<< Background >>WHO developed the “WHO Campaign against Ageism” with a strategic plan named “Global strategy and action plan on ageing and health (2016-2020)” in 2016. In this document some recommendations are highlighted. For instance, regarding the health systems, “A transformation is needed in the way that health systems are designed to ensure affordable access to integrated services that are centred on the needs and rights of older people''. When it comes to the issue of long-term care, mainly provided by NGO’s, the action plan refers that “Every country needs to have an integrated system of long-term care. Each system should (...) allow older people to live with dignity and enjoy their basic human rights and fundamental freedoms”, where the right of being LGBTQI+ freely and living their sexuality with dignity is included. On the other hand, while estimates are that around 10% of the residents of elderly care homes & services are LGBTQI+, when asked about LGBTQI+ residents, management and care professionals of care homes & services usually state not to ‘have’ them or not to have ‘any problems with homosexuality’, and increasing discrimination and exclusion turned out to be an unknown subject to them which they had not thought of before. LGBTQI+ people are at high risk of being discriminated against in residential care homes as they lack ‘voice’ due to heteronormativity and the social taboo on sexual diversity (Leyerzapf, H., Visse, M., De Beer, A., & Abma, T. (2018) Moreover, LGBTQI+ older persons, as they experience and fear to be rejected by health-care providers, care professionals and other residents, can feel forced to go ‘back into the closet’ (Stein, Beckerman and Sherman 2010).While the need to have more LGBTQI+ friendly care services is clear, the number of explicitly LGBTQI+-friendly elderly care services is very limited and, with 2 exception in UK and NL, we couldn’t find any evidence of programmes aimed to identify inclusive care services. The 5 partners of the project (FR PT RO GR IT) want to tackle similar issues and enrich their solution proposal from the specificities of their contexts. Given partners' respective expertises, field of intervention and missions, they all show complementarity in addressing the topics treated in the project. Through sharing their experiences, perspectives, and knowledge of the audience, they will be able to develop an approach that encompasses a wide range of situations while being specific about the strategies and tools elaborated. Thus, this partnership is also a way to develop and create training and tools that will adapt to various situations while remaining relevant. Partners share common needs that they want to overcome. The project takes over REC project Best4OlderLGBTI. This project aimed to develop tools and strategies to raise awareness among the general public and some selected target groups about sexuality in old age and older LGBTI, to contrast ageism and discrimination through challenging stereotypes. The BestCare4LGBTQI+ is complementary to this previous work, as it makes a step forward from awareness to action, supporting professionals in residential care as well as in home care services in finding and applying strategies to make services inclusive & accessible to all.Four organisations of the strategic partnership participated in the REC project Best4OlderLGBTI (Anziani e non solo ( IT), Caso50+ (PT), KMOP (GR) & EaSI (RO) ). Afeji (FR) joins the partnership as a service provider and because of a high interest in these matters. Partners have a complementary experience and brings a large network they involve to ensure to reach the target group and promote a better inclusion & non-discriminatory care for older LGBTQI+ peopleThe complementarity of their approaches, experiences and contexts will allow a pooling of practices and transversality necessary to build a comprehensive and reflexive methodology for better care of older LGBTQI+.<< Objectives >>The mission of the BestCare4LGBTIQ+ project is to support the development of LGBTQI+ friendly elderly care services, providing tools, awareness-raising material and learning resources to home care and residential care services managers and staff to ensure a better adapted and more respectful and inclusive care for LGBTQI+ older people living in care facilities. Concretly:1-To raise awareness on specific older LGBTQI+ needs among care home & services managers and staff as well as in the general audience2-To equip home care and residential care managers and staff with tools and skills for a better integration of older LGBTQI+ people3-To support care services to assess their inclusiveness and to implement an action plan to become more LGBTQI+ friendly 4-Ultimately, to ensure better care for LGBTQI+ older people in residential care facilities & home care services, especially when living with dementiaThe whole BestCare4LGBTQI+ purpose is to make home care services places where LGBTQI+ people can feel safe and welcomed, and free to live and express their identity in day-to-day life.Through cooperation, training and replicability of our project, we will have a strong and lasting impact on home care & residential care services managers and staff, on care professionals at large (through the database) as well as aging LGBTQI+ people and anyone interested as production as results will be available to all.We expect the following results:1-For professionals and stakeholders_Strengthening capacities to work with older LGBTQI+ people_New skills and tools for a better non-discriminatory care of aging LGBTQI+ people_Develop and make accessible a new set of didactic tools fine-tuned to a wide range of contexts_Increased cooperation capacity_Creation of a community of practices _New skills to overcome a heteronormative society (and services) and make it more inclusive for all_Encourage resilience, by strengthening ability to collaborate _Increase ability to identify discriminatory situations and ways to address them in day-to-day practice_Making residential care services places that are all encompassing in their approach to the well-being of residents2-For LGBTQI+ care service users_Increased safety_Sense of belonging and confidence for older LGBTQI+ people in regards to quality of care in all contexts (disabilities, dementia…)_No concern that the (life) partner is present or identified as such_Effective access to services_Services to be perceived as safe places where all their needs are taken into account3-For all_Sensitising on the issue of effective access to care services for LGBTQI+people and, in particular, for LGBTQI+ elderly people_Encourage critical questioning of practices for inclusion of older LGBTQI+ people and at large_Promote inclusion_Expand public horizons, improve the knowledge of a specific audienceThis project will reach 12 840 people, most of them care professionals. The transnational aspect of the project is at the heart and will lead to:_More best practices detected & promoted to support the rights and non-discriminatory practices toward older LGBTQI+ people in home care services or residential care services_A community of practices created at a European level with regards to a taboo topic_A transnational training created and tested in order to be replicable and transferrable_Tools created to be relevant in a wide range of contexts _Links between organisations to enable long-term cooperation_The sense of belonging to a European project strengthens the sense of citizenship of all participants_Better analyse, reading and understanding of the different types of issues affecting access to non-discriminatory care services for LGBTQI+ elderly people in EU_Sensitising on a European level on the difficulties to access non-discriminatory care services for LGBTQI+ elder people, and that these issues are not isolated issues, nor limited to specific culture or social enviroronment.<< Implementation >>BestCare4LGBTQI+ is composed of 5 results:Result 1: “Make me feel at home” - proposals for a better service provision of care for older LGBTQI+ users based on storytellingAccording to Addis et al. (2009) the understanding of older LGBTQI+ people's needs with regard to their health and social care is low and research on this is scarce. Together with professionals and elder LGBTQI+ people the project will create a multilingual captivating booklet with 45 testimonies of elder LGBTQI+ people and professionals in 6 languages (EN, PT, RO, IT, FR, GR), peer-reviewed and validated. This PR is a base for all following results as it will allow to detect the needs and expectations of older LGBTQI+ residents as well as professionals willing to build more inclusive services.Result 2: Provide Training for more inclusive care services: training course and toolsResearch has shown that there is an urgent need to provide services that are more sensitive to LGBTQI+ issues and to address the education and training needs of their staff (Browne, 2007; Equality and Human Rights Commission, 2009). Anti-discrimination training seems to be a key approach to ensure that LGBTQI+ people can enjoy appropriate and sensitive health and social care, but such training is not yet widespread and there is no standard approach for it (Ross & Carr, 2010). The training course curricula will include at least 5 modules, covering topics related with human rights; inclusion; discrimination; equality; diversity charts; health, emotional and social specific issues about LGBTQI+ older people; gender identities and sexual orientations; harassment; inclusive language; among others. Tools will be developed alongside. 100 professionals will be trained. Result 3: Train the trainerIt will be implemented after the test of the pilot training (result 2) and followed by fine tuning, and will equip trainers with tools to replicate the training, thus enhancing its scope and impact. 60 trainers will be trained and at least 35 replications are expected (10 of them during the project's life, reaching another 60 professionals). Result 4: methodology for awarding a Badge of Excellence for inclusive residential care of older LBGTQI+ service users. Values and beliefs of service providers, together with organizational constraints and lack of awareness, can be a significant barrier to LGBTQI+ inclusive practice. That is why, in order to be able to implement inclusive practices in elderly care, it is important to have a framework that sits alongside education and which identifies a set of quality standards to be achieved in practice. The tool can be a practically usable resource for professionals, which will support them in practically implementing strategies to make their services inclusive for LGBTQI+. The methodology will be easily transferable and expandable to other care-contexts, type of end-users or languages. Result 5; database for inclusive careThis is a publicly available and multi-lingual data base that provides a searchable repository of practices, policies, tools and lessons learned in relation to inclusive care for older LGBTQI+s. The platform will also incorporate a toolbox of resources developed within PR2 to assist the training and awareness raising of professionals and institutional environments.The aim of this tool is to provide users (primarily: health professionals; care professionals; care managers; service providers; policy makers; LGBTQI+ associations etc.) practical examples complemented with suitable tools.The project is supported by a strong dissemination strategy, including partners networks and 5 ME. Sustainability plan include:_Durably raised awareness thanks to acquisition of new knowledge and skills related to inclusive care _Production of free reusable and replicable tools, useful in a wide range of situations_A fine-tuned communication strategy to broadly disseminate PR_Long-term maintained results with an online database<< Results >>The project will reach more than 12840 people in total and activities will directly involve 2840 of them in 5 countries.The project will produce:1 multilingual captivating booklet with 45 testimonies in 6 languages (EN, PT, RO, IT, FR, GR).1 training course with at least 5 modules involving 100 participants from at least 5 care homes1 train the trainer module with at least 4 modules involving 60 participants and at least 10 replication of the training during the project life as well as 25 commitment to replicate after the life of the project1 transferrable methodology for awarding a badge of excellence to services1 public database of best practices for inclusive care reaching a minimum of 10 000 people1 toolbox on the database with at least 5 tools developed with LGBTQI+ elderly people & care professionals1 STJSTE training reaching 20 professionals 5 Multiplier events (1/country) engaging a total of 100 stakeholders to disseminate the project results 1 Final evaluation report1 quality plan + quality reports 1 dissemination plan + dissemination reports 1 sustainability plan1 project website / database to support project dissemination and communication, community of practice, information related to events and news, dissemination of results, possibility for participants to share the results of their practices, 1 Facebook page (and any other relevant social media) to support project dissemination and communication, mainly through posting news and information about the project and inviting people to like the page and participate in the events6 transnational project meetings (TPM) : program, agenda, minutes approved by all (4 face-to-face and 2 online)

Dementia has become a high priority in the 21st century as OECD estimates 9.6 million people live with some type of dementia in EU countries and WHO reports the economic costs of dementia to be higher than the expenditure in cancer, heart diseases or depression. The support and care for dementia patients has been delivered by public and private health sectors, but there is also a great number of informal caregivers (family, friends, neighbours or other relative who provide care for a patient, usually at home) who take this role on their own – more than 15% of people aged 50 refers to have taken care of an older person. Although informal caregivers, also called carers or family caregivers, feel benefits from caring, such as increased self-esteem, society has not yet been able to tackle its disadvantages – difficulties on balancing work and caring, burnout and stress, drop-out from labour market, increased risk of poverty and social exclusion. There is a need for interventions with informal caregivers, providing them with effective support. This support has been reached over the years throughout training programmes, psychoeducational programmes, support groups and mutual aid groups, information-technology based support or other formal approaches delivered by healthcare professionals.Mutual aid (or support) groups are being more and more used with dementia caregivers to support them dealing with the disease and ease up their burden and stress. Mutual aid groups are commonly associated with several benefits, including mental and social well-being, by increasing self-confidence, resilience and knowledge. Mutual aid groups are a powerful opportunity for non-formal learning, as they help caregivers cope with difficulties, by sharing of experiences, interaction with peers, building connection and affectivity. Nevertheless, it seems that caregivers have not yet considered mutual aid groups as a priority. One possibility can be the lack of information about the advantages of the participation on a mutual aid groups, as well as the recognition of what it really stands for. The organisations who provides this type of psychosocial interventions also feel that absent in mutual aid groups might be due to lack of opportunity to participate (no other person to take care of patient, far distance, …). In this sense, «ICT Tools can support the social integration of carers, provide them with social, emotional and peer support, facilitate their participation in aspects of life outside the home and thus supporting carers’ quality of life» (Eurocarers, 2016).The CARE4DEM project aimed to develop a new and innovative model of mutual aid groups which promotes caregivers’ involvement by introducing web-based tools and integrating it with other type of interventions, in order to enhance caregivers’ satisfaction with care and reduce burnout. It also intended to expand the professional development of mutual aid groups’ facilitators by recognizing and developing their skills creating a network for mutual and peer learning across Europe. The specific objectives were: 1-Design and develop a new and innovative web-based model of mutual aid groups for informal caregivers of people with dementia, to enhance caregivers’ satisfaction with care and reduce burnout, including learning materials for caregivers; 2-Identify the suitable profile and competences to perform the facilitator role of mutual aid groups; 3-Develop a multimedia training course to enhance the competences of mutual aid groups’ facilitators to perform a better role and address caregivers’ needs; 4-Pilot a web-based mutual aid group model to support informal caregivers to better care of their relative, including the training courses for facilitators; 5-Create a network of professionals across Europe who work towards better informal caregivers of people with dementia.The project has involved over 2000 persons, including: informal carers, academic and professionals experts, professionals willing to experiment the model, professionals interested in getting to know more about the model and policy makers. On the completion of project, we have contributed to reach the following results: 1-Enhanced competences of mutual aid groups’ facilitators participating to the project, taking evidence from the comparison on the initial, ongoing and final self-assessment; 2-Increased number of organisations and/or professionals implementing mutual aid groups for dementia caregivers, with at least 6 professionals taking part of the piloting per country; 3-Increased number of caregivers attending mutual aid groups, with at least 1 group for 6 caregivers per country; 4-Enhanced caregivers’ satisfaction with care and reduce caregivers’ burnout, taking evidence from the effectiveness assessment.After the project, we expect a rise in the implementation of web-based mutual aid groups as the outputs will be available and the process mapping is described in the step-by-step implementation guide.

In Europe, in case of chronic illnesses, 80% of all care is provided by informal carers – i.e. people who provide unpaid care to someone with a chronic disease, disability or other long-lasting health or care need, outside of a professional or formal framework. While caring for a loved one can be a source of great personal satisfaction, it does create its own set of challenges. Although in households when a member has a chronic illness or disability one of the relatives is often designated as “primary care” (i.e. the person bearing the main care responsibilities), we know that when there is a change in one family member, it affects all family members (Wright and Leahey, 2000). A functional relationship among caregivers and care recipient is the key for a successful change of roles and the adaptation of the family. Therefore, to face this change, a new balance should be established in the family. On the other hand, we know that people belonging to different age groups and with different kinships to the care-recipient (young children, adult children, grandchildren, spouses…) can have different experiences and perspective on the burden of care, so it is necessary to take all of them in account in order to be able to provide a comprehensive and effective support to families with caring responsibilities. In order to respond to all these needs the S.IN.CA.L.A. partnership believes in the importance of developing and piloting a model of pedagogical interventions based on a family-focused approach able to identifying strengths as well as vulnerabilities of all family members, addressing the challenges that might arise from the disease and building individual and family resilience. The educational tools developed will be based on experiences carried out in Greece, by partner Alzheimer Hellas, and will be adapted and transferred to all other country contexts.During the implementation of the project, the main outcome has been the development of Intellectual Output 1. This resulted in the research report focusing on the family member's experiences of caring role. With the research report the partnership created literature review that informed the methodology and built towards data collection and analysis on the respective findings. For the data collection, use of focus group interviews brought together 86 participants from the partnership countries (spouses, children and grandchildren of 60+ family member with care needs). Alongside these activities the partnership formed guidelines for such data collection, assembled data collection kit, created qualitative data analysis forms and delivered the research report with the input from the professionals working with carers in partnership countries, 42 in total. Such approach validated the findings, improved the overall process and informed the build-up of following Intellectual outputs. Especially, the Intellectual output 2, which would have resulted in pedagogical intervention tailored for family carers in partnership countries.In order to communicate the aims of the project, activities and the results of the Intellectual output 1, different type of dissemination activities were completed - project leaflets, press releases, newsletters, articles, presentations etc. The target audience varied based on the type of activity, 20-40 people in audience to 15 000 visitors on the websites monthly. Efforts were made to reach different audiences, starting from the family carers, social workers on local level, working up to national level policy makers and support networks.The main practical results expected on the completion of the project would have been: (1) a tested pedagogical method based on narration, adapted to different EU-country contexts, and targeting household who are caring for older dependent family members with the goal of increasing their family-resilience; (2) a MOOC, to transfer the results achieved and the lessons learnt to a wider audience of professionals. We therefore expect to make available a methodology that educators, social workers and carer support workers can use in their local contexts to engage with families with caring responsibilities in order to improve the resilience of the household and mitigate the negative impacts of caring in the households. The project was coordinated by MTÜ Eesti Omastehooldus and developed by a diverse partnership of NGOs working with older persons and their carers in Portugual (CASO50+), Italy (Anziani e non solo), Slovenia (Spominčica /Forget-me-not - Alzheimer Slovenia) and Co-Creation Support CLG (Ireland). The expert partner, is the Greek Association of Alzheimer’s Disease and Related Disorders (Alzheimer Hellas).For professionals and stakeholders, we expect an increased consciousness of how providing care can impact on the whole family and the capacity to use this deeper understanding to improve and innovate their services, including through the introduction of narrative techniques. On local stakeholders and communities, we expect an increased awareness of the challenges of caring at societal level and on innovative experiences and practices carried out in other countries that could be of inspiration for new policies and services. We also expect increased openness towards other European countries and cultures, increased awareness of the importance to adopt a whole-family approach and an increased awareness about the contribution of the European Union activities towards the support to informal carers. In whole, the expectations were met and the innovative approach created momentum for different interventions in favor of family carers.

In Europe, 80% of all chronically ill people are taken care of by informal carers – people who provide unpaid care outside of a professional or formal framework. While caring for a loved one can be a source of great personal satisfaction, it also creates challenges, like physical and mental health problems, a feeling of social exclusion, difficulty in balancing paid work with care responsibilities and other possible financial worries (Eurocarers).Although when a family member has a chronic illness or disability one of the relatives often acts as the “primary care provider”, in which roles are often reversed (i.e. a child taking care of their parent) which often affects all family members (Wright and Leahey, 2000). A functional relationship among caregivers and care recipient is the key for a successful change of roles and the adaptation of the family, therefore, supporting only the primary carer is not enough. Furthermore, people belonging to different age groups and with different kinships to the care-recipient (young/adult children, grandchildren, spouses) can have different experiences and perspective on the burden of care, so it is necessary to take all of them into account in order to be able to provide comprehensive and effective support. Research has also demonstrated that the caregiver stress that often arises in informal caregiving situations can lead to situations of abuse. Almost 10% of older people who are cared for by family caregivers are at risk of elder abuse (Ananias, Strydom, 2014).From a family-resilience perspective, families are regarded as a unit with intrinsic strengths and resources, and potential for growth (Black & Lobo 2008; Zauszniewski et al. 2010), with positive relational bonds and connections between family members being integral to maintaining their ability to weather adversity (Walsh 2006). However, it should be considered that resilient abilities are not innate, but can and should be learnt and cultivated through dedicated pedagogical methods, such as that of the therapeutic narrative.In order to respond to all these needs the partnership believes in the importance of developing and piloting a model of pedagogical interventions based on a family-focused approach able to identifying strengths as well as vulnerabilities of all family members, addressing the challenges that might arise from the disease and building individual and family resilience. The educational tools developed will be based on experiences carried out in Greece, by Alzheimer Hellas, and will be adapted and transferred to all other country contexts.The main practical results expected on the completion of the project are: (1) a tested narrative based workshop for informal caregivers, adapted to different EU-country contexts, and targeting households who are caring for older dependent family members with the goal of increasing their family-resilience; (2) guide for professionals to identify and address issues that emerge from workshops; (3) a MOOC, to transfer the results achieved and the lessons learnt to a wider audience of professionals; and (4) E-course and online educational platform for informal care givers and professional support providers.We therefore expect to make available a methodology that educators, social workers and carer support workers can use in their local contexts to engage with families with caring responsibilities in order to improve the resilience of the household and mitigate the negative impacts of caring in the households.The project is coordinated by NPO Women’s Support and Information Center (domestic violence org, Estonia) and developed by a diverse partnership of NGOs working with older persons and their carers or domestic violence victims in Portugual (CASO50+), Italy (Anziani e non solo), Slovenia (Spominčica, Slovenia) and Union of Women’s Association in Heraklion Prefecture (Greece, Creta). The expert partner, is the Greek Association of Alzheimer’s Disease and Related Disorders (Alzheimer Hellas). University of Tartu will be responsible for developing & managing the MOOC for the project due to its strong expertise on designing and developing e-learning courses.For professionals and stakeholders, we expect an increased consciousness of how providing care can impact on the whole family and the capacity to use this deeper understanding to improve and innovate their services, including through the introduction of narrative techniques. On local stakeholders and communities, we expect an increased awareness of the challenges of caring at societal level and on innovative experiences and practices carried out in other countries that could be of inspiration for new policies and services. We also expect increased openness towards other European countries and cultures, increased awareness of the importance to adopt a whole-family approach and an increased awareness about the contribution of the European Union activities towards the support to informal carers.