Alternative Sociale_Elders Methodology

Cătălin Luca Daniela-Tatiana Gîrleanu-Şoitu(coordinators)

WORKING METHODOLOGY

for the psycho-social-juridical assistance of elders

Translated by Dana Pîrvu

Junumea Publishing HouseIași, 2012

Ana-Maria Grigorescu

Nicoleta Ungurianu

Traian Isăilă

Dana Pîrvu

Liliana Foca

Dumitru Pușcașu

Milka-Nicoleta Rotaru

Raluca-Andreea Neculai

Maria Simona Minuț

© Copyright 2012 by Alternative Sociale AssociationNo part of this publication can be reproduced without the written consent of Alternative Sociale Association

ISBN: 978-937-1645-7

LIST OF AUTHORS

Dr. Cătălin Luca is a psychologist specialized in clinical psychology and the CEO of Alternative Sociale Association.

Univ. conf. dr. Daniela-Tatiana Gîrleanu-Şoitu teaches courses of social assistance for the elderly and counseling at the Faculty of Philosophy and Political Sciences of the „Alexandru Ioan Cuza” University in Iași.

Dana Pîrvu is a project coordinator within the Alternative Sociale Association, specialized in social management and community development.

Drd. Liliana Foca is a project coordinator and psychologist within the Alternative Sociale Association.

Nicoleta Ungurianu is a social worker within the Alternative Sociale Association, specialized in family resources management.

Milka-Nicoleta Rotaru is a psychologist within the Alternative Sociale Association , specialized in Clinical psychology and psychotherapy.

Raluca-Andreea Neculai is a social worker within the Alternative Sociale Association, specialized in family resources management.

dr. Ana-Maria Grigorescu is a primary doctor in psychiatry at the „Socola” Psychiarty Hospital in Iași.

Dumitru Pușcașu is a social worker and senior practitioner at the Social Services for Adults in the United Kingdom.

Minuţ Maria Simona is a social worker at the Congregacy of the Daughters of St. Mary of Providence, specialized in family resources management.

Traian Isăilă is a lawyer in the Bucharest Bar.

CONTENTS

INTRODUCTION (7)CHAPTER I. SOCIAL ASSISTANCE FOR THE ELDERLY (9)I.1. Theories used in the social assistance of the elderly (Daniela-Tatiana Gîrleanu-Șoitu) (9)I.2. Perspectives in assisting the elderly (Daniela-Tatiana Gîrleanu-Șoitu) (13)I.3. Case management in assisting the elderly (Dana Pîrvu) (24)I.4. Case study: presentation and investigation (Nicoleta Ungurianu, Raluca-Andreea Neculai) (38)CHAPTER II. THE PSYCHOLOGICAL ASSISTANCE OF THE ELDERS (83)II.1. Psychological theories (Milka-Nicoleta Rotaru, Dumitru Pușcașu) (84)II.2. Considerations regarding the psychological evaluation (Milka-Nicoleta Rotaru) (92)II.3. Counseling themes in the psychological assistance (Liliana Foca, Dumitru Pușcașu) (96)II.4. Motivational interviewing (Liliana Foca) (103)II.5. Elders resilience (Liliana Foca) (115)II.6. Instruments used in the psychological assistance (Milka-Nicoleta Rotaru) (119)

CHAPTER III. DEPRESSION AND DEMENTIA – HIGH RISK DISORDERS DURING THE THIRD AGE (Cătălin Luca, Ana-Maria Grigorescu) (134)III.1. Depressive disorder (134)III.2. Dementia (139)

CHAPTER IV. LEGISLATIVE FRAMEWORK IN ASSISTING THE ELDERS (Dana Pîrvu) (143)IV.1. International recommendations (143)IV.2. Romanian legislation (144)IV.3. Institutional competences (145)IV.4. Socio-demographical challenges (149)

CHAPTER V. SOME JURIDICAL PROBLEMS OF THE ELDERS (Traian Isăilă) (153)V.1. Preliminary aspect. Terminology. Applying the law in time (153)V.2. The capacity to make juridical acts and the consent of the elder (157)V.3. Patrimonial rights and obligations of the spouses. Matrimonial regims (167)V.4. The inheritance of the surviving spouse (170)V.5. The enstrangement of rights from the personal heritage (182)

ANNEXES (201)1. Presentation of elders center ”St. Joseph” Iași (202)Social assistance instruments2. Request for services (208)3. Initial file of the case (209)4. Social assistance contract (210)5. Social evaluation (218)6. National grid for assessing the needs of elder persons (221)7. Force field analysis (233)8. Life cycle matrix (234)9. Individualized plan for care and assistance (235)10. Program and schedule of the activities done at the beneficiary’s home (237)11. Medicine administration table (238)12. Individualized plan of recovery (239)13. Social integration program (240)14. Meeting/phone conversation report (241)15. Donation document (242)16. Decision for ending the services (243)17. Final report (244)18. Monitoring report (245)Psychological assistance instruments19. Contract for psychological assistance (246)20. Report of psