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SUPPORT Internal Guidelines & Measures to cope with COVID-19 Pandemic

As many people at EASPD already know, SUPPORT Fundació Girona provides a non-stop 24/7/365 global, individualized, social service to 1004 adults with psychosocial disabilities (56%), intellectual disabilities (26%), or cognitive impairment as a result of degenerative diseases (18%). Currently, a majority of them (54%) live either in their own home or community-based housing/shelter arrangements, where they receive tailor-made support based on their needs either psychological, emotional, educational or related to basic everyday activities. The rest of the persons live in different typologies of residential services – including a small percentage of persons locked in prison – with most of their needs covered by professionals. It is especially noteworthy that we support about 50 persons with psychosocial disabilities without permanent residence or in a homelessness situation.

The organisation was born in 2003 to assume the traditional role of guardian – considered a social service under public responsibility when guardian is not a relative – and  since the Convention was adopted by Spain we are focusing on introducing legal mechanisms on support decision-making not only helping people taking decisions but managing and coordinating the support to make their decisions a reality. On a normal day, our social support is oriented to ensure the coverage of basic needs, manage the provision of personal care services by hiring and coordinating other service providers, apply for financial benefits, social programmes or services and support people managing their finances while providing legal advice and legal action if needed.

In March 2020 we directly employ 92 professionals and a group of external services also provide services for the organisation to run their operations. The situation caused by the COVID-19 epidemic has caused had a profound impact, affecting our lives, our task as professionals and our role as service providers as  the fast paced turn of events and daily changes causes uncertainty.

Since the widespread application by the authorities of confinement measures in Catalonia and Spain which turned out in the closing of day-time social and health services, a restriction on general services and a lockout on the access to residential facilities and nursing homes, the organisation, both at a management and at a frontline level, had to react very quickly.

The organisation has been working round the clock to deploy the measures summarised in the following document and expanded at the end. It is important to understand that all the measures were not developed instantly but some of them were implemented organically as the situation arises.

Chronologically speaking, the first concrete instructions were issued by the authorities on Thursday 10th February 2020 recommending to close schools and education centres, day-time services and basic social services.  Stricter measures had already been confirmed by the authorities on 12th March 2020 affecting the normal service provision of our organisation. Since Wednesday 11th March 2020 the organisation has been working internally to prevent this foreseeable situation and minimise the impact on the normal development of the service and the negative consequences for their service users.

SUPPORT issued a first set of recommendations to the whole workforce of the organisation, setting the priorities to be considered during professional interventions and also helping the authorities widespread the recommendations to mitigate the risk of infection, considering the purpose of our organisation and focused on the service it provides. Priorities and measures evolve organically as the situation changes.

The following priorities are set to be considered and followed by SUPPORT professionals

  1. Ensure that people with less resources (material, financial or social), including the ones living in infra-housing arrangements or in homelessness situations have their basic needs covered and guaranteed (food supply, medication, access to health and access to channels of communication and contact with professionals).
  2. Persons living in their own homes and with high or intense support needs are the most affected by the closure of day services. This situation potentially increases the emotional stress of caregivers and families. In this case, the priority established is to fully coordinate with personal support staff and document every detail of the situation to the area coordinator or immediate superior to seek alternative formulas to day-time centres, cover basic needs (food, medication and any related activity to help cope with the lockout situation) and share solutions and approaches among the different teams.
  3. People living in residential facilities. Priority is set to contact professionals from these services and offer logistical help to provide them with basic tools and supplies to continue the service in a lockout situation.
  4. People with less intense support needs are to be guaranteed to have enough resources to develop themselves autonomously, helping them prioritise, offering logistic when necessary or in urgent situations and helping them understand and follow basic recommendations from the authorities.

Incidents and observations

During the first days of this week, several incidents were reported by the professionals and the organisation is trying to be proactive tackling them:

  • Situations where the caregiver abandoned the person they are taking care occurred. This happens especially when service is hired individually by the person and the caregivers lacks accreditation or doesn’t work for a service provider (or even without a work contract).
  • An effect of “centrifugation” is happening where residential facilities or services try to seduce families to take care of the person without consulting with professionals, either by sending them directly to the family home. The situation is specially stagnant and is affecting quality of life of persons with disabilities since most families doesn’t have the means, resources or formation to help their beloved ones or address their needs. Service providers operating on the verge of negligence can potentially face legal consequences.
  • Since the organisation is trying to provide self-protection material to their workforce reality shows that there is not enough available material to everyone so SUPPORT is actively looking through standard and non-standard channels allocating extra financial resources to obtain it.

