on the brim: impact of volunteer support on vulnerable ......4 impact of volunteer support on...

DR RENU NARCHAL, DR AHMED MOUSTAFA AND DR VALENTINE MUKURIA

NOVEMBER 2017

On The Brim: Impact of Volunteer Support on Vulnerable Elderly

2 | On The Brim: Impact of Volunteer Support on Vulnerable Elderly

On The Brim: Impact of Volunteer Support on Vulnerable ElderlyDr Renu Narchal, Dr Ahmed Moustafa and Dr Valentine Mukuria

November 2017

RESEARCH TEAMDR RENU NARCHAL Senior Lecturer, School of Social Sciences and Psychology Western Sydney University

DR AHMED MOUSTAFA Senior Lecturer, School of Social Sciences and Psychology Western Sydney University

DR VALENTINE MUKURIA Curriculum Advisor, Office of Pro-Vice Chancellor (learning Transformations) Western Sydney University

Research Assistance:MR NICHOLAS SZAFRANIEC Masters of Clinical Psychology Candidate Western Sydney University

3On The Brim: Impact of Volunteer Support on Vulnerable Elderly |

DisclaimerAll rights reserved. Although University of Western Sydney holds a copyright of this report, permission is granted to trainers and service providers to use the report within their own agencies or workplace settings for educational and training purposes, subject to acknowledgement of this source. Findings and conclusions presented in this report reflect a summary of information obtained through quantitative and qualitative data from this study. The views contained in this report do not necessarily represent those of Catholic Community Services (CCS), Catholic Healthcare LTD (CHL) nor do they represent their policies. All reasonable precaution and effort has been made to verify the information contained in this report. Any opinions, interpretation of findings and conclusions suggestions for improving service delivery in this report are those of the researchers.

Contact Person:Dr Renu Narchal Senior Lecturer in Psychology School of Social Sciences and Psychology Western Sydney University

FUNDING: This research was funded by Catholic Community Services and Catholic Healthcare LTD (CHL)

Further information on the project can be obtained by contacting Dr Renu Narchal at the above address.


Acknowledgements The research team acknowledges the support Catholic Community Services and Catholic Healthcare LTD (CHL) at all the stages of the study. We also thank and acknowledge Ms Janis Redford, General Manager Catholic Healthcare Community Services, Ms Margaret Woods, Manager Mission and Pastoral Care Catholic Healthcare Community Services for her initiative and involvement with the study; for her input and all the necessary support with data collection. We are extremely thankful to Dr Niv Srivastava, Volunteer Coordinator Catholic Healthcare Community Services for helping with data collection and providing valuable inputs to enhance the quality of this research.

We wish to add special thanks to Care Advisors, Mr Francisco Brosas and Ms Val Bryceland for facilitating meetings with their participating clients and helping build their trust in the study. We would also thank all the participants, the volunteers and all the service providers at CCS associated with the volunteer support program for their time and for sharing their valuable experience. Our thanks are also due to all our focus group participants for sharing their personal stories and experiences with us to enrich this research.

We take this opportunity to thank Western Sydney University and our Dean, Prof Kevin Dunn for providing the opportunity and support to carry out this research.

Finally, a huge thanks to the research team for staying together through the process of this research.


EXECUTIVE SUMMARYThis study is a mixed-design study on vulnerable elderly people living in Sydney, Australia. This contract research project was carried out for Catholic Community Services (CCS), Catholic Healthcare LTD (CHL) at Western Sydney University (WSU). Ethics approval was sought from Western Sydney Ethics committee prior to the commencement of the study. Of the 10 participants (vulnerable elderly), 7 were males (mean 74.5 years) and three were females (age mean 68.83 years). Participants were provided with a gift card for the completion of each task (survey completed at Time-1 and Time-2; 1 interview and participation in the focus group).

The study was designed to evaluate the relationship between volunteer support, loneliness and social support, and anxiety, depression, trust, hoarding, attachment, and cognitive decline. The study has both a quantitative and qualitative component, incorporating a pre-and-post design for each participant. Each participant, (an elderly vulnerable person) completed a questionnaire at Time-1. He or she was then matched with a volunteer visitor who provided social support to the participant over a 3-4 month period. Thereafter the participant completed the same questionnaire at Time-2. Participants were individually interviewed by a staff member associated with the service. These semi-structured interviews were conducted to determine their experience of volunteer support program.

Apart from individual interviews, 3 focus groups were conducted. The first focus group comprised the vulnerable elderly; the second group was of the volunteers who provided support to the elderly whilst the third and final group comprised the service providers at CCS. Results for both aspects, quantitative and qualitative reveal the underlying issues and concerns.


KEY FINDINGS AND RECOMMENDATIONS

Quantitative Aspects:Due to the very small sample size and missing data, the results reported in this section must be interpreted with caution. Our participants reported a mix of living arrangements including private rental, public housing and boarding house. Furthermore, 30% of participants reported living alone. A total of 70% of participants said that they were not working and 30% had retired; 80% of participants reported that they receive care from a particular health professional with GP and Cardiologist topping the list followed by Psychologist and Optometrist. Participants rated their general health twice over the course of the study. Their general health was reported to improve between time-1 to time- 2. Consistent with their life experience, a larger number of participants were insecurely attached. The measure of personality did not reveal any major changes over time.

Results for the depression, anxiety, and stress dimension indicate that there is a moderate level of depression, stress, and anxiety present among the participants. Findings on the Hoarding dimension provide interesting information. Results at both times show average hoarding score to be above the control group used by Frost, Steketee, and Grisham (2004). However the scores were well below those of the hoarding participant group. It is important to note that at least one participant showed scores similar to that of the hoarding group.

The results on the trust scale indicate a lower level of trust amongst participants of the current study which reflects their life experience. Loneliness is an important dimension to consider in the elderly population. It was found participants had an increase in the average loneliness rating from time-1 to time-2. We compared our findings with the four data samples employed by Russell (1996) and it was found that the participants from the present study had a higher average loneliness score compared to all four comparison groups. Further, participants reported experiencing elevated levels of loneliness after they had volunteer support. This finding suggests that once the participants had experienced volunteer support, they actually missed the company and support of the volunteer. Scores on cognitive aspects indicate little or mild decline between the two time periods, which may be age related.


Qualitative Aspects:CCS clients (Group-1 CCS clients comprising vulnerably elderly): The participants in the study were individually interviewed; they also participated in focus groups. The common themes from both the interviews and focus groups surrounded around issues related to:

GRIEF, LOSS AND SOCIAL ISOLATION: Participants reflected on their course of life and expressed feelings of grief and loss surrounding their current situation. This theme includes immense grief and loss surrounding the breakdown of important relationships such as marriages and with their children; their gains and losses over the lifespan and the circumstances that led them to their current situation in need of help and ‘on the brim’ of homelessness. Social isolation and lack of connection to society was freely expressed and represents an increased vulnerability. Formal connection with CCS volunteers and service providers seems to be the only source of connection and hope of contact with the external world.

HEALTH AND WELLBEING: Most clients expressed a high level of physical and psychological impacts on health. They spoke about their increased need for support leading to loss of independence. This included physical health and mobility issues related to falls and mental health issues that leave them extremely susceptible. This may in turn have further adverse impacts leading to increased need for hospitalisation and enhanced dependency on the health system. The decline in overall health and wellbeing amongst CCS clients is also associated with age and their own sense of competence to survive in a hostile world. It is also clubbed with the psychological aspects of living on the brim for long periods. Their struggles highlight the key message of social isolation and its relationship with health and wellbeing.

RECOVERY THROUGH CONNECTION: Another dominant theme from the data was the concept of recovery of self through social connection. This theme focuses on the opportunity that the volunteer support program is able to provide for their clients, a way to get back in touch with their sense of the self and reconnect with their identity, have a purpose in life, reflect on their skills and their journey of life. This essentially relates to a sense of ‘re-living’ and belonging through reconnection with an enhanced self-efficacy and self-worth. This was evoked via the connection provided by CCS volunteers who have constantly revived their self-worth. Above all the validation by CCS volunteers of their clients as ‘normal’ people worthy of a conversation and connection was enormously valued by almost all the clients that were interviewed.

1

2

3


SUGGESTIONS FOR SERVICE ENHANCEMENTS FROM CCS CLIENTS: This theme had 3 sub-themes:

A GREATER FOCUS ON VOLUNTEER TRAINING: The clients echoed that the volunteers need additional training to perform their role indicating that the level of service and support is impacted by inadequate training. Therefore specific and targeted training in certain areas like mental health training, attachment and hoarding will be helpful in assessing client needs and benefits from further referrals.

B CLIENT CHOICE IN BEING MATCHED WITH VOLUNTEER: CCS clients appreciated the option to change the volunteer involved in the delivery of service. However a number of clients expressed the desire to have more flexibility and choice of the volunteers they are paired with, especially when it came to specific skill sets and interests. This suggestion indicates the clients’ insight into their needs.

C COMMUNICATING WITH CLIENTS: Some clients expressed varying degrees of dissatisfaction with variations in service and its communication. For example simple procedures for establishing contact and other changes to services. Since clients value the service, they expressed a need for communicating changes to them as genuine relationships are formed through trust building and ongoing interaction. This was specific for exit strategies, particularly when volunteers leave or any changes in support are required.

4


CCS Volunteers Focus GroupA number of themes emerged from the focus group data that may help to enhance the overall provision of the service. Common themes arising from focus groups comprising CCS volunteers and CCS service providers:

VOLUNTEER TRAINING: CCS volunteers suggested that there would be a benefit from additional training about the specifics like attachment theory and how it may help whilst working with clients. Training could further include some interaction and information from current volunteers at CCS for example, what a typical day may involve, what to expect from the role and learn from the experience of previous volunteers.

CLIENT INFORMATION: Another domineering theme was the opportunity to have additional information about clients. Volunteers expressed this need to allow greater preparedness in their role with specific clients. They also expressed the need for more formal training, specifically when sometimes they work with clients with complex psychological issues. Better knowledge about their client’s needs and interests will prepare them to engage with their clients in meaningful ways. Such information will help the volunteer to be aware of the life experiences of their client that they will be associated with and will further their relationship.

VOLUNTEER DEVELOPMENT, DEBRIEFING AND SUPPORT: Volunteers unanimously expressed the need for a regular cycle of debriefing in the form of multiple group meetings throughout the year as well as one-on-one sessions, as required. Irrespective of the frequency, one-on-one and group debriefing sessions were envisioned to be helpful for the further development of individual volunteers and to enhance their performance of their role.

CONNECTION OVER TIME: Another important theme from the focus group data is development of connection between volunteers, staff and the clients over time through interaction. This means necessary regular interaction and time is required for the development of these relationships. This has important connotations for funding and service delivery models as well which need to account for the time it takes to impact the lives of the clients.

4

1

2

3


CCS Staff Focus GroupFocus group with the CCS service staff reveals a number of relevant ideas to further support and enrich service delivery in order to expand the support toward vulnerable clients. The following themes were identified:

CONNECTION TO SPACE: This concept refers to the ways in which CCS can enhance the delivery of services for clients. Providing a meeting space for volunteers and clients to engage with each other. The importance of connection to space is also related to the need for a safe space for clients to be with staff. This not only relates to the facility but has funding implications based on the need to maintain and lease such a space.

ADDITIONAL SUPPORT AND REFERRALS: Most often the client’s only connection with the external world is through engagement with the formal service providers. This translates to increased vulnerability and need for support amongst this elderly section of the population. Connection with clients across a wide range of services will facilitate the identification of additional support for clients who need them most for example, hoarding and de-cluttering that can be identified with ongoing interaction. Clients in the due course of time begin to trust the service providers for identifying their needs and providing appropriate referrals and other support mechanisms.

CONNECTION OVER TIME: A similar theme emerged from the volunteer focus group data as well, about the development of connection over due course of time. This reiterates the significance of time that is necessary to develop an effective relationship of care and trust. Data highlights the positive impact of the program on the life and wellbeing of the vulnerable elderly.

1

2

3


RECOMMENDATIONS FOR IMPROVING THE QUALITY OF LIFE OF THE VULNERABLE ELDERLY:

Programs that encourage befriending have been found to be beneficial for reducing isolation and consequently depression (Kremers, Steverik, Albersnagel, & Slaets 2006). CCS to consider developing such befriending schemes to enhance their service for their clients, and to continue to enhance such programs that currently exist.

Encourage group participation. This inclusive approach is essential to develop a sense of purpose, new learning skills and new knowledge. Clients will experience a sense of togetherness and control when they participate in activities and carry out some decision making that relates to their wellbeing.

Meaningful activities must be part of group activities provide a good support system that helps clients to connect with others and share their everyday experience. Group participants have been found to have lowered hospital bed days, fewer visits to their GP and out-patient appointments compared with those who were not in a group intervention program (Pitkala, Routasalo, Kautiainen, Tilvis, 2009). CCS to continue with such activities and provide new and different activities for continued client involvement.

Cultural activity, a mentoring initiative or a rehabilitation intervention like art, music, discussion group and or exercise will be helpful for alleviating loneliness related depression (Pitkala et.al. 2009; Holt-Lunstead, Smith, & Layton, 2010). CCS to look into similar program/s and or continue with existing ones.

Some vulnerable elderly may be more willing and more able to support others in their groups. Encourage them. This will keep them motivated; enhance their self-esteem and self-worth leading to a sense of accomplishment. Involving elderly in community and social enterprises is recommended (Le Mesurier, 2011).

The key message here is to support the elderly in the community rather than through the hospital care system. We need to provide pro-active care. This would mean that we attempt to prevent the crisis and avoid the pressing need for emergency hospitalisation or emergency care.

Men tend to use fewer community-based health services than women; find it harder to make friends in later life; they have higher rates of social isolation and loneliness and are reluctant to seek health services. This places men higher on vulnerability as compared to women. Our sample of participants supports the gender number, i.e. we have more men than women and therefore they are at greater risk than women. CCS to be aware of this and provide necessary support.

Attempts to provide a sense of community and belongingness are important to enhance self-esteem, self-worth and self-image. Some common get-together days will further assist in the process.

1

2

3

4

5

6

7

8


The elderly know what their needs are and therefore involving them to determine what will be in their best interest will provide meaningful ways to address their needs. Involving the elderly into research is also an effective way into improve the quality of research. Thus, this research used best practice to include their voice in matters that relate to them as a matter of human right.

RECOMMENDATIONS FOR IMPROVING SERVICE DELIVERY:

Develop standard forms with essential demographic information along with finer details about matters that relate to the client. CCS to use its disclosure policy whilst developing these forms. This information will be helpful for discussion with volunteers prior to their interaction with clients.

Information about the life trajectories of clients to be discussed with volunteers. Volunteer coordinator to provide appropriate information to the volunteer for better understanding of the client’s needs, trauma etc. over the lifespan.

Hold periodic meetings for feedback and a better understanding of the relationship between the client and volunteer and to identify current and emerging needs. The timing and frequency of these meetings to be determined by volunteer coordinator in consultation with their Managers.

Establish volunteer training days on a yearly training calendar. Some basic information about attachment, grief and loss issues and trauma; hoarding along with impact of loneliness, anxiety, depression on quality of life be part of the training. These issues will allow volunteers to have a better understanding about where their clients fit.

Volunteer Coordinator to have periodic meetings with their Manager to discuss the progress, needs and other support mechanisms required to provide best possible service. This is particularly important when changing needs are identified in the clients for appropriate referrals and support.

CCS to review the existing program in the light of current findings and gaps that have been identified to provide a better insight into what needs to be changed or upgraded.

1

2

3

4

5

6


Final Comments: In addition to service and program enhancements, two main ideas have emerged that help to provide valuable insight into the impact on the lives of vulnerable elderly clients at risk, vulnerable and sometimes on the brim of homelessness. The theme of recovery through connection demonstrates that the volunteer support is a valuable way of lifting the mist of living on the brim by allowing clients to reconnect with their sense of self, their history, skills and past experiences. Above all it makes them feel they are human beings worthy of connection!

Through genuine connection clients have had a rare opportunity to reconnect and have a sense of ‘re-living’, a sense of being and belonging. This strengthens the need for such programs to exist. Future funding for such programs be actively sought to enrich the lives of the vulnerable elderly. The fact that clients reported higher scores on loneliness after volunteer support was introduced, highlights the need for such service. Clients were able to rediscover what they had been missing in life, a sense of self-worth and connection.

Providing adequate information to both client and volunteer will foster a better understanding of each person’s role and responsibility. Thus, the manner in which the relationship between volunteers, staff and clients develops over time and through interaction is an important concept. This further leads to an understanding that for genuine support and for the impact of such support to be felt by clients, necessary time and infrastructure must be made available.


Executive Summary .................................................................. 5

On the brim: Impact of volunteer support on vulnerable elderly ................................................ 21

Loneliness and Social Isolation ............................................. 23

Attachment theory .................................................................. 26

Attachment Anxiety and Hoarding ........................................ 28

Social Support ........................................................................ 29

Aged care services ................................................................. 32

The present study ................................................................... 33

Method .................................................................................... 34

Participants ............................................................................. 34Group-1 .........................................................................................34Group-2 .........................................................................................34Group-3 .........................................................................................34

Procedure ............................................................................... 34

Material ................................................................................... 35

Participant Survey .................................................................. 35Demographic Information ...............................................................35General Health................................................................................36Tri-dimensionality personality questionnaire (TPQ-44) ......................36Relationship styles questionnaire (RSQ) ..........................................36Relationship questionnaire (RQ) ......................................................36Depression, Anxiety Stress Scale (DASS-21) ..................................37Saving Inventory – Revised (SI-R) ...................................................37Trust scale (Ts) ................................................................................37UCLA Loneliness scale (UCLA-LS) .................................................37Mini Mental Status Examination (MMSE) .........................................37

Thematic Analysis .................................................................. 38Group-1 CCS clients ......................................................................38Grief, loss and social isolation .........................................................38Health and wellbeing ......................................................................38Recovery through connection .........................................................38Group-2 CCS Volunteers ................................................................39Group-3 CCS Service providers .....................................................39

TABLE OF CONTENTS


Results .................................................................................... 40

Quantitative Analysis - Demographic Information ................ 40Age and gender ..............................................................................40Country of Origin ............................................................................40Living arrangements .......................................................................40Employment status .........................................................................41Involvement with Health Professionals ............................................41General health ................................................................................41Tri-dimensionality personality questionnaire .....................................

43

Relationship styles questionnaire ....................................................43Relationship questionnaire ..............................................................44Depression, stress, and anxiety ......................................................44Savings Inventory – Revised (SI-R) ..................................................45Trust scale (Ts) ................................................................................46UCLA Loneliness scale ...................................................................46Mini Mental Status Examination (MMSE) ...............................................48

Qualitative Analysis ................................................................ 49

CCS Clients Interviews and Focus Groups ........................... 49Grief, loss and social isolation .........................................................49Health and wellbeing ......................................................................49Recovery through connection .........................................................49Grief, loss and social isolation .........................................................49Health and Wellbeing ......................................................................51Recovery through Connection ........................................................52

Suggestions for service enhancements from CCS clients ... 54Greater focus on volunteer training .................................................54Client choice in being matched with volunteers .......................................................................................55Communicating with clients ............................................................55

CCS Volunteers Focus Group ......................................................56Volunteer training ............................................................................57Client information............................................................................57Volunteer development, debriefing and support ..............................

58

Connection over time .....................................................................59CCS Staff Focus Group ..................................................................60Connection to space ......................................................................61Additional support and referrals ......................................................62Connection over time .....................................................................63

Discussion ............................................................................... 64

Limitations in the Study ......................................................... 70

Suggestions for Further Research ......................................... 70

References .............................................................................. 72


ON THE BRIM: IMPACT OF VOLUNTEER SUPPORT ON VULNERABLE ELDERLYIn 2016, older Australians represent approximately 3.7 million people, or 15% of Australia’s estimated population of 24.3 million people (Australian Institute of Health and Welfare (AIHW), 2016). This figure is comprised of what the Australian Institute of Health and Welfare (AIHW) define as ‘older Australians’, that is, those aged 65 or over, or 50 and over for older Indigenous Australians. Of significance is the fact that the older population of Australia is growing; it is predicted that by 2056 the proportion of older Australians will be 22% or 8.7 million (AIHW, 2016). Crucially for services working within this population is the changing profile of culturally and linguistically diverse older Australians, with three in ten, or 36%, of Australians in 2011 aged over 65 born overseas an increase of 11% from 1981 (Australian Bureau of Statistics (ABS), 2012).

The overall level of health and wellbeing of older Australians was reported to be good, very good or excellent health in the 2014-15 National Health Survey (ABS, 2015). Despite these results it is important to also recognise the significant disparities in the health and wellbeing of vulnerable individuals who are socially and financially disadvantaged. Statistics from the ABS suggest that disadvantaged Australians are more vulnerable to higher disease risk factors than those who experience socioeconomic advantage (ABS, 2015). Further data from the National Health Survey (ABS, 2008) highlights the relationship between increased level of disadvantage and poorer health outcomes for people living in those areas. For example, mental health and behavioural problems have also been found to impair an individual’s wellbeing. In 2007-08, 16% of people living in the most disadvantaged areas had psychological and or behavioural problems when compared with 11% of people living in the most disadvantaged areas (ABS, 2008). Moreover, it is the link between vulnerability and psychological distress among older Australians.

In 2014-15, 52% of older Australians reported psychological distress, which is concerning as chronic stress and psychological distress can lead to anxiety and depression, as well as physical health troubles as well such as high blood pressure (ABS, 2014). It is important to understand that the linkage between vulnerability and pathways into homelessness are multidimensional and include poverty, disadvantage, social isolation, and enduring unemployment (Somerville, 2013). Vulnerability and disadvantage among older people is primarily associated with physical or mental health problems and social isolation (Crane & Warnes, 2007).

In this sense vulnerability may be seen as resulting from a combination of structural and individual factors that combine together to increase the risk not only of becoming homeless, but also in terms of additional stress and distress for those living in vulnerable circumstances (Somerville, 2013). Thus, there may be countless causes of risk and vulnerability for older Australians, including structural determinants (economic and policy conditions; poverty, unemployment, housing availability) and individual vulnerabilities (relationship issues, gambling, substance abuse, mental health, disability) (Seal, 2005).


Loneliness and Social Isolation Loneliness is ‘the unpleasant experience that occurs when a person’s network of social relations is deficient in some important way, either qualitatively or quantitatively’ (Perlman & Peplau, 198, p.31). This notion also includes the experience where either or both the quantity and quality of relationships is smaller than desirable, and is often accompanied by feeling emptiness and rejection. Loneliness has been associated with a myriad of aversive consequences; reduced life satisfaction, decreased academic performance and persistence, and psychological distress (Drageset, 2004; Bernardon, Babb, Hakim-Larson, & Gragg, 2011). Interestingly research by Golden, Conroy, Bruce, Denihan, Greene, Kirby, & Lawlor (2009) concludes that older adults more commonly endorse social engagement than physical health when articulating their beliefs on successful ageing.

This definition of loneliness has gained popularity in terms of its use in research and theory, and is different to other forms of loneliness such as voluntary withdrawal from social interaction and existential loneliness (de Jong Gierveld, van Tilburg & Dykstra, 2016). Furthermore, Weiss’s (1973) seminal work on loneliness helps to distinguish between types of loneliness further by differentiating between emotional loneliness and social loneliness. According to Weiss, emotional loneliness flows from a lack of intimate emotional attachment compared with social loneliness that relates to a distinct lack of contact with a broader social group including friends, colleagues, and people within a neighbourhood. This study revolves around the concept of concerns about loneliness being rooted in an unpleasant or unacceptable lack of relationships with a social orientation.

The term social isolation is often used in conjunction with loneliness and can be best defined as a continuum with social isolation at one extreme and social participation at the other (de Jong Gierveld, van Tilburg & Dykstra, 2016). The corollary here is that people with a lack of or minimum number of meaningful relationships are by definition socially isolated. Indeed, de Jong Gierveld, van Tilburg, and Dykstra (2016) argue that those who are socially isolated pose a higher risk of becoming lonely, and that feeling socially embedded and ultimately alleviating loneliness relies on being surrounded by a social network of meaningful relationships.

Importantly in understanding social isolation and loneliness is the idea of the interaction of expectations of individuals with regards to subjective feelings of loneliness and social isolation. For example, Victor, Scambler, Bond, and Bowling (2000) highlight how socially isolated persons may not experience loneliness and lonely people are not essentially socially isolated objectively.


Ultimately while the size of the personal network is important, the composition and functioning of the network are also important characteristics. For example, research by Silverstein, Chen, and Heller (1996) has shown that people with networks consisting entirely of kin relationships are more at risk of experiencing loneliness than networks consisting of kin and non-kin relationships equally.

In terms of prevalence of social isolation and loneliness among older Australians, an issues paper by Aged & Community Services Australia (ACSA) (2015) highlights the high proportion of older Australians living alone (24.3%), decreased social mobility, and greater healthcare needs among older Australians as posing a greater risk of experiencing social isolation and loneliness for this cohort. This is reflected in international research using data from the European Social Survey (Yang & Victor, 2011) in which the over 60 age group is reported to have the highest prevalence of loneliness across all 25 countries surveyed. Drageset, Kirkevold, and Espehaug (2011) also acknowledges the notion that loneliness is common in elderly populations.

Of particular importance for the present study is research to show that a group at higher risk of experiencing social isolation and loneliness is older people who receive care and support. This group tends to be older aged, worse health, and increased issues with regards to mobility and cognitive impairment when compared to consumers who do not use aged care services (ACSA, 2015). Worthy of note is research amongst organisations providing aged care services in Australia that suggests 41% of new clients are lonely (Australian Ageing Agenda, 2013). Another important consideration in terms of prevalence among older Australians is that of migrant groups which are at risk of low social integration and higher experiences of loneliness manifested in the characteristics of multiple vulnerabilities including low socio-economic position, poor language proficiency, and weakening ties to their country of origin (deJong Gierveld, van Tilburg, & Dykstra, 2016).

This is especially relevant in light of findings by Fokkema, de Jong Gierveld, and Dykstra (2011), which highlight that socioeconomic position and availability of social welfare policies for those in need were crucial country-level requisites for the achievement of a certain quality of life and alleviating loneliness.

A major theoretical approach in understanding loneliness comes with a focus on individual characteristics that may contribute to the experience of loneliness. In their research of antecedents of loneliness Hawkley, Hughes, Waite, Masi, Thisted, and Cacioppo (2008) distinguish between distal and proximal factors of loneliness. Distal factors can be understood as factors that influence the features of individual living conditions that impact the level of social integration of people and include demographic and socio-structural factors (for e.g. age, gender, education, income, migrant status) and personality characteristics (for e.g. anxiety, social skills, self-esteem, introversion / extroversion). Proximal factors on the other hand are


defined as the descriptive characteristics of the level of social engagement, such as size, composition, and function (Hawkley, Hughes, Waite, Masi, Thisted, & Cacioppo, 2008). Of particular focus for the current study are the so called distal factors related to personality and attachment style which are now explored in relation to social isolation and loneliness.

Attachment theoryAttachment theory says that early attachment relationships with caregivers helps to form internal working models (cognitive frameworks) that affect individuals’ expectations for security and support in future relationships (Bernardon, Babb, Hakim-Larson, & Gragg, 2011). Social relationships contribute to overall psychological well-being and importantly form the bedrock for deeper and more intimate relationships to develop, for example romantic relationships (Kafetsios & Sideridis, 2006).

Individual models of attachment reflect two underlying constructs, model of self and a model of others. The model of self reflects the degree to which individuals feel a sense of self-worth and competence in relationships compared to the model of others that reflects the degree to which individuals feel that relationships with others are positive experiences and actively seek them out (Kafetsios & Sideridis, 2006; Bernardon, Babb, Hakim-Larson, & Gragg, 2011)

It is argued that an individual’s model of self and others combine with negative or positive orientations to produce four styles of attachment. The four styles are; secure attachment style – those with positive models of self and others; fearful-avoidant – negative models of self and others; preoccupied – have a negative model of self but positive of others; dismissing-avoidant – negative model of others but positive of self (Bernardon, Babb, Hakim-Larson, & Gragg, 2011).

Bernardon, Babb, Hakim-Larson, and Gragg, (2011) illustrate that securely attached individuals have a positive view of themselves and others, they typically expect their social environment to be supportive of help-seeking and feel confident in their own ability to seek out the instrumental or emotional support they require. This is compared to insecurely attached individuals whom expect others to be unresponsive to their needs and may dismiss seeking social support as a coping option.

These broad themes are reflected in the work of Kafetsios & Sideridis (2006) who demonstrate that insecure individuals are less adjusted on measures of wellbeing including loneliness, depression, anxiety, hostility, and psychosomatic illness.


Attachment Anxiety and HoardingHoarding behaviours are habitual practices that involve the excessive acquisition of obsolete objects and the inability to relinquish possession of these objects, resulting in significant distress or impairment (Frost & Hartl, 1996). Hoarding is a chronic disorder with prevalence rates ranging from 2% to 6% of the population (Pertusa et al., 2010; Timpano et al., 2011) with adverse consequences for individuals who hoard such as unemployment, social withdrawal, and even risk of eviction (Pertusa et al., 2008; Tolin, Frost, Steketee, Gray, & Fitch, 2008). Thus, hoarding does not just affect only the collector but also systemically influences and places strain on other family members, friends, and the public health system (Büscher, Dyson, & Cowdell, 2013; Frost, Steketee, & Williams, 2000; Tolin, Frost),

Earlier classification of hoarding conceptualised it as a subtype of obsessive-compulsive disorder (OCD; American Psychological Association [APA], 2000). Thus, most of the earlier research used OCD measures. More recently hoarding has been recognised as a separate psychiatric disorder (APA, 2013) with a prevalence rate that is double of OCD (Samuels et al., 2008), leaving researchers to question the validity of previous work in the area (Pertusa et al., 2010). Furthermore, hoarding disorder has a relatively more chronic course compared with OCD (Muroff, Bratiotis, & Steketee, 2011).

As interpersonal attachment shares some parallels with object attachment (hoarding), recent research is attempting to explore the link between these two bodies of research. For instance, Keefer, Landau, Rothschild, and Sullivan (2012) found that individuals who score higher on attachment anxiety become more attached objects or tend to turn to objects when faced lack of availability of attachment figures or reliable individuals who are there for them, should they be distressed. This further indicates that objects may represent sources of comfort for these individuals (Grisham et al., 2009). Further hoarding behaviour and attachment anxiety have also been found to be related to childhood adversities and trauma (Hinnen, Sanderman, & Sprangers, 2009; Samuels et al., 2008; Tasca et al., 2013), personality disorder traits (Samuels et al., 2007), anxiety and depressive disorders (Marganska, Gallagher, & Miranda, 2013; Picardi et al., 2013), and associated with materialistic values (Frost, Kyrios, McCarthy, & Matthews, 2007; Norris, Lambert, DeWall, & Fincham, 2012).

Social SupportThere is a significant amount of research to highlight the potentially protective effect of social support in terms of individual wellbeing, where social support refers to the ability of individuals to obtain help from peers in facing problems or troublesome situations (Tummala-Narra & Claudius, 2013). Social support has been linked across a number of areas to better outcomes in terms of individual wellbeing for example social support among secondary school teachers (Sheffield, Dobbie & Carroll, 1994), with regards to mental health in pregnant women (Zachariah, 2009), amongst military spouses (Skomorovsky, 2014), and even within whole communities (Mair, Diez Roux, & Morenoff, 2010).


Hwang, Kirst, Chiu, Tolomiczenko, Kiss, Cowan, and Levinson (2009) list a myriad of positive effects of social support such as; buffering events that negatively impact physical and mental health, creating positive affective states, and access to social support and other resources. Furthermore, positive social relationships have been found to improve quality of life and the degree of involvement in the community is a predictor of subjective quality of life (Henwood, Matejkowski, Stefancic & Lukens, 2014).

This notion is a key factor in the development of wellbeing, that is, the degree to which people have access to social support and their perceptions about whether or not they can rely on the support when it comes to important life transitions. Recent research has highlighted the potentially important role of social support on individual well-being for vulnerable populations, such as older Australians. For example Johnstone, Parsell, Jetten, Dingle and Walter (2016) found that nurturing positive social support mechanisms was important for well-being for those at risk at homelessness.

In regard to migrant groups, a recent meta-analysis into the determinants of wellbeing among international economic immigrants by Bak-Klimek, Karatzias, Elliot and Maclean (2014), concluded that social support played a critical role in the wellbeing of immigrants. Furthermore, a study by Tummala-Narra and Claudius (2013) investigated the relationship between perceived levels of social support and experiences of discrimination in order to examine the potentially protective effect of social support in terms of individual wellbeing in the face of discrimination and other stressors. The study argued that social support facilitates coping as opposed to offsetting the effects of ‘everyday discrimination’ (Tummala-Narra & Claudius, 2013, p. 266). The potential for social support to be a significant predictor of wellbeing amongst migrant populations is especially relevant given the potential for exposure to discrimination as well as the effects of discrimination on individual wellbeing regardless of frequency (Umaña-Taylor, Vargas-Chanes, Garcia & Gonzales-Backen, 2008).

The placement of a volunteer as a presence in people’s lives, such as those in focus for the present study, impacts greatly on health outcomes, quality of life, reduces health risks and increases life enjoyment. For example, it has been found that positive emotional support, often from family or caseworkers, is associated with better mental wellbeing amongst vulnerable individuals (Klinkenberg, Calsyn, & Morse, 1998; Hwang, Kirst, Chiu, Tolomiczenko, Kiss, Cowan, and Levinson, 2009). However, research on the impact of social support on vulnerable populations and well-being has a limited evidence base (Johnstone, Parsell, Jetten, Dingle & Walter, 2016). Therefore, this study aims to review the ‘value-add’ volunteers may have on the lives of vulnerable elderly clients who are experiencing disadvantage and may be on the brim of homelessness in the delivery of support services.


Aged care servicesSupporting vulnerable older Australians, like other populations, is about addressing poverty, stigma, loneliness, and social exclusion (Johnstone, Parsell, Jetten, Dingle, & Walter, 2016). Support services need to be multidimensional with influences including mental health, poverty and addiction (Woolrych, Gibson, Sixsmith, & Sixsmith 2015). Along this line service providers have identified the importance of people developing and nurturing positive social support mechanisms as a means to both exit homelessness and promote the realisation of non-housing outcomes (Johnstone, Parsell, Jetten, Dingle, & Walter, 2016).

It is argued (Crane & Warnes, 2007) that the services have knowledge about welfare and housing services that allow people who are facing disadvantage and are socially isolated to be connected to services and help. This knowledge is especially relevant when considering the increasing migrant proportion of older Australians.

Similarly Somerville (2013) describes another catalyst pulling people out of vulnerability as when staff from services showed care, which created a realisation that the people they were helping existed and mattered, which in turn increased self-esteem, created hope and motivation to begin resettlement (Somerville, 2013). This factor combines with availability of support and guidance from people and organisations and essentially constitutes a necessary precondition for intervention of services to succeed.

In terms of adopting a multidimensional approach to service delivery, Martijn and Sharpe (2006) reflect on the high frequency of trauma experience among vulnerable populations, highlighting an implication for services working with this population. They suggest that that the focus needs to be on preventing problems from getting worse rather than focusing on housing and employment.

The present studyThis study aims to investigate the impact of support services among vulnerable elderly people supported by an aged care service provider in Sydney, Australia. The research employs both qualitative and quantitative measures to assess the interrelationships of individual characteristics such as personality, mood, general health, and attachment styles to determine the impact, if any, on loneliness and overall general health for those people in receipt of aged care services.


METHOD

Participants

Group-1This group comprised of the vulnerable elderly clients. All 10 clients were recruited through their involvement with Catholic Community Services (CCS), Catholic Healthcare LTD (CHL). Of the 10 participants seven were males (age range 66 – 84 years, mean 74.5 years) and three were female (age range 66 – 71 years, mean 68.83 years). Participants were provided with a gift card for the completion of each task (survey completed at Time-1 and Time-2; 1 interview and participation in the focus group).

Group-2The focus group for volunteers had three participants. Two participants were males and 1 participant was female.

Group-3The third group of participants comprised of CCS service providers. Six staff members from CCS participated in the focus group. There were 5 females and 1 male participant.

ProcedureAll the 10 participants from group-1(vulnerable elderly) were given a survey to complete at time-1 and then the same survey to complete at time-2, three to four months after the provision of support services from a CCS volunteer.

Additionally, one-on-one interviews were conducted with each of the 10 clients. The interview was done by the same staff member at CCS. Participants from the 3 groups were also invited to take part in a focus group. Three clients from the vulnerable elderly group (group-1) consented for the focus group.

Two more focus groups were conducted. One focus group for the volunteers at CCS and the second for the CCS staff were conducted in order to gain insight into the volunteer program.

The individual interviews with CCS clients were recorded with prior consent of participants and then transcribed to facilitate a thematic analysis of the data from these interviews. Similarly, all the 3 focus groups were audio recorded with prior consent and were transcribed for ease of analysis. Focus group sessions lasted approximately 1-hour. For consistency across groups, the same trained facilitator conducted all the focus groups. Participants in the three groups were encouraged to express their views and opinion freely. Intermittent probing and sometimes re-focusing on the topic was done by the facilitator to maintain group interaction. The questions for the focus groups were semi-structured and predetermined.


Material

Participant Survey

DEMOGRAPHIC INFORMATION. The first section of the survey was related to demographic details of the participants (questions 1 – 12) including: age, gender, country of origin, living arrangements, employment status, and their Involvement with health professionals.

GENERAL HEALTH. General health status was reported using The General Health Questionnaire, a single item indicator used to measure self-rated health (Jasinskaja-Lahti, Liebkind, & Perhoniemi, 2006). Participants answer a single question ‘How well is your general health at the moment? The answer scale consists of five intervals – good, quite good, average, quite poor and cannot say/ not sure.

TRI-DIMENSIONALITY PERSONALITY QUESTIONNAIRE (TPQ-44). The Tridimensional Personality Questionnaire (TPQ-44) was developed by Sher, Wood, Crews, and Vandiver (1995) based on the Tri-dimensional Personality Questionnaire (version 4) (TPQ-4) (Cloninger, 1991). The TPQ-44 measures the three dimensions of temperament posited as novelty seeking, harm avoidance, and reward dependence, and has high correlation against the TPQ-4; novelty seeking (.89), harm avoidance (.96), and reward dependence (.79) (Sher, Wood, Crews, and Vandiver, 1995).

RELATIONSHIP STYLES QUESTIONNAIRE (RSQ). The RSQ is based on the work of Griffin and Bartholomew (1994). It contains 30 short statements in which participants rate the extent to which each statement best describes their typical style in close relationships. The statements relate to the different aspects of attachment styles including secure, fearful, preoccupied, dismissing styles.

RELATIONSHIP QUESTIONNAIRE (RQ). The RQ was developed by Bartholomew and Horowitz (1991). It is a single item measure made up of four short paragraphs, each describing a prototypical attachment pattern as it applies in close adult peer relationships. Participants are asked to rate their degree of correspondence to each prototype on a 7-point scale. These ratings (or “scores”) provide a profile of an individual›s attachment feelings and behaviour.

DEPRESSION, ANXIETY STRESS SCALE (DASS-21). The DASS-21 was administered to assess the negative emotional states of depression, stress, and anxiety developed by Lovibond and Lovibond (1995). It is a brief measure with seven responses under each of the three dimensions, depression, anxiety and stress.

SAVING INVENTORY – REVISED (SI-R). The Saving Iventory – Revised (SI-R) was developed by Frost, Steketee, and Grisham (2004) as a measure of compulsive hoarding. The scale has 23 items that come together to form three subscales; clutter, difficulty discarding, and acquisition.


TRUST SCALE (TS). The Trust scale (Ts) (Rempel, Holmes, & Zanna, 1985) is a 23-item scale designed to measure the level of trust within close interpersonal relationships. The scale is comprised of three sub-components; predictability, dependability, and faith. ‘Predictability, dependability, and faith are seen as arising out of different levels of cognitive and emotional abstraction’ (p98, para 2, Rempel, Holmes, & Zanna, 1985).

UCLA LONELINESS SCALE (UCLA-LS). The revised UCLA Loneliness Scale (UCLA-LS) (Version 3) is a 20-item measure of subjective feelings of loneliness as well as social isolation (Russell, Peplau, & Cutrona, 1980).

MINI MENTAL STATUS EXAMINATION (MMSE). The Mini Mental Status Examination (MMSE) developed by Cockrell and Folstein (1988) was given to participants in the present study to assess the presence, if any, of neurocognitive decline.

Thematic Analysis Following the 15-point checklist for good thematic analysis the interviews were transcribed verbatim and de-identified (Braun & Clark 2006). Two researchers conducted thematic analysis independently, reading, becoming familiar with depth of data and placing comments alongside the transcript. The researchers in this way attempted to determine the themes, sub-themes and concepts on all the transcripts from individual interviews and focus groups before compiling the themes together for final coding in order to increase internal reliability and consistency (Bourgeois, 2007). Following the method of emergent theme analysis, this process was continued until no new themes could be identified. Through this process, the researchers gained better insight into the emerging patterns or themes in the content (Lingard, Reznick, DeVito, & Espin, 2002).


The following common themes were found in the interview and focus group data of participants:

Group-1 CCS clients (vulnerably elderly):

1. Grief, loss and social isolation

2. Health and wellbeing

3. Recovery through connection

4. Suggestions for service enhancements from CCS clients

A. greater focus on volunteer training

B. client choice in being matched with volunteer

C. communicating with clients

Common themes arising from focus groups comprising CCS volunteers and CCS service providers:

Group-2 CCS Volunteers

1. Volunteer training

2. Client information

3. Volunteer development, debriefing and support

4. Connection over time

Group-3 CCS Service providers

1. Connection to space

2. Additional support and referrals



RESULTS

Quantitative Analysis - Demographic InformationAGE AND GENDER. There were 10 participants in total, including seven males and three females with an overall average age of 73.3 years.

COUNTRY OF ORIGIN. The majority of participants (80%) were born in Australia and 20% were born overseas (Poland and South Africa).

LIVING ARRANGEMENTS. Among participants the average length of residence in their current accommodation was 225 months. Participants reported a mix of living arrangements including private rental (1), public housing (7) and boarding house (1). Furthermore, 30% of participants reported living alone. Figure 1 displays the results of these questions.

Figure 1. Living arrangements of participants involved in the study

EMPLOYMENT STATUS. All participants were either not employed (70%) or retired (30%), the results are displayed in Figure 2.

Figure 2. Employment status of participants involved in the study

Alone

Not Employed Retired

25%

70%

30%

8% 8%

58%

Boarding House Private Rental Public Housing

Living Arrangements

Employment Status

Type of health professional involved in care of participants

Self-rated general health comparison T1 and T2

14%

3.3

3.2

3.1

3

2.9

2.8

2.7

2.6

2.5Time 1 Time 2

5%

10%

Psyc

holo

gist

Type

of h

ealth

prof

essi

onal

Psyc

hiat

rist

CC

S Se

rvic

es GP

Car

diol

ogis

t

Opt

omet

rist

Neu

rolo

gist

Endo

crin

olog

ist

(dia

bete

s re

late

d)

Onc

olog

ist

Gas

troen

toro

logi

st

19% 19%

14%

5% 5% 5% 5%

Alone


25%

70%

30%

8% 8%

58%


Living Arrangements

Employment Status



14%

3.3

3.2

3.1

3

2.9

2.8

2.7

2.6

2.5Time 1 Time 2

5%

10%

Psyc

holo

gist

Type

of h

ealth

prof

essi

onal

Psyc

hiat

rist

CC

S Se

rvic

es GP

Car

diol

ogis

t

Opt

omet

rist

Neu

rolo

gist

Endo

crin

olog

ist

(dia

bete

s re

late

d)

Onc

olog

ist

Gas

troen

toro

logi

st

19% 19%

14%

5% 5% 5% 5%


INVOLVEMENT WITH HEALTH PROFESSIONALS. In regard to the involvement of participants with health professionals, 80% of participants reported that they receive care from a particular health professional. The number and type of health professionals involved are outlined in Figure 3.

GENERAL HEALTH. Participants were asked to self-rate their general health at the initial interview (T1) and then again at the follow-up interview (T2). Two participants were removed from the analysis due to incomplete survey responses. These scores were assessed using a 5-point likert scale and then inverted for interpretation meaning that 1 = Poor through to 5 = Good. The average reported self-rated general health for Time 1 was 2.8 (between ‘quite poor’ [2] and ‘average’ [3]) compared to Time 2 which was 3.2 (between ‘average’ [3] and ‘quite good’ [4]). The results are presented in Figure 4.

Figure 3. Type and count of health professionals involved in caring for participants in the study

Figure 4. Self-rated general health of participants between time 1 and time 2

Alone


25%

70%

30%

8% 8%

58%


Living Arrangements

Employment Status



14%

3.3

3.2

3.1

3

2.9

2.8

2.7

2.6

2.5Time 1 Time 2

5%

10%

Psyc

holo

gist

Type

of h

ealth

prof

essi

onal

Psyc

hiat

rist

CC

S Se

rvic

es GP

Car

diol

ogis

t

Opt

omet

rist

Neu

rolo

gist

Endo

crin

olog

ist

(dia

bete

s re

late

d)

Onc

olog

ist

Gas

troen

toro

logi

st

19% 19%

14%

5% 5% 5% 5%

Alone


25%

70%

30%

8% 8%

58%


Living Arrangements

Employment Status



14%

3.3

3.2

3.1

3

2.9

2.8

2.7

2.6

2.5Time 1 Time 2

5%

10%

Psyc

holo

gist

Type

of h

ealth

prof

essi

onal

Psyc

hiat

rist

CC

S Se

rvic

es GP

Car

diol

ogis

t

Opt

omet

rist

Neu

rolo

gist

Endo

crin

olog

ist

(dia

bete

s re

late

d)

Onc

olog

ist

Gas

troen

toro

logi

st

19% 19%

14%

5% 5% 5% 5%


Tri-dimensionality personality questionnaire.The results of the TPQ-44 are displayed in Figure 5 for each subscale of the TPQ-44 across T1 and T2. These results show little change between T1 and T2, which was as expected across the timeframe within the study.

Figure 5. TPQ-44 results by subscale for T1 and T2

RELATIONSHIP STYLES QUESTIONNAIRE. The average scores for the RSQ are shown below for all participants across T1 and T2 (see Figure 6).

Figure 6. RSQ results by attachment style for T1 and T2

Anxiety T1 Depression T1 Stress T1 Anxiety T2 Depression T2 Stress T2

Average scores on the DASS-21

TPQ-44 Subscale Results for T1 and T2

Harm Avoidance Novelty Seeking

T1 T2

Reward Dependence

Average scores for RSQ attachment styles

Secure Style Fearful Style Preoccupied Style

T1 T2

Dismissing Style

RQ attachment style for T1 and T2

33% 33%

13%13%11%

22%

38% 38%

FearfulSecure Preoccupied

T1 T2

Dismissing





T1 T2

Reward Dependence



T1 T2

Dismissing Style


33% 33%

13%13%11%

22%

38% 38%


T1 T2

Dismissing


Relationship questionnaireThe results of the RQ questionnaire are presented below in Figure 7, with results indicating a diverse profile of attachment style across the participants of the study.

Figure 7. RQ attachment style results for T1 and T2

DEPRESSION, STRESS, AND ANXIETY. Scores from the DASS-21 that was administered at both Time 1 and Time 2 shows that on average participants reported results that place them in the moderate range for Anxiety, Depression, and Stress. One participant was removed from the analysis due to incomplete survey responses. These results indicate that there is a moderate level of depression, stress, and anxiety present among the participants of the present study.

Figure 8. DASS-21 average scores for participants at T1 and T2





T1 T2

Reward Dependence



T1 T2

Dismissing Style


33% 33%

13%13%11%

22%

38% 38%


T1 T2

Dismissing





T1 T2

Reward Dependence



T1 T2

Dismissing Style


33% 33%

13%13%11%

22%

38% 38%


T1 T2

Dismissing


SAVINGS INVENTORY – REVISED (SI-R). The results of the SI-R can be seen in figures 7 and 8, and have been compared to the sample data used by Frost, Steketee, and Grisham (2004). Two participants were removed from the analysis due to incomplete survey responses. The comparison groups include a community control sample (n=23) and a hoarding participant sample (n=70). Results at both T1 and T2 show averages above the control group used by Frost, Steketee, and Grisham (2004), but still well below those of the hoarding participant group. It is significant however to note that at least one participant showed scores similar to that of the hoarding group which underscores the importance of this measure within this sample population.

Figure 9. SI-R results compared to control and hoarding participants from Frost, Steketee, and Grisham (2004).

TRUST SCALE (TS). The results of this scale are presented in Figure 10 and indicate that on average participants do not score very highly on the three component subscales of predictability, dependability, and faith. One participant was removed from the analysis due to incomplete survey responses. These results may indicate a lower level of trust amongst participants of the current study.

No impairment Mild

CCS T1 CCS T2 Students Nurses Teachers Elderly

Percentage of responses to the MMSE for T1 and T2 combined

SI-R results for CCS participants compared to control and hoarding sample

CCST1 CCST2 Control Group

Difficulty Discarding Acquisition Clutter

Hoarding Group

Average scores on the trust scale for T1 and T2

Dependability Faith Predictability

T1 T2

Loneliness Score

19.4 18.4

29.226.4

20.7 19.2

87%

13%


UCLA LONELINESS SCALE. The results from the present study show that participants had an average loneliness rating of 55.3 at T1 and 57.4 at T2. One participant was removed from the analysis due to incomplete survey responses. Using the four data samples employed by Russell (1996) by way of comparison it can be seen that participants from the present study had a higher average loneliness score compared to all four comparison groups used by Russell; students (mean = 40.08), nurses (mean = 40.14), teachers (mean = 19.22), and elderly (mean = 31.51). Figure 11 displays these results.

Figure 10. Average scores on the trust scale for T1 and T2

Figure 11. UCLA Loneliness scale scores compared to Russell (1996)

No impairment Mild






Hoarding Group



T1 T2

Loneliness Score

19.4 18.4

29.226.4

20.7 19.2

87%

13%

No impairment Mild






Hoarding Group



T1 T2

Loneliness Score

19.4 18.4

29.226.4

20.7 19.2

87%

13%


MINI MENTAL STATUS EXAMINATION (MMSE). 5 responses to the MMSE were removed due to missing data leaving a sample size of 15 responses for the analysis. Folstein, Folstein, and McHugh (1975) suggest that scores between the 25-30 range on the MMSE relate to a degree of impairment that is questionably significant, meaning no impairment, which was found to be the case for 87% of all responses. The remaining 13% of scores were within the 20-25 range, suggesting the presence of mild impairment (Folstein, Folstein, & McHugh, 1975). Figure 12 shows the results.

Figure 12. Percentage of responses to the MMSE by impairment category with T1 and T2 combined

No impairment Mild






Hoarding Group



T1 T2

Loneliness Score

19.4 18.4

29.226.4

20.7 19.2

87%

13%


Qualitative AnalysisThematic analysis has been conducted on the transcribed data from the individual and focus group audio recordings. A brief summary of dominant emerging themes, along with examples, is presented below.

CCS Clients Interviews and Focus GroupsGroup-1 CCS clients (vulnerably elderly):

1. Grief, loss and social isolation

2. Health and wellbeing

3. Recovery through connection

4. Suggestions for service enhancements from CCS clients

A. greater focus on volunteer training

B. client choice in being matched with volunteer

C. communicating with clients

Themes arising from the interviews and focus group data are summarised below in no particular order of rank.

GRIEF, LOSS AND SOCIAL ISOLATION. Many client’s express feelings of grief and loss surrounding their current situation in which they find themselves in need of help and ‘on the brink’ of homelessness. This includes expressions of plans and dreams for a life lived differently to their current situation,

“It’s not the way I saw my retirement’ (Client IV6),

‘I’d worked all my life…I finished up with nothing, and finished up in housing” (Client IV4).

There was a similar sentiment expressed within the focus groups as well,

“It shouldn’t have been like that, you know, but when you haven’t got any money, you’re,

you’re relegated to it, you know, because everything was taken from me” (Client P6).

This theme also includes immense grief and loss surrounding the breakdown of important relationships such as marriages and with children,

“My family is estranged from me because I, my wife divorced me in 89, and, ah, so I’m

really on my own” (Client P3FG1).


Another participant echoed his loss and mentioned,

“And the kids don’t talk to me… I just had to agree to the divorce… I thought they would

understand as time went on, but it doesn’t seem like it” (Client IV3),

“I suppose my problems started back in 2001 when we had a complete family break up”

(Client IV7).

What emerges through these experiences of grief and loss is social isolation,

“Started becoming, I suppose you’d say socially isolated. So I, as I say, I’m not happy

about any of that” (Client IV6).

Indeed, many clients within the data report little to no social support networks outside of their contact with formal service provision through Catholic Care Services (CCS),

“Im just living alone now’ (Client IV5),

“I suppose I got used to being on my own” (Client IV3) and

“I’ve been on my own here for over 12 years” (Client IV4).

This isolation and lack of connection to society represents an increased vulnerability whereby formal connection to service providers, such as CCS, are the only source of hope and contact with the external world. Client IV1 illustrates this in response to a question about the presence of friends and family,

“There’s a few people I’ve gotten to know…social life would mainly be here, um, I’ve got

no real friends”.

This theme was exemplified many times throughout the data,

“It’s been good just being out with somebody” (Client IV7)

and “

Certainly makes me different because middle of the week you got no one to talk to you” (Client IV8).

HEALTH AND WELLBEING. Clients expressed a high level of physical and psychological impacts on health that increased their need for support and decreased their independence. This included physical health and mobility issues, for example Client IV1 who described the impact of recent health challenges,

“I’ve been having trouble with falls…we have trouble going down to the shop and getting

back again”.


Another client describes a similar change in the need for support due to changes in physical health

“it’s made me very scared of going out. I make myself, but I’m not going out as much” (Client IV6).

These impacts physical mobility and also includes the impact of psychological illness as well,

“Then I landed on the street, because I became, ah, you know, I became mentally, ah, ill” (Client IV3)

and

“I suppose I got used to being on my own. But of course, I’ve got a, a problem with, ah,

with bipolar” (Client IV7).

This increased need for support included practical aspects, such as

“He’s trying to get me onto Skype to talk to my people in South Africa and, ah, Zimbabwe,

so, ah, that’s for our little project” (Client P3)

and psychosocial aspects,

“It’s been good to be able to talk to someone who’s got like interests, and a sense of

humour” (Client IV6).

When the increased need for support is combined with the reality and perception of having little to no support around them, clients may become much more vulnerable and insecure, which in turn may have further adverse impacts,

“Then I landed on the street, because I became, ah, you know, I became mentally, ah, ill”

(Client IV3).

The decline in overall health and wellbeing amongst CCS clients, whilst also associated with age, increased their level of vulnerability in terms of their own sense of competence to navigate a particularly hostile world and the associated psychological aspects of living on the brim for long periods. However, there was a sense of resilience expressed,

“I’m sort of one of these guys who never gives up, you know, like I; as hard as it may get,

the harder I go at it, you know, but now it’s got me now by the short and curlies. It’s got

me by the throat” (Client P6).

The struggles that the clients have indicated provide us with the key message of social isolation and its relationship with health and wellbeing.


RECOVERY THROUGH CONNECTION. A dominant theme from the data was the concept of recovery of self through the social connection provided by the volunteers in the program. This theme centres on the opportunity for clients to get back in touch with their sense of identity prior to their current circumstances and reconnect with their identity, purpose, skills and previous memories and experiences. This essentially relates to a sense of ‘re-living’, a sense of being and belonging through an opportunity to reconnect with an enhanced self-efficacy and self-worth. This is essentially because of the connection they have with their volunteers who have constantly revived their self-worth. Client P1 from the focus group for example mentioned,

“It’s been great because they’ve kept on reminding me that I’m not that useless. They’re

talking about things that I’ve been involved in the past, or things we could have been

involved in. To say, I am someone, I am something”.

Similar experiences were throughout the data,

“When people are with me, I feel better. You know, and I can ask him anything I like” (Client IV3).

This sentiment was reiterated by others

“Another sane human being who you can have a sane conversation with and not be

attacked and just feel like things are normal” (Client IV7).

The connection with the volunteers has been fully acknowledged.

Moreover, the experience of being validated as a ‘normal’ person via the interaction with the volunteers was enormously valued by and important to the clients that were interviewed, underscoring the importance of this service to the CCS clients. These moments of validation afforded through the interaction with the volunteer are the opportunities to reconnect with a lost sense of self and purpose for many of the clients. Examples of this validation were rich throughout the dataset, for example,

“The meetings with Daniel has shown me I’m still a human being, there’s still skills and

means” (Client IV1),

or

“They sort of, ah, keep us happy, if you like. They talk to us at times, and it’s just natural

behaviour, if you like, when people come into contact with one another and of course, they

treat us, ah, like other people wouldn’t treat us” (Client IV3)

with another client mentioning, and

“It’s just feeling like being normal again; just going out with people and having coffee and

going to the park for a walk” (Client IV7).


A sense of belonging, being acknowledged for their existence; everyday conversation that normal human beings have, are aspects of client-volunteer relationship that CCS clients have valued.

The experiences of connecting to people in genuine relationships leads to the development of a sense of ‘re-living’, of being and belonging, by enhancing opportunities to revisit self-efficacy and self-worth. The opportunity to recover a lost sense of self through being connected in a social relationship of care and support offered by the volunteer support program through CCS speaks to the true value of the program in the lives of these clients,

“I’m enjoying it so much I’m terrified and worried when it’s gonna [sic] stop” (Client IV7).

Suggestions for service enhancements from CCS clientsAmongst the data also emerged a number of key themes that the participants perceived to be important to help to enhance the services currently offered by CCS; these are outlined below:

GREATER FOCUS ON VOLUNTEER TRAINING. The clients felt that the volunteers need additional training to be able to perform their role indicating that the level of service and support is impacted by inadequate training, for example one participant said,

“But the people that they’ve got need a lot of training. I mean, you know some of the

people that come here are hopeless. Like the regular guys that come are very good, and

that. But when they get from other agencies, or people that are just new, hopeless” (Client IV4).

This is also especially relevant considering the role of all frontline staff, paid or voluntary, in referring clients to additional services or seeing other potential clients who are in need when delivering services to clients. Specific and targeted training in certain areas will be helpful. An example of this is volunteers helping to support the work of other CCS staff in alleviating hoarding behaviours,

‘The last, ah, couple of times he came, he was over, what do you people call it? Ah,

decluttering the place. So we got rid of all the, and the stuff I didn’t want to throw away

I just put in suitcases. Because…the people were coming to, to, ah, have a look at the

building” (Client IV3)

and also

“They were helping me do de-cluttering” (Client IV7).


CLIENT CHOICE IN BEING MATCHED WITH VOLUNTEERS. A number of clients expressed the desire to have more choice in terms of the volunteers they were matched with, especially when it came to specific skill sets, like

“Sort of matching the volunteer to what the person’s needs are. Like at the moment, I’m

in need of someone who can, ah, maybe edit, maybe criticise; maybe classify my poems” (Client IV3).

However, the option for clients to also change the staff involved in the delivery of service was also very greatly appreciated,

“I changed a couple of them because we just didn’t gel, and that was lovely the way that I

was allowed to do that; I appreciated that” (Client IV7).

This also indicates that the clients have an insight into their needs and are in a position to determine what works best for them.

COMMUNICATING WITH CLIENTS. A number of volunteers expressed varying degrees of dissatisfaction with regards to any variations in service and its communication, for example simple procedures to reach CCS staff or information about new volunteers, who to contact and other changes to services. There were clients who mentioned that;

“They’re very bad with communication. I mean, extremely bad, at letting you know what’s

going on, and when they’re changing things” (Client IV4)

and

“I rang them up and said I wasn’t happy with – it was with – who was – with one or two of

the people and they were nice and said, no, we’ll change it. And then they – then they did

point out, oh you’re not supposed to ring us, you’re supposed to ring Catholic Community

Services. And I thought, all right, okay, I know now; I just didn’t know the procedure”

(Client IV7).

Communicating changes to the clients is especially important when considering the importance of the service to clients, as genuine relationships are formed through trust building and ongoing interaction. This speaks particularly to the need for specific exit strategies, for example when volunteers leave or any changes in support are required,

“And, you know, I – I really appreciated the time with George and I was really upset when

he decided to go back home; I’m happy for him, I know he had to and that - - -but, you

know, I missed him. Lovely man. And then I – I can’t quite recall the details, I think he

said somebody would contact me but then, you know, I think funding problems were

happening and – I didn’t get contacted straight away” (Client IV7).

Such instances of no or lack of information and communication make the client feel let down and or abandoned.


CCS Volunteers Focus GroupA number of themes emerged from the focus group data that may help to enhance the overall provision of the service. Common themes arising from focus groups comprising CCS volunteers and CCS service providers:

Group-2 CCS Volunteers

1. Volunteer training

2. Client information

3. Volunteer development, debriefing and support


VOLUNTEER TRAINING. A number of volunteers suggested that there would be a benefit from additional training about the speci

on the brim: impact of volunteer support on vulnerable ......4 impact of volunteer support on...

Documents