccontent/selandra-rise">Selandra Rise demonstration project</a> presented an opportunity to explore such an approach. Our research set out to evaluate the viability and success of embedding principles of health and wellbeing into urban planning as a blueprint for future communities. </p>
<p>A key outcome was the early delivery of some facilities and services. These included a community centre, a school and a park before or close to when the first residents moved in. More parks were completed within two to three years. </p>
<p>Public transport via a bus service was delivered after three years, before standard business practice of about five years. This service connected residents to the Cranbourne shopping centre and train station.</p>
<h2>What did the study find?</h2>
<p>Our research, funded by VicHealth, assessed key design features. It was undertaken by RMIT University’s Centre for Urban Research in collaboration with Stockland, the Metropolitan Planning Authority, the City of Casey and the Planning Institute of Australia. </p>
<p>The research found the community centre reduced social isolation for some residents; provided a meeting place for new mothers and residents planning the community garden; and was a hub for other community development activities. </p>
<p>Overall, residents were more satisfied with opportunities to meet people compared to those living in pre-Selandra Rise neighbourhoods. Our research also showed that residents were more satisfied with parks at Selandra Rise. </p>
<p>Although 42% reported that physical activity increased on moving there, most reported no change or their physical activity decreased. We found decreasing physical activity and weight gain were associated with long commute times. More than one-third of residents commute over an hour each way to the CBD or northern suburbs. </p>
<p>This finding illustrates the importance of the spatial dynamics of where people live and work. Integrated planning across housing and transport systems is needed. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/121322/original/image-20160505-13603-dcsxg1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/121322/original/image-20160505-13603-dcsxg1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/121322/original/image-20160505-13603-dcsxg1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=611&fit=crop&dpr=1 600w, https://images.theconversation.com/files/121322/original/image-20160505-13603-dcsxg1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=611&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/121322/original/image-20160505-13603-dcsxg1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=611&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/121322/original/image-20160505-13603-dcsxg1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=768&fit=crop&dpr=1 754w, https://images.theconversation.com/files/121322/original/image-20160505-13603-dcsxg1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=768&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/121322/original/image-20160505-13603-dcsxg1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=768&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Having a bus service can make a big difference to the lives of some residents.</span>
<span class="attribution"><span class="source">Cecily Maller</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Despite most residents using their cars to get to and from work, the bus was shown to be highly important. It provided a vital service to residents without access to other forms of transport or who were reliant on other household members for a lift. </p>
<p>After the bus was introduced, public transport patronage (a combination of bus and/or train), although not high to begin with, returned to the same level it was in residents’ previous neighbourhoods (14%). </p>
<p>The early delivery of some key features of Selandra Rise has had small but positive impacts on health and well-being. However, such gains are unevenly distributed in the resident population and were offset by long commute times and increasing resident dissatisfaction with this. </p>
<p>The early delivery of services at Selandra Rise is a step towards integrating health into community planning, but more needs to be done. Early delivery in new residential areas depends on partnerships and long-term collaboration, involving multiple levels of government, planning authorities, developers and service providers. </p>
<p>Any blueprint for the creation of healthy communities in the future requires that early delivery and integrated planning for resident health become standard practice. Many things will be required to make this happen – including, above all, a whole-of-government strategy for implementation.</p><img src="https://counter.theconversation.com/content/58790/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Cecily Maller receives funding from the National Environmental Science Program of the Australian Government. For the research cited in this article, she received funding from VicHealth's Research Practice Fellowship scheme, with additional funds provided by the Metropolitan Planning Authority, The City of Casey, and Stockland. She is affiliated with the Institute of Australian Geographers and The Australian Sociological Association.</span></em></p><p class="fine-print"><em><span>Larissa Nicholls has previously received funding from the Consumer Advocacy Panel and Consumer Action Law Centre for research unrelated to this article.</span></em></p>Early residents in new communities are known as ‘pioneers’ – they arrive before many services are in place. A five-year study points to the many benefits of putting in good services early on.Cecily Maller, Vice Chancellor's Senior Research Fellow, RMIT UniversityLarissa Nicholls, Research Fellow, RMIT UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/308952014-10-07T04:23:11Z2014-10-07T04:23:11ZConfronted by begging for spare change? Vouchers might be better<p>Even before reports of police <a href="http://www.theage.com.au/victoria/proceeds-of-crime-seizure-beggars-belief-20140820-3e109.html">seizing the takings</a> of Melbourne’s beggars as <a href="https://theconversation.com/forget-your-coins-we-want-change-begging-should-not-be-a-crime-4658">proceeds of crime</a>, their plight has been a disturbing one in this, the world’s <a href="http://www.abc.net.au/news/2014-08-19/melbourne-worlds-most-liveable-city-for-the-fourth-year-running/5681014">“most liveable city”</a> - and in <a href="http://www.watoday.com.au/wa-news/wa-police-could-seize-beggars-coins-as-proceeds-of-crime-20140822-106tw0.html">other</a> major <a href="http://www.smh.com.au/nsw/newstart-no-start-when-diet-friends-and-health-go-begging-20140523-38uep.html">Australian</a> cities <a href="http://www.adelaidenow.com.au/news/opinion/craig-cook-i-wont-give-money-to-adelaide-beggars-again-and-i-want-you-to-do-the-same/story-fni6unxq-1226877121610">too</a>. Few of us are so callous or cynical not to feel uncomfortable when confronted by someone sitting on the footpath asking for a couple of dollars for a meal or somewhere to sleep for the night. Yet many of us decline to respond to the request. </p>
<p>Usually this reluctance to give is not for lack of generosity. Often the discomfort felt is quite genuine. Our <a href="http://chp.org.au/should-i-give-money-to-people-who-are-begging/#.U__WvMWSyao">reasons for not giving</a> are, however, fairly predictable and, if my experience is anything to go by, often the basis of lively if slightly anguished discussion at middle-class dinner parties, or even at outdoor restaurants virtually within earshot of the person whose need has prompted the discussion.</p>
<h2>The giver’s dilemma</h2>
<p>Typically, the reasons for not giving are our concern that a token dollar or two will do nothing to deal with the <a href="http://www.portphillip.vic.gov.au/begging.htm">real reasons</a> for the plight of the beggar. Indeed, the money may be used to maintain the substance dependency or bad habits arising from socio-economic disadvantage or emotional disorder that have led to the need to beg. And, let me own up: I believe these are often proper considerations, by which, rightly or not, I myself am largely persuaded.</p>
<p>At the same time, community agencies that seek to help the homeless usually depend on endless and distracting fund-raising campaigns and the efforts of volunteers. These organisations are forced to operate with resources so limited that they cannot do the work they wish - whether in the form of short-term shelter or longer-term support. They are constantly <a href="http://www.probonoaustralia.com.au/news/2012/08/homeless-services-crisis-levels-report#">turning away those in need</a>.</p>
<p>So all parties are left unsatisfied, and their needs unmet, by this situation. The beggar continues to beg, the many generous citizens who would genuinely like to help feel unable to do so, and the service providers are frustrated at constantly being short of the funds they need to do the work so clearly required.</p>
<p>There is a better way. I, and I am sure countless others, would be quite willing to buy, from a reliable community agency, a book of vouchers that offer a meal, shower, bed and transport - and perhaps longer or more substantial support, too. These vouchers could then in good conscience be offered to people seeking help, on the basis that those who accepted them genuinely needed, were willing to accept and would benefit from these services. </p>
<p>Those who declined the help the vouchers offered could be assumed to be seeking a few dollars for the sort of purposes many would-be donors remain reluctant to support.</p>
<p>A more hard-headed analysis would suggest these vouchers would sometimes be accepted by those who intended to trade them rather than use them - and who, paradoxically, perhaps are therefore in the greatest need of the assistance they offer. Even then the final result of that trade would be that the vouchers would end up with someone who would benefit in the way intended.</p>
<h2>Voucher system offers broad benefits</h2>
<p>I do not for a moment suggest that the problems of homelessness and distress can so easily be solved. However, using this method, albeit on a small scale, all three parties involved can gain. </p>
<p>Those in genuine need of help can receive it. Those with a true wish to be generous in an effective way can offer it. And the agencies that issue the vouchers would have a new, larger and more predictable income stream from donors than is currently available to them. That would create an opportunity to better plan and expand their services. </p>
<p>Perhaps such an arrangement could be developed on a collaborative basis between several agencies working in this field. Government, too, could support such a program with subsidies based on the more targeted use of funds to provide services that this approach would allow.</p>
<p>One current popular expression in the community sector is <a href="https://theconversation.com/will-more-business-like-social-enterprises-improve-care-23643">social enterprise</a>. Among other things, this exhorts charities to be more business-like in their work, with more effective approaches to sustainability than reliance on government grants and donations from the public. At the same time business is urged to recognise that profitable activities should be directed at social as well as commercial purposes, and to form partnerships with community agencies.</p>
<p>A voucher system, with the more systematic approach it envisages to matching supply and demand in servicing a very specific market, might be one example of how this type of thinking might be advanced.</p><img src="https://counter.theconversation.com/content/30895/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Liffman does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Even before reports of police seizing the takings of Melbourne’s beggars as proceeds of crime, their plight has been a disturbing one in this, the world’s “most liveable city” - and in other major Australian…Michael Liffman, Senior fellow and founding director of the Asia-Pacific Centre for Social Investment and Philanthropy, Swinburne University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/272322014-06-17T04:23:38Z2014-06-17T04:23:38ZHard times getting harder for cash-starved community services<p>The federal government’s <a href="http://www.acoss.org.au/images/uploads/WEB%20VERSION_ACOSS%202014-15%20Budget%20analysis.pdf">austerity budget</a> is expected to hit disadvantaged people the hardest, including the unemployed, single parents and people with a disability. In times of increasing social need, it would seem logical to ensure the community sector is well-resourced and sustainable. After all, these organisations work at the front line of social problems and provide support where governments fail to deliver.</p>
<p>Unfortunately for community organisations, hard times look set to get harder. While public funding is likely to remain the main source of income, governments want community service providers to become more self-reliant. State and federal governments have suggested that organisations should depend more on private and corporate donations, community fundraising and grants from philanthropic funds.</p>
<h2>Private funding is hard to find</h2>
<p>Recent <a href="https://www.sprc.unsw.edu.au/media/SPRCFile/State_of_the_community_service_sector_in_NSW_2014.pdf">survey data</a> collected by the Social Policy Research Centre casts light on some of the challenges of funding these services. Leaders in both large and small agencies perceive their organisations to be poorly equipped to access philanthropic funding: </p>
<ul>
<li><p>59% of respondents felt their organisation did not have the resources to seek philanthropic support;</p></li>
<li><p>28% felt philanthropic funds were unlikely to support the type of service provided by their organisation; </p></li>
<li><p>Only 10% of respondents said their organisation was considering sourcing social investment. </p></li>
</ul>
<p>Yet the pressure is on to find new funding sources. </p>
<p>After spending the last 20 years engaging community organisations to provide public services, it seems that governments now want to break free from their funding role. They are urging non-profit service providers to do more to help themselves. A key element of the New South Wales state government’s <a href="http://www.facs.nsw.gov.au/__data/assets/file/0010/279037/3005_FACS_AR_2012-13_WEB_FACS_R.pdf">reform agenda</a> in family and community services, for example, is to expand partnerships between community organisations and philanthropists, investors and business.</p>
<p>Federally, the Productivity Commission’s <a href="http://www.pc.gov.au/__data/assets/pdf_file/0003/94548/not-for-profit-report.pdf">landmark 2010 report</a> on the not-for-profit sector identified a lack of access to private capital as a concern. The <a href="http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Economics/Completed_inquiries/2010-13/capitalmarket2011/report/index">Senate Economics References Committee</a> subsequently recommended ways to develop capital markets and stimulate private investment in organisations with public interest goals. The budget decision to reinstate the <a href="http://www.dss.gov.au/our-responsibilities/communities-and-vulnerable-people/publications-articles/community-business-partnership">Prime Minister’s Community Business Partnership</a> also reflects the renewed commitment to develop philanthropy. </p>
<p>Many community organisations agree that there is good reason to diversify their funding base and reduce reliance on governments. As last year’s Australian Council of Social Service (ACOSS) <a href="http://www.acoss.org.au/images/uploads/Australian_Community_Sector_Survey_2013_ACOSS.pdf">sector survey</a> showed, the most important issue nationally was underfunding by government. Some 58% of services reported that the costs of delivering services exceeded revenues. Underfunding was acute in emergency relief, disability and family and relationship services.</p>
<p>The administrative burden of short-term contracts may be another reason to reduce reliance on income from delivering public programs. Furthermore, relationships with government can constrain organisations’ activities, independence and public advocacy. Political decisions can result in sudden <a href="http://refugeecouncil.org.au/n/mr/140530_RCOAfunding.pdf">withdrawal of funding</a>.</p>
<h2>Matching funding models to services</h2>
<p>The prospect of increasing private funding for community services raises questions about relationships between governments, markets and communities. What is the right balance between public and private support? Which funding models work best?</p>
<p>How can we ensure private investment decisions are evidence-based, transparent and accountable to communities, and not the preferences of wealthy individuals or corporations? How well will private investment address social needs and rights of vulnerable people. How can we monitor this?</p>
<p>Pressures to increase private funding in community services raise questions about the varying capacity of community organisations to obtain it. </p>
<p>In particular, the Social Policy Research Centre’s recent survey findings from 576 community sector leaders confirmed that larger organisations have best access to private funding. Income from community fundraising was fairly widespread. However, smaller organisations (with annual revenues of under A$250,000) were least likely to receive income from individuals or estates, businesses or corporations, philanthropic foundations or funds, or through payroll giving initiatives. </p>
<p>When asked what supports they needed to access private funding, many wanted basic advice about how to obtain support from business or philanthropists. Some wanted help to obtain Deductible Gift Recipient status. This would give access to tax-deductible donations. </p>
<p>Of course, many larger community service providers (including religious organisations) have long-standing streams of private income, including investment portfolios. But for most, accessing private funding is uncharted territory. </p>
<p>In times of rising inequality and pressure for self-reliance, we need to know much more about community organisations’ experiences of developing streams of private income. Importantly, we need to know what private funding means for service users, and for the sector’s effectiveness in overcoming social disadvantage.</p><img src="https://counter.theconversation.com/content/27232/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Natasha Cortis and Megan Blaxland have conducted research on community services for non-government and government agencies. </span></em></p><p class="fine-print"><em><span>This article draws on research commissioned by the Council of Social Service of New South Wales (NCOSS), but the views expressed are those of the authors.</span></em></p>The federal government’s austerity budget is expected to hit disadvantaged people the hardest, including the unemployed, single parents and people with a disability. In times of increasing social need…Natasha Cortis, Research Fellow, Social Policy Research Centre, UNSW SydneyMegan Blaxland, Research Associate, Social Policy Research Centre, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.