Experience Counts: Chapter 3 - Voluntarism And Productive Aging

Objective: to provide loans of medical supplies and equipment and auxiliary services through a nationwide volunteer service organization

Description:

In 1994 Yad Sarah (literally, Memorial to Sarah) was a recipient of the prestigious Israel Prize, awarded annually by the State of Israel in recognition of outstanding contributions to Israeli society. A nationwide, nonprofit organization founded in Jerusalem in 1976 with the help of the American Jewish Joint Distribution Committee, Yad Sarah provides rehabilitative, medical and para-medical equipment and some 20 additional supportive services at no cost to recipients. Since its establishment, Yad Sarah has grown from a home-based service lending humidifiers to neighbors to a nation-wide organization providing a range of home-care equipment and services to meet the needs of the homebound. Although the majority of its clients are elderly, individuals of all ages benefit from its services.

Employing only 40 salaried workers, Yad Sarah has recruited 4,000 volunteers who serve at 72 branches and help over 200,000 families annually. It has been estimated that roughly 65 percent of the volunteers are over 60 years of age; 65% are women. Two-thirds of the volunteers work twice a week, and one-third more frequently. On-going training programs, seminars, and social events are sponsored for the volunteers.

Yad Sarah provides the following services:

— Loans of medical equipment — Yad Sarah annually loans 270 types of personal and medical equipment (a total of 236,000 items), including wheelchairs, walkers, high-tech equipment and other assistive devices. These loans are provided free of charge, although voluntary contributions are welcomed.

— Warehouse/repair centers — Yad Sarah operates four regional warehouse/

repair centers. Each center includes a workshop to repair both simple and technologically advanced medical and nursing equipment, so that equipment is recycled on a timely basis.

— Oxygen service which supplies oxygen purifying machines and standby cylinders to the disabled. Yad Sarah is reimbursed for providing this service by the major health insurer and the National Insurance Institute.

— Guidance and Exhibition Centers: these centers house model apartments and display the full range of equipment available to allow the physically disabled to function independently at home; the Center's staff offers guidance to the caregivers in caring for clients and in handling the equipment.

— Laundry service provides clean bedding and bedclothes for the incontinent in Israel's three major cities for a nominal fee. The linens and clothing are picked up, washed, mended, ironed, and delivered.

— Assembly and Production Centers Providing Employment to Older Workers: Yad Sarah has begun to assemble and produce a growing amount of the equipment which it lends. Prior to the founding of the assembly and production centers, wheelchairs, emergency beeper systems and other equipment were imported fully assembled. By importing the components and assembling them at the center, the organization saves large sums of money. Unemployed new immigrants, aged 50 plus, from the former Soviet Union and Ethiopia learn a new trade assembling Yad Sarah's orthopedic equipment and hi-tech medical equipment from parts. Graduates of the six-month course, which includes time set aside for instruction in Hebrew, receive a certificate recognized by the Ministry of Labor. Three training centers are now in operation.

Over the years, Yad Sarah has expanded its activities. Additional innovative services include:

— A national computerized communication center to provide emergency aid to the elderly and disabled. The emergency alert systems are installed by volunteers and are repaired and serviced free of charge. The transmitters are lent for an unlimited period, following payment of a token initial deposit.

— A home repair service manned by volunteers. Mobile workshops manned by volunteers perform small home repairs for the homebound and elderly. There is a token charge for parts.

Since its inception, Yad Sarah has answered a critical social need unmet by governmental programs, and as a result of its success, has helped to educate the professional and lay public to the benefits and feasibility of maintaining chronically ill and handicapped individuals in their homes.

Special Features:

— The program demonstrates how on a narrow base of salaried employees one can provide nationwide services through the mobilization of volunteers.

— Yad Sarah's system of loans and volunteer manpower maximizes the recycling of the equipment.

— The organization demonstrates the development and use of volunteer manpower and expertise in highly technical areas.

— The program demonstrates that volunteers from varying socioeconomic sectors and from varying cultural and religious backgrounds can be recruited effectively to provide services to a population which is also heterogeneous.

— The program provides volunteer work with which men are comfortable — 35% of the volunteers are male.

— While Yad Sarah's services are provided free, recipients often voluntarily contribute money or services beyond the market value of the services received. Thus, service provision, voluntarism and financial contributions are closely linked as a result of the manner in which service is provided. This is in contrast to voluntary organizations which seek to sell their services at a profit in order to subsidize recipients without sufficient means.

Replication:

In South Africa, the Medilend organization has been established based on the model developed by Yad Sarah. The American Jewish Joint Distribution Committee and Yad Sarah have recently implemented the Yad Sarah model in several cities in Russia, including St. Petersburg.

Sponsor: Yad Sarah, a non-profit charitable organization

Financing: Yad Sarah's annual operating budget is over $6 million. This is covered by general contributions, contributions given in response to services and reimbursement for services rendered.

Bibliography:

Barnea, T. and Cohen, H. 1987. "Yad Sarah." In Care at the Crossroads: Innovative Programs and Services for the Elderly in Los Angeles and Jerusalem. Bolduc, M.; Salend, E.; Beck, J. and Rahman, A. (eds.) Multicampus Division of Geriatric Medicine, UCLA and JDC-Brookdale Institute, Jerusalem, pp. 41-54. (English)

For Further Information:
Yad Sarah
43 Haneviim Street, P.O. B. 6992
Jerusalem 95141
Israel
Tel. 972-2-244242; Fax 972-2-244493

Objectives: To inform senior citizens of their rights under social security and within the health and social service system and refer them to the appropriate community agencies

To identify elderly who are at high risk and provide social outreach and informal support to the homebound

To provide meaningful and skilled volunteer roles for the elderly

Description:

The program has three components:

Counseling Centers:

Counseling centers were established in 1972 by the National Insurance Institute (NII), Israel's social security administration, to respond to the special needs of the older population for more and better information. As the social welfare system has become more complex, many older persons and their families (including many immigrants who do not know the language well) lack the ability and know-how to realize their entitlements, access services and use them appropriately. Counseling centers operate today in all of the NII's branches throughout the country. The centers are staffed by over 400 volunteers who are themselves elderly. The majority of the volunteers have served as counselors for more than four years.

This program is a unique example of the use of volunteers as an integral part of a social security administration, having specified functions related to furthering the well-being of recipients.

Areas of counseling at the centers include: entitlements under social security; information on community services, institutional care, and financial, housing and legal issues; and access to crisis intervention. When appropriate, referrals are made to other agencies. In addition, through the centers the elderly may access the friendly visiting program operated as part of the program.

Friendly Visiting:

30,000 home visits per month are provided by some 3,000 highly-trained volunteers to those who are unable to come themselves to the branch counseling centers as well as to those who are isolated or lonely. Assistance provided includes accompanying the older person to the health and social services, monitoring the elderly's condition and being a link with services in the community.

Identification of Older Persons At-Risk:

A new component of the program provides one-time home visits to at-risk populations who have been identified by the NII as well as referred by local health and social service personnel. The function of the initial visit is to assess the condition of the older person, identify problems, and transfer this information to the professionals in the community. The at-risk populations include those who live alone, who are homebound, who have recently lost a spouse, and those who have reached age 75. One such important at-risk population is older people who are not yet eligible for home care services under Israel's Community Long-term Care Insurance Law, but who are nevertheless frail and dependent on the help of others. A questionnaire has been developed for completion by the volunteers which provides systematic information on the quality of life of the older person and indicates problem areas which require intervention. Roughly one-third of those who are visited are found to have problems which require follow-up. The volunteers fulfill a valuable preventive role in identifying problem areas before they become more serious.

Use of Volunteers in Monitoring Quality of Care under the Community Long-term Care Insurance Law:

Volunteers perform a unique role in helping to monitor the quality of home care provided to dependent elderly under the law. Approximately 2,000 home visits to eligible elderly were conducted by elderly volunteers from the counseling centers during 1993. The volunteers fill out a standard questionnaire which examines the care plan implementation and satisfaction of recipients. Information gathered during this visit is transferred to the National Insurance Institute for follow-up and intervention if problems in service provision are identified. This is a good example of the use of volunteers by an institution for close-hand monitoring of the quality of its services.

The counselors and home visitors are trained and supervised by thirty-nine professionals, most of them social workers. They receive training in special courses which are provided at all the universities in Israel.

Sponsor: The National Insurance Institute (Israel's Social Security Administration)

Financing: The National Insurance Institute

Bibliography:

Baich-Moray, S. and Z. Givoli. 1992. "The Role of Elderly Volunteers in Helping to Identify Elderly-at-Risk." Paper Presented at Symposium of the European Behavioral and Social Science Research Section, International Association of Gerontology, Bratislava, Slovakia. (English)

Givoli, Z.; Berkman, B. and B. Oberlander. 1990. "The Role of Volunteers in the Service for the Elderly and Pensioners." Social Security, Special English Edition, pp. 157-171.

For More Information Contact:

The National Insurance Institute
13 Weizmann Blvd.
Jerusalem 91909
Israel
Tel. 972-2-709587; Fax 972-2-528508.

Objectives:

— to provide elderly with information, referral and guidance at the neighborhood level

— to assist elderly in their contacts with formal agencies and to overcome language, geographical and psychological barriers

— to recruit and train volunteer manpower from different age groups to supplement services provided by the formal network

— to identify unmet needs at the community level and provide outreach to elderly at risk

— to develop effective volunteer service models in low-income and disadvantaged neighborhoods

Description:

In 1984 the U.S. Department of Health and Human Services and the Ministry of Labor and Social Affairs in Israel signed a Memorandum of Understanding (MOU) to foster cooperative projects in services for the elderly. The Los Angeles Jewish Federation and the Los Angeles Municipality were awarded a grant under the terms of the MOU for a Cooperative Cities Project. The project was implemented in both Jerusalem and Los Angeles in cooperation with the Jerusalem Municipality and the JDC-Brookdale Institute. Within the framework of a demonstration project begun in 1988, the concept of neighborhood volunteer information centers was developed.

Neighborhood volunteer information centers have now been established in 21 neighborhoods in Jerusalem in low and high-income neighborhoods comprising a broad range of ethnic backgrounds, including both Arab and Jewish neighborhoods. Today 600 volunteers provide thousands of senior citizens with information and services and the city plans to expand the program to serve the elderly in every neighborhood in Jerusalem.

The centers operate at the neighborhood level, with a minimum professional staff. The volunteers are recruited from within the local neighborhood and perform a range of functions. Information and referral is provided at the center, house-to-house screening is conducted to identify elderly at-risk, and follow-up is conducted of those identified as at-risk. By monitoring changes in the status of elderly residents and notifying formal services when conditions warrant it, the centers fulfill a valuable "watchdog" function. In addition to screening and surveillance, the volunteers provide a range of supportive services, including meals-on-wheels, friendly visits, home repair services and transportation. As an example of the centers role, they were able to mobilize volunteers during the Gulf War to assist the elderly in making emergency preparations in their homes. The work of the volunteers is linked closely with the community service agencies and professionals who work in the neighborhood and enhances their ability to maintain contact with the elderly in the community.

The three-year demonstration project was accompanied by an ongoing evaluation conducted by the JDC-Brookdale Institute, to provide continuous feedback on how to improve the project. Staff of the Institute designed a database for the day-to-day operation of the program. Upon completion of the demonstration phase, the Institute, in cooperation with the Jerusalem Municipality, prepared a manual on how to develop and operate a neighborhood volunteer center, published in 1992. It is hoped that the manual will facilitate the expansion of neighborhood volunteer centers to other cities in Israel.

Special Features of the Program:

— the mobilization of the neighborhood as a unit for information, referral and outreach

— the mobilization of volunteers at the neighborhood level, building on and helping to develop a sense of community

— the recruitment of volunteers from ethnic and socioeconomic groups not traditionally involved in voluntarism

— the effective integration of volunteers as aides to the professional network of services

Sponsors: Jerusalem Municipality

JDC-Brookdale Institute

Financing: Jerusalem Municipality

Bibliography:

Barnea, T.; Steigman, N.; Heshkes, H. and Y. Shalit. 1993. Planning and Running a Neighborhood Volunteer Information Center for the Elderly: Instruction Manual and Role Description. JDC-Brookdale Institute and Jerusalem Municipality, Jerusalem. (Hebrew)

Barnea, T.; Steigman, N. and Shalit, Y. 1992. Promoting Voluntarism for the Elderly at the Neighborhood Level: The Jerusalem-Los Angeles Demonstration Project. JDC-Brookdale Institute and Jerusalem Municipality, Jerusalem. (Hebrew)

Barnea, T.; Steigman, N. and Shalit, Y. 1991. Promoting Voluntarism for the Elderly Among all Age Groups at the Neighborhood Level: The Los Angeles-Jerusalem Demonstration Project. Final Report. Submitted to the U.S. Administraiton on Aging, Department of Health and Human Services. Washington, D.C. (English)

For Further Information:

Jerusalem Municipality
Department of Community and Family Services
212 Jaffa Road
Jerusalem
Israel
Tel. 972-2-392344; FAX 972-2-370699.

Objectives:

— to increase the level of voluntarism in the 60+ population by broadening the sources of recruitment to include those from lower socioeconomic and educational backgrounds, men, the very old, the homebound, ethnic minorities and first-time volunteers

— to increase the range and content of jobs offered to elderly volunteers

— to increase the benefits of voluntarism to both the employer and volunteer

— to promote a community-wide effort

Description:

In 1983 JDC-ESHEL and the Voluntarism Unit of the Ministry of Labor and Social Affairs began a pilot project named PITGAM in three cities to expand voluntarism by the elderly. The department of social services in each community has a unit to promote voluntarism, which is responsible for mobilizing volunteers to work with the social services. In order to develop a community-wide effort to promote voluntarism by the elderly, a special coordinator for the elderly population was added to the staffing structure of these units. A key concern was to develop a mechanism to maximize the leverage that such coordination could have on the broader community and the cost effectiveness of efforts to promote voluntarism.

The key strategic elements of the program include:

— Recruitment and job-development targeted to pre-existing groups, to make more effective use of the coordinator's time

— Strengthening peer contact and support among the volunteers and enhancing the recognition of the volunteers in the workplace

— An emphasis on group as opposed to individual placement to broaden publicity for the program

— Using selected volunteers as coordinators of their group's activities, reporting periodically to the local program coordinator

— Locating volunteer roles which provide personal satisfaction to the volunteers and which are suited to their capacities and abilities

— Widespread publicity throughout the community about the program and the contribution of the volunteers

A key element in implementing the strategy is the role of the broad-based local steering committee, composed of representatives of local agencies and organizations that are important potential employers or promoters of voluntarism. The role of the steering committee is to translate the overall objectives of the national program into programs which meet the specific needs of the local community, to advise the program coordinator, to advocate for the program, and to assume leadership roles in implementing the various programs.

Examples of new roles that were developed include that of the "Grandparent-Kindergarten", in which senior citizens assist the professional staff at pre-school centers, and road safety advocates and instructors among children and adults.

At the time the program began, approximately 10% of the 60+ population were involved in regular (at least once per month) volunteer activities. In each of the three cities which participated in the pilot program, the number of elderly volunteers recruited rose significantly. Fifty-five percent of those recruited were first-time volunteers. The participation of men, and of those from the lower socio-economic groups, improved markedly. Almost all volunteer employers and volunteers expressed satisfaction with the program.

The program has to date been implemented in 14 communities in Israel.

Special Features:

— A public agency is willing to supplement formal services by operating a volunteer service for its own and other agencies in the community.

— Recruitment of volunteers is not always for an existing service; new services may be established to fulfill unmet needs and volunteers are then recruited.

— Volunteers are recruited in significant numbers from groups not traditionally associated with voluntarism.

— Group recruitment and placement predominates.

The PITGAM program shares many common elements with the SERVE program in the U.S. However, unlike RSVP, the nationwide attempt in the U.S. to more broadly implement the SERVE program, PITGAM is implemented through the social welfare system.

Sponsor: JDC-ESHEL

Ministry of Labor and Social Affairs

Financing: Ministry of Labor and Social Affairs

Bibliography:

Steigman, N. 1988. PITGAM: Promoting Voluntarism by the Elderly, Final Evaluation Report. JDC-Brookdale Institute, Jerusalem. (Hebrew)

For Further Information:

JDC-ESHEL (Association for the Planning and Development of Services in Israel)
POB 3489
Jerusalem 91034
Israel
Tel. 972-2-6557111; Fax 972-2-5662716.

Objectives: to create a framework for meaningful activity on the part of the elderly through the production and sale of high-quality handicrafts, the proceeds of which are used to provide social and recreational services on a cooperative basis

to provide meaningful intergenerational activities

to integrate into one framework the well elderly, the disabled and the mentally impaired in a spirit of mutual help

Description:

Lifeline for the Elderly is a nonprofit organization operating a workshop and social center for needy and disabled elderly. It was started by the late Miriam Mendilow in 1962 in the then impoverished Jerusalem neighborhood of Musrara. Lifeline's unique character derives from the fact that it is simultaneously a workshop producing high-quality handicrafts, a social center for the elderly with auxiliary supportive services and a multi-generational educational meeting place. Its programs are based on the principles that only through work, purposeful recreation and activities of self-help can an elderly person lead a life of meaning and dignity, and that youth and younger generations will best respect and understand the elderly if they see them being productive and not passive recipients of assistance.

In the 32 years since its founding, Lifeline has developed 10 craft workshops with activities ranging from ceramics, jewelry and macrame to bookbinding and fine metal work. Nearly 250 elderly craftspersons work every morning in the workshops for a minimal stipend. Most of them have limited education and social skills. Among the participants are 60 severely mentally and physically handicapped persons, for whom specially-adapted work settings have been designed. Trained, salaried teachers design the workshops' craft products and instruct the elderly in production. The craft products are of first-rate quality and are marketed in Lifeline's shop, which is visited by guests and tourists from all over the world.

The proceeds are used to subsidize a range of auxiliary and supportive services, including a dental clinic, medical and optometric services, counseling, a cafeteria and an afternoon social program that includes a choir and dance group.

In addition to its occupational and supportive services focus, Lifeline encourages the development of intergenerational understanding. Israeli high-school students often work in the workshops as volunteers, preparing raw materials, cleaning and assisting the elderly craftspersons. School children come to Lifeline to celebrate holidays and birthdays, bringing gifts for the elderly and performing skits for them. Some 4,000 teenagers spend a day during their summer vacations visiting Lifeline's workshops and learning about Lifeline's educational message.

Special features of the Program:

— the strong training and skill development component of the 10 crafts workshops

— the sale of products, which finances 40% of the annual operating budget

— the operation of the program as an association, with social activities and auxiliary services subsidized by self-generated income

— the integration of high-level professional designers and marketing specialists

— the integration in one setting around a common ideology of self-help and mutual help of the well elderly and the physically and mentally disabled elderly

— unrestricted acceptance of individuals into the program, no matter what their difficulties and problems, and an emphasis on adapting the work environment to the capacities and limitations of each individual.

Sponsor: Lifeline for the Elderly, a private nonprofit organization

Financing: $800,000 annual budget

40%: sales of handicrafts

60%: contributions from Israel and abroad; occasional grants and bequests

Bibliography:

Barnea, T. and Cohen, H. 1987. "Lifeline for the Elderly." In Care at the Crossroads: Innovative Programs and Services for the Elderly in Los Angeles and Jerusalem, Bolduc, M.; Salend, E.; Beck, J. and Rahman, A. (Eds.) Multicampus Division of Geriatric Medicine, UCLA and JDC-Brookdale Institute, Jerusalem, pp. 29-41. (English)

For Further Information:

Lifeline for the Elderly, 14 Shivte Israel St., P.O.B. 28, 91000 Jerusalem. Tel. 972-2-289737; FAX 972-2-273739.