Facts, Forecast & Concerns

  • Cases of professionals and users infected with COVID19 are already documented.
  • Medical forecasts suggests that the peak of the pandemic will occur on Wednesday 25th March 2020.
  • SUPPORT is especially concerned about personal situations where a positive diagnosis is confirmed and there’s no family, relatives or services available for the person to be taken care at home if the health system is collapsed or saturated.
  • SUPPORT is concerned of the conflicts that forced cohabitation for many days by people who have difficulty in their relationships and have nothing to do throughout the day due to the closure of work spaces or daytime services. They were the ones receiving low-intensity support and an increase on home support services is expected, with no guarantee on how well they will be paid or who will provide this support.

List of concrete measures taken by support in different spheres

At an organisation or internal professional level

Transition from an office-centred job to a decentralised formula of flexible work by using technology to safeguard the workforce and ensuring the service is provided to persons.

  • Ensuring availability of the technology to all their professionals including the provision of tablets, laptops and smartphones). 75% of the workforce already had a corporate tablet,
  • Ensuring access to the database and servers through a VPN.
  • Ensuring troubleshooting, tech support and manuals on how to use it.2
  • Schedule online meetings at different levels of the organisation to ensure continuity of the service (management meetings, area meetings and general meetings).

Schedule online meetings with experts (Mrs. Catalina Devandas; UN Disability Special Rapporteur) and Health Experts at a Local level (Dean of the Medicine Faculty from the University of Girona) to help and motivate all professionals of the organisation get direct insight and verified information on what is currently happening.

Creation a pool of hours for professionals to provide flexibility in case of emergency situations and flexibility to work extra-hours.

Promotion of a decentralised way of working. Instead of working in closed teams with a fixed location and service user as a reference professionals the organisation and professionals are reorganising themselves to work as a cluster of professionals to cover all the territory in rural areas or persons who are not directly on their team in case the situation needs it.

Temporarily suspended the system to control the entrance-exit time of employees and activated an automatized system.

Buying protection material and ensuring availability to professionals in case of urgent domiciliary or medical visits or interventions that require direct interaction.

Created a document for professional attesting that the professional is considered “essential personnel”. The document intends to ensure freedom of movement for professionals who might be retained in police checkpoints when providing the service as it requires mobility.

At an external service level

  • Increase communication channels with the Catalan Government, local authorities, public health services and police forces. Using NTIC to coordinate actions, verify information and follow procedures in case special situations arise. Channels are open 24/7 and are centralised in professionals in the management area or with specific roles within the organisation.
  • Increase vigilance on the role of external service providers to safeguard service user’s rights and avoid negligent behaviour or “bad faith-picaresque actions” affecting service users or their families.

At a service user level

  • Adapted and translated to Catalan an EASY-TO-READ version with (1) info of the virus, (2) how to detect it and (3) indications and general health and communication recommendations.
  • Allocated part of the organisation budget to cover basic needs of persons with insufficient means (i.e. homelessness, shortage of food, basic utilities).
  • Created a logistic “food point” where people with less resources can come to our offices and receive a basic package.
  • The organisation created a document for persons with disabilities targeted to local authorities and police forces explaining the situation of persons who might be retained in the street or that they require special consideration on police controls and checkpoints (this document explicit that SUPPORT is in charge of covering their needs, their special needs, their home address and other useful information for authorities. It is not an officially recognised document since there’s not a specific document accredited by the authorities with the same purpose.

Other / Uncategorised measures

  • External pharmacies have developed collaboration strategies with the organisation and its professionals, actively willing to suspend normal protocols or requirements to provide pharmacological treatment to persons with disabilities. For example if the prescription is expired (providing that the person or the professionals asks for a previously-prescribed pharmacological treatment).
  • Doctors enabled teleconsultation and are facilitating prescriptions online to persons with disabilities or professionals in case the prescription is expired.

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Our organisation is composed of social workers, psychologists, social educators, jurists, economists,… and allocates the 69% of its workforce to the Social Area.

 

SUPPORT · Social inclusion and supported decision making (Girona, Catalonia)

The assistance mechanism, a step towards the end of incapacitation