For the last in our Palliative Care and Public Health blog series, Liesbeth De Donder gives key learning points for palliative care from her research into Caring Neighbourhoods and why we cannot talk about ageing in place (the ability of older adults to live in their homes and communities) without talking about dying in place.
I am no expert in palliative or end-of-life Care, nor on public health, nor on medicine. I am an Adult Educational Scientist with a passion for social and environmental gerontology (which is the scientific study of old age and the process of ageing). A lot of my work has centred around the issue of ‘ageing well in the right place’. I only learnt about Compassionate Communities three years ago, but immediately felt this could be a missing link in our work on Caring Neighbourhoods.
Let me first start with explaining the importance of Caring Neighbourhoods in Flanders and Brussels, by telling you about its history. In 2013, our government launched a tender for six innovative ‘Care Living Labs’ which needed to develop new care concepts, processes and products to help with ageing well in the right place for individuals and to test them in practice over three years. In the Active Caring Neighbourhood project, based in Brussels and Antwerp, we explored how we could create or facilitate an environment to support frail older people to age in place of their choice (1, 2). After this project ended in 2016, the concept of Caring Neighbourhoods had gained momentum and in 2018, a large charity foundation in Belgium decided to support its further development by supporting 35 Caring Neighbourhoods (3). In 2022 the Flemish Minister of Welfare and Public health made Caring Neighbourhoods one of his priorities and subsidised the development, implementation and evaluation of 133 of them.
Since the beginning we have been evaluating the first Active Caring Neighbourhood project, as well as the second 35 neighbourhoods, and many lessons can be drawn. But I would like to take out three in particular, which may interest you:
1. Caring Neighbourhoods build on the triangle of care, housing and social relationships. A neighbourhood that is supportive of ageing well in place not only pays attention to professional and informal care and help, but also issues linked to social relationships such as civic engagement; community cohesion; safety; ‘small talk’ and light, informal conversations; ambiance and pleasant atmosphere in the neighbourhood, and combating stereotypes attached to frailty and care stigma. In addition, housing and physical neighbourhood infrastructure are essential but often overlooked factors. Good care, starts with a house adapted to an individual’s needs, in an adapted, age-friendly community environment with, for example, attention for mobility and accessible sidewalks.
2. Caring Neighbourhoods are more than merely ‘neighbourhoods where neighbours care for each other’ as a means of compensating for ill-working governmental care provision. In Caring Neighbourhoods well-functioning care organisations operate and collaborate with each other towards an integrated community care approach. Social security remains the necessary institutional instrument to combat lack of access to quality care. No warm solidarity (i.e. engagement of citizens for their community) without cold solidarity (i.e. structural, institutional basis).
3. Our research underlines the importance of continuous investment in local care networks, combining formal primary and specialised care, informal and family care, neighbourhood support and self-care. A Caring Neighbourhood cannot simply be launched and then expected to become self-sustaining. The model should not be exploited or misused to justify budget cuts and savings in the health and care sector. In contrast, if such models of care indeed save societal costs, these should be reinvested in the organisational support available in the Caring Neighbourhood to protect and support caregivers, for instance, from being overburdened as well as supporting existing initiatives and networks which enhance a Caring Neighbourhood and community.
The other way around of course, Caring Neighbourhoods can also learn a lot from the Compassionate Communities movement. European policymakers are nowadays very much focused on keeping people out of residential care. But that will also require that they need to think more about end-of-life in the community, grieving as well as death. We cannot talk about ageing well in place, without talking about dying well in place.
References
- De Donder, L. et al. (2017). Zorginnovatie in Vlaamse proeftuinen: Onderzoek naar Actief Zorgzame Buurten in Brussel en Antwerpen. Brussel: Kenniscentrum Woonzorg Brussel. (in Dutch)
- Smetcoren, A.S et al. (2018). Towards an Active Caring Community in Brussels. In T. Buffel, S. Handles, C. Phillipson (Eds.) Age- friendly communities: A Global Perspective (pp.97-118). Bristol: Policy Press.
- De Donder, L. et al. (2021). Lokaal Samenwerken in Zorgzame Buurten”. Brussel: KBS/ Fonds Dr. Daniël De Coninck. (in Dutch)
Links and resources
- Find out more about the EAPC Reference Group on Public Health and Palliative Care.
- Read more about Public Health and Palliative Care on the EAPC blog.
- The End-Of-Life Care research group is hosting the 7th international Public Health Palliative Care International conference ‘Democratizing caring, dying and grieving: participation, action, understanding and evaluation’. Bruges, Belgium, 20 – 23 September 2022. Find out more here.
- The End-Of-Life Care research group Public Health & Palliative Care Research Summer School is taking place on 14 to 17 September 2022, in Ghent, Belgium.
About the author
Liesbeth De Donder is Professor of Adult Educational Sciences and together with Prof. Luc Deliens is Head of the Centre of Expertise on Compassionate Communities at the Vrije Universiteit Brussel. This interdisciplinary centre brings together eight different research groups, committed to research the development, implementation and evaluation of Compassionate Communities. Twitter: @liesbeth_donder. Orcid: 0000-0003-4999-5902.
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