CRISIS MANAGEMENT IN RESIDENTIAL CARE FOR THE ELDERLY

76 ACC JOURNAL 2022, Volume 28, Issue 3 DOI: 10.15240/tul/004/2022-3-007 CRISIS MANAGEMENT IN RESIDENTIAL CARE FOR THE ELDERLY Kateřina Thelenová Technical University of Liberec, Faculty of Science, Humanities and Education, Department of Social Studies and Special Education Studentská 1402/2, 461 17 Liberec 1, Czech Republic e-mail: katerina.thel[email protected] Abstract The aim of this text is to describe the procedure and outcomes of the research in the area of management of coping strategies among helping professionals. The study focuses on the professionals in residential social care facilities for the elderly, their definitions of the stress connected to the epidemic, and anti-epidemic measures concerning the Covid-19 disease. We described and analysed the coping experience through qualitative research with one organisation in Liberec. The outcomes from individual open interviews and focus groups were coded and analysed, and consequently formulated into the grounded theory. In the future, this theory will be the base for methodology. We also plan to develop an evaluation study. All the steps mentioned above are parts of a project called “Crisis Management Innovation of Residential Social Services for the Elderly”. Keywords Stress management; Residential social care facilities for the elderly; Crisis; Crisis management. Introduction The presented text offers a summary of the current outputs of the project Innovation of crisis management of residential social services for the elderly, which is implemented with the support of the Technology Agency of the Czech Republic. The project is implemented in the ÉTA programme, in the area of Man and Society in the context of dynamic social and technological changes and challenges of the 21st century. Specifically, these are the challenges of the 21st century in social services, social work, social housing and social inclusion. Social work reflects social dynamics in a specific way. The project is implemented in cooperation with a residential facility for the elderly, which is a specific social microclimate that is not only in dynamic contact with its environment but also has its own internal climate and organisational culture. These aspects are reflected in the possibilities of conducting research, but also in the outputs that are available based on the information found. The research is carried out in collaboration with two basic expert entities. The main beneficiary of the project support is the Technical University of Liberec, the solution team is professionally anchored at the Faculty of Science, Humanities and Education, and the specific workplace is the Department of Social Studies and Special Education. The team that processes the research is made up of experts, academic workers, who at the same time have professional experience in the social work environment. PhDr. Kateřina Thelenová, Ph.D. is the main researcher of the project. She is an academic worker, a sociologist by profession, a social worker and a supervisor. PhDr. Pavel Kliment, Ph.D. is a member of the research team, a psychologist, an academic worker, and a supervisor. Mgr. Lenka Nádvorníková Ph.D. is an 77 academic worker and an expert on social policy and quality in social services. Mgr. Martin Korych is an academic worker, a crisis manager and a professional director of social services. In 2021, two interviewers were involved in the project activities – a student of Social Work and a student of Special Education. Both students provided valuable contributions to the research team, especially with regard to the requirement to eliminate the distortion of research data by the researcher. The role of co-workers in the application guarantor’s workplace is irreplaceable. The main contact people for the needs of data collection were the director of the organisation Bc. Jan Gabriel, MBA and the head of the social work department Bc. Petr Kučera. 1 Theoretical Background The research is based on a professional review of previous achievements of both research and practical nature in the field of practice of crisis management of social services with special regard to residential social services for the elderly and residential services with a special regime. For the purposes of the presented article (taking into account its scope), we offer a dense summative presentation of the starting points in the field of crisis management and coping strategies in the helping professions. Crisis management is a systematic response to unexpected events that threaten people, property and financial and operational stability [7]. In professional literature, we can also encounter the term crisis leadership, which can be considered the same as the term crisis management. Antušák [1] states that it is a “comprehensive set of theoretical approaches, practical recommendations and methods, applied in a hierarchical and functionally connected system of public administration bodies, legal entities and individuals, the aim of which is to minimise (prevent) the possibility of a crisis or (if the crisis has already occurred) to reduce the extent of damage and minimise the duration of the crisis. An important part of crisis management is also the removal of the consequences of negative crisis factors, the restoration of the system, and its return to a new (improved) normal state.” Vodáček [9] adds that crisis management, by its very nature, works with situations that are characterised by little possibility of prediction, a high speed of progress and impact of changes, a critical negative impact on the functioning of the organisation and its collective, causing psychological stress in the organisation and requiring a lot of attention. From the point of view of the organisation providing residential social services, the basic principles of crisis management include the identification of real causes, the appointment of crisis management, the short-term centralisation of powers in its hands, and the implementation of a complex of recovery measures [3]. A crisis manager is a specific type of a manager who heads crisis management. According to Antušák and Kopecký [2], it is generally true that the ideal crisis manager has strong personality qualities and knows how to maintain peace in the organisation; they can sensitively implement changes and find internal resources for surviving a critical period. Lednický [5] adds that a crisis manager can come directly from the environment of the organisation, be invited by the organisation, or the function of crisis manager can be held by a consulting company. The presence of a manager unburdened by functioning informal structures within the organisation can be an advantage for solving a crisis, but on the other hand, it can be a depletion in the area of possible resources for solving a crisis situation, precisely because of ignorance of the internal 78 environment of the organisation. Such starting points are reflected when working with the data that we obtain in the field thanks to the cooperation with the application guarantor. The other theoretical starting point is the knowledge of coping strategies specifically grasped by workers in the so-called helping professions. A coping reaction is a natural and more or less conscious response of an individual with the aim of preventing (averting), eliminating (gradually reducing) or mitigating the effects of stressor-type demands on the individual or creating, supplementing, strengthening the individual's resources to effectively manage the given type of demands. A stressor-type demand is ideally transformed into a challenge-type demand by a coping response. In other words, the coping response can be simultaneously directed both against the acting stressor and towards creating, supplementing or mobilising internal resources. The goal of the coping response is to prevent harm at the level of the organism, the individual’s psyche, or harm related to the individual's social space [4, 8]. In this context, it is expedient to add that individuals do not always achieve the mentioned ideal, in the sense of preventing harm. Therefore, coping is sometimes divided at the basic level into effective adaptive and ineffective or non-adaptive coping [10]. It is necessary to point out that an adaptive response does not have to be an action that is approved in society; one can encounter responses that are outside the usual normative definition. If we stick to the above division, coping strategies such as attack and escape can be included among the coping responses that can ultimately be considered rather maladaptive. Despite the fact that it is one of the most natural responses in a stressful situation, attack (against an obstacle that stands in the way of the pursued goal) is strangely neglected in the professional literature. It is a response that, like escape, is innate and observable even in sub-human animals and it takes two forms. These are two types of physical and psychological (the psychological one is found in the form of verbal, non-verbal, and it can also be communicated by the actions of its bearer) aggression. Physical aggression is increasingly pushed out of life, but we still encounter the psychological one, and the latter takes on different forms. Coping strategies such as problem solving, search for meaning, or social coping are considered to be adaptive forms of coping in contrast to the above-mentioned forms. Problem solving is a welcome alternative to the coping responses mentioned above. As part of solving the problem, paths leading to set goals are sought and found, when it is expected that the set goals will be achieved in socially accepted forms. The following problem solving strategies are distinguished [4]:  Analysis of the problem situation  Determination of transformational goals  Selection of appropriate procedures  Creation and use of the plan  Non-aggressive direct response  A restrained deliberative approach  Redoubling efforts  Focusing attention exclusively on the problem  Utilising acquired experience  Considering your own options  Positive gains from the situation  Finding the benefit  Reminder of the benefit by comparison  Redefining values  Reflection on strengthening own competences 79  Leaning towards a positive experience of everyday life  Seeking the presence of others to satisfy the need for safety  Talks about the problem  Talks about feelings  Accepting support from others  Seeking or requesting advice  Seeking or requesting help It is interesting that the data obtained in the research in a qualitative form not only conforms to the above-mentioned overview of functional solutions to stressful situations by means of coping strategies, but also expands them with specific ones that are a reaction to the unusualness of the stressor which is a life-threatening epidemic in the environment of the performance of the helping profession. 2 Research Objectives The current and still changing situation in connection with the epidemic of the new disease Covid-19, with the introduction of various measures that have an immediate impact on the operation of the organisation and its daily regime, point to changes also in group dynamics at the workplace, in communication models towards the environment, in which the residential setting is located and to family members who are in contact with the service. To change the approach to the crisis, it is necessary to understand the wider context of social changes and their impact on the daily performance of work in the helping professions. The aforementioned research wants to contribute to such a change with its outputs. The aim of the research and its methods are given by the project application. In the project, the goal is formulated as follows: on the basis of qualitative research and pilot verification in cooperation with an external application guarantor to develop an innovative methodology for crisis management of residential social services for the elderly. The methodology is based on qualitative data reflecting the experience of the crisis by its actors (employees, clients) in a residential care facility for the elderly in the Liberec region. The research focused on reflecting crisis situations in social services for the elderly in connection with the management of these services at all levels of management (top, middle, and lower). Thematic research used the current experience of actors in the provision of services in 2020 with regard to Covid-19. The methodology, which is the final practical output of the project, is based on real experience and is ready for replication and wide use in all services for the elderly in the Czech Republic. The subject of the investigation was, in the first step, an experiential definition of crisis, then an experiential definition of crisis management with application requirements to the practice of providing residential care services for seniors in the Senior Citizens Home Františkov in Liberec. 3 Research Methods The research environment is the environment of the application guarantor of the project, namely the Senior Citizens Home Františkov in Liberec https://www.dsfrantiskov.cz/, whose founder is the Statutory City of Liberec from 1 January 2022. The application guarantor provides two types of social services: a care home for the elderly and a care home with a special regime. The research sample consists of workers, clients and family members of the Senior Citizens’ Home Františkov. In total, 33 individual interviews and 3 focus groups were conducted. 80 Based on an agreement with the application guarantor, those respondents who were also respondents to individual interviews were approached for Focus groups. The respondents were both men and women; the gender aspect was not primarily monitored. The same applies to not tracking the length of experience, education, or exact job title. Those who were willing to devote time and energy to data collection entered the research. The aspect of voluntariness and willingness is reflected in the data evaluation. The research methodology is based on the concept of qualitative research, which was defined in their work by Anselm Strauss and Juliet Corbinová (in Czech language, 1999) [6], especially on the concept of grounded theory. The research is mainly based on methodological considerations of these two authors published in Czech in 1999 under the title Basics of Qualitative Research. The methodological procedure we have chosen for our initial research is as follows: we will use quantitative data, in this case the evaluation of the crisis management innovation methodology for residential services for the elderly to verify the qualitative analysis carried out as an initial investigation of the research. Stasuss and Corbinová [6] mention this possibility of methodological anchoring of research on page 11. The reason - the argument of the research team - here is the nature of the investigated problem, where they try to reveal the essence of the problems of the people involved, the essence of people's experiences with the crisis associated with the epidemic of the Covid-19 disease in the Czech Republic in 2020 and 2021, and the measures that brought about the realisation of residential social services for the elderly. The purpose is to find new essential information about the phenomenon, about which a lot is already known, but there is a lack of understanding of the specific form of the investigated phenomenon in the practice of residential social services for the elderly. At the same time, the application level in the form of crisis management methodology is lacking. The central category of the research is the behaviour of people – actors of residential social services for the elderly in crisis, one selected residential care service provision for the elderly in Liberec respectively. The components that enter the research are three basic ones that include research activities: 1. data from interviews, observations, video recordings of Focus Groups, data from documents, 2. analytical or interpretation procedures or coding, creation of schemes of relationships between concepts, 3. research reports. Data are interpreted in a theoretically based way and conceptualized, that is, similar data are grouped together and given adequate names. Here, the theoretical background of the researcher is needed as well as his creativity and abstract thinking skills. This grounded theory of managing the stress in the residential care service provision for the elderly in Liberec must meet the general four criteria in relation to the investigated reality according to Strauss and Corbin [6]: 1. match 2. clarity 3. generality 4. control The theory clearly establishes the conditions under which the theory will apply, meaning conditions that the researchers are aware of and name as valid only for the situation under 81 investigation. Therefore, evaluation research will be carried out, which will determine the parameters of replication and dissemination of the formulated innovation. 4 Research Results The obtained data are presented as the basic axes of the grounded theory of the crisis and its management. The word “Crisis” is used by the respondents to denote a situation in the everyday life of the provision of social services, and in the interviews it is described via various situations and feelings that the respondents felt in these situations. It can be argued that crisis can be understood as three areas of experience:  Uncertainty that has internal and external sources.  Events that reduce uncertainty.  Protective factors (how uncertainty can be prevented or dealt with) of uncertainty. The sources of the crisis were named in the internal-external dichotomy. The thematic analysis shows how these two dimensions meet and are inherently linked like two sides of the same coin. The fact that the crisis is perceived by the respondents in just such a way leads to an understanding of the overall context of the crisis in the management of social services, or in the way of its implementation. The concept of crisis has the following effect on defining (or re-defining) the quality of service:  New quality of service – innovation. The respondents talk about the fact that the provision of the service acquired new characteristics, a new context and new methods of implementation that they had not applied until then.  Objective and subjective quality innovation. Innovations - news - in the provision of the service - had their objective reasons (new regulations, obligation to wear protective equipment, etc.) and subjective reasons – experiencing the situation on the part of all interested actors of the service.  Maintenance tools and changes in the concept of quality (with expectations towards crisis management). The previous two points lead to the fact that the respondents – workers have realised that the new situation in the provision of service should not have the characteristics of randomness and chaos, but should be consciously controlled.  In such a situation, crisis management must respect the imperative of social innovation. Innovation in the field of service quality must be reflected in social care service quality standards as an effective management tool, including management of crisis, change management and crisis management. Effective communication plays the most important role in this area. General recommendations for crisis management are based on subjective attributes:  confirmation of the validity of experienced emotions – in a situation of strong internal and external uncertainty, a situation defined in the public space as threatening life and existence, workers need to know that they can experience fear, and anxiety. That they are emotions corresponding to the situation and not expressing, for example, their weakness or lack of competence,  definition of some graspable framework of the situation – timing of sub-tasks and steps, offering a time perspective that is based on valid and real information, and opening the topic of uncertainty in the service setting if even managers do not have information that 82 allows the framework to be defined. Not to lie, not to hide. To pay attention to media reports and rumours,  to find situations in the workplace that remain the same or those whose change takes place without conflict and it is successful (in the case of our respondents, it was, for example, moving, changing the technical parameters of the premises for the provision of services) and to appreciate the management of such change,  to create a network of functional relationships in the workplace, both formal and informal, face-to-face as well as those mediated by technology,  to devote time and space to appreciation, strengthening employees' awareness that their work has a positive impact on the functioning of the organization and the lives of clients,  to innovate the team only if it is absolutely necessary, create the position of mentor of new workers, who mediates communication between newcomers and the original actors of the situation. The arrival of new workers always has the attributes of a crisis, if it is situated in the moment of crisis of the entire organism of the facility, it must be perceived as potentially conflictual,  prevention of conflicts in the facility through open communication, information sharing, legitimising errors and failures as due more to the situation than to the skills of individuals. Conclusion The research, as a necessary premise of the methodology, was carried out with the aim of finding out how helping professionals coped with the stress associated with Covid-19, or with the change in the service delivery regime that resulted from the epidemic of the new disease. From the point of view of the creation of the methodology (spring 2022), this is a retrospective, where we can use the concrete experience with the topic of Covid-19 from the years 2020 and 2021 to formulate the principles of crisis management of residential care services for seniors in a situation of threat to health and life in general. Acknowledgement The presented text is supported by a project and offers a summary of the current outputs of the project Innovation of crisis management of residential social services for the elderly, which is implemented with the support of the Technology Agency of the Czech Republic. Number of project: TL05000664, Programme: TL – Programme to support applied social science and humanities research, experimental development and innovation of ÉTA. Project solution time: 05/2021 – 04/2023. Main beneficiary: Technical University of Liberec. Principal investigator: PhDr. Kateřina Thelenová, Ph.D. Literature [1] ANTUŠÁK, E.: Krizový management. Hrozby, krize, příležitosti. (Crisis Management: Threats, Crises, Opportunities). Wolters Kluwer ČR, Prague, 2009. ISBN 978-8073574-888. [2] ANTUŠÁK, E.; KOPECKÝ, Z.: Krizový management: krizová komunikace. (Crisis Management: Crisis Communication). 1st ed. Oeconomica, Prague, 2005. ISBN 80-2450945-8. [3] HÁLEK, V.: Krizový management: teorie a praxe. (Crisis Management: Theory and Practice). 1st ed. DonauMedia, Bratislava, 2008. ISBN 978-808-9364-008. 83 [4] KLIMENT, P.: Zvládací (copingové) odpovědi v pomáhajících profesích. (Coping Responses in Helping Professions). Univerzita Palackého v Olomouci (UPOL), Olomouc, 2014. ISBN 978-80-244-4206-8. [5] LEDNICKÝ, V. a kol.: Krizový management. (Crisis Management). Slezská univerzita v Opavě, Obchodně podnikatelská fakulta v Karviné, Karviná, 2012. ISBN 978-807248-782-0. [6] STRAUSS, A. L.; CORBIN, J.: Základy kvalitativního výzkumu: postupy a techniky metody zakotvené teorie. (Basics of Qualitative Research. Techniques and Procedures for Developing Grounded Theory). 1st ed. ALBERT, Sdružení Podané ruce, Brno, 1999. ISBN 978-80-8583-460-4. [7] ŠPAČEK, M.: Krizový management a jeho zvládání. (Crisis Management and its Management). Ekonom. 2008. ISSN 2787-9380. [8] ŠPATENKOVÁ, N. a kol.: Krize: psychologický a sociologický fenomén. (Crisis: Psychological and Sociological Phenomenon). Grada, Prague, 2004. ISBN 80-2470888-4. [9] VODÁČEK, L.; VODÁČKOVÁ, O.: Management: Teorie a praxe v informační společnosti. (Management: Theory and Practice in the Information Society). 3rd extended ed. Management Press, Prague, 2001. ISBN 80-85943-94-8. [10] ZEIDNER, M.; SAKLOFSKE, D.: Adaptive and Maladaptive Coping. In. Zeidner, M.; Endler, N. S. (eds.), Handbook of Coping: Theory, Research, Applications. John Wiley & Sons, Oxford, England, 1995. pp. 505–531. ISBN 978-0-471-59946-3. PhDr. Kateřina Thelenová, Ph.D. 84 KRIZOVÝ MANAGEMENT V POBYTOVÉ SOCIÁLNÍ SLUŽBĚ PRO SENIORY Cílem předloženého textu je popsat základní postup a výstupy výzkumu na téma zvládání zátěžových situací v pomáhajících profesích. Konkrétně se výzkum zaměřuje na pracovníky pobytové sociální služby pro seniory a jejich definování zátěže v souvislosti s protiepidemickými opatřeními ve vztahu k nemoci covid-19. Zkušenosti se zvládáním situace nadlimitní zátěže byly zjišťovány kvalitativním výzkumem ve spolupráci s vybraným poskytovatelem služeb v Liberci. Výstupy individuálních otevřených rozhovorů a focus groups byly podrobeny kódování, následně formulovány do podoby zakotvené teorie. Zakotvená teorie bude sloužit jako základ metodiky, která bude dále podrobena evaluačnímu výzkumu. Všechny dosud zmíněné kroky jsou podpořeny projektem „Inovace krizového řízení pobytových sociálních služeb pro seniory“. KRISENMANAGEMENT IN EINER SOZIALEN WOHNEINRICHTUNG FÜR SENIOREN Das Ziel des vorliegenden Textes besteht in der Beschreibung der grundlegenden Vorgehensweise bei der Untersuchung zum Thema der Bewältigung von Belastungssituationen in helfenden Berufen. Die Untersuchung befasst sich mit den Angestellten sozialer Wohneinrichtungen für Senioren und deren Definition der Belastung im Zusammenhang mit den Covid-19-Maßnahmen. Die Erfahrungen mit der Bewältigung der Situation der ausufernden Belastung wurden durch eine Qualitätsuntersuchung in Zusammenarbeit mit einem ausgewählten Dienstleister in Liberec zusammengetragen. Die Auftritte individueller offener Gespräche und von focus groups wurden einer Kodierung unterzogen und anschließend in die Form einer verankerten Theorie formuliert. Die verankerte Theorie soll als Grundlage der Methodik dienen, welche dann einer Evaluation unterzogen wird. Alle bislang erwähnten Schritte werden durch das Projekt „Innovation des Krisenmanagements von sozialen Wohneinrichtungen für Senioren“ unterstützt. ZARZĄDZANIE KRYZYSOWE W ZAKŁADACH STACJONARNYCH OPIEKI SPOŁECZNEJ DLA OSÓB STARSZYCH Celem artykułu jest opisanie podstawowej procedury i wyników badań na temat radzenia sobie z trudnymi sytuacjami w zawodach opiekuńczych. Konkretnie, badania skupiają się na pracownikach domu opieki społecznej dla osób starszych i ich definicji obciążenia w odniesieniu do restrykcji antypandemicznych w związku z chorobą covid-19. Doświadczenia z radzeniem sobie z sytuacją wyjątkowego obciążenia były badane w ramach badań jakościowych we współpracy z wybranym podmiotem świadczącym omawiane usługi w Libercu. Wyniki indywidualnych wywiadów pogłębionych i grup fokusowych zostały zakodowane, a następnie sformułowane w formie teorii ugruntowanej. Teoria ugruntowana posłuży jako podstawa metodyki, która zostanie następnie poddana badaniom ewaluacyjnym. Wszystkie wymienione do tej pory działania zrealizowano w ramach projektu pn. „Innowacyjność zarządzania kryzysowego w zakładach stacjonarnych opieki społecznej dla osób starszych”.