Exploring a Community Psychosocial Care Model for Rural Elders with Early-Stage Dementia

Background and Purpose:

Early intervention for dementia is beneficial, but providing adequate care for elders with early-stage dementia is challenging, especially in the rural areas. Policies and service provisions have long struggled to design models that address the challenges of manpower and transportation in the rural areas to ensure equal accessibility to quality care for rural elders with needs. This study focuses on a newly developed and well-received model in Taiwan where intervention for early-stage dementia is delivered locally via community care stations in rural communities. The study aims to: (a) identify the care model’s goals and objectives, (b) delineate the design and operation of the community care stations, (c) investigate the roles and functions of involved stakeholders, and (d) analyze contextual and environmental influences on the implementation and development of the model in community care stations.

Methods:

The care model was developed by a dementia treatment center in a local hospital and its implementation took various forms, depending on the community contexts. This research applies the case study method and studies two community care stations, one led by the community organization, and the other led by the center. The researcher conducted field observation during the once-a-week, two-hour activities over 5 months at each station to develop a broad understanding of implementation and contextual influences. She also conducted in-depth interviews with people from the primary stakeholder groups at each station, including the elders, their caregivers, professionals, and volunteers for their perceptions and experiences.

Results:

Findings showed that while the care model aimed for reducing the decline of the elders’ cognitive functioning, more importantly, its practices were designed to enhance the elders’ quality of life by providing a supportive social environment to combat isolation. Local customs and artifacts were incorporated into activities designed for each session to promote elders’ physical, psychological, and cognitive wellbeing. Both stations relied heavily on community resources, including manpower and existing relational bonds to support the model’s operation. The community-led station depended greatly on elders without dementia living in the same community as volunteers, which created a natural “growing-old-together” style of care. In comparison, to compensate for the lack of prior relationships, the center-led station adopted home visits to deepen the connections with individual elders. At this early stage of development, both stations were confronted by the instability of funding and the funding source mandates, as well as influences of the evolving policy-making process of the Long-term Care Services Act in Taiwan.    

 

Conclusions and Implications:

Essentially, the care model purposed to be “developed in the community and delivered by the community,” which materializes the concept of “aging in community.” Findings showed the importance of collaboration between the community and the professionals to create an uplifting and healing environment, built upon community bonds and relationships, for the elders with early-stage dementia. Findings also highlighted the significant influences of funding and policy-making, which calls for further discussions on the balance between service sustainability and community autonomy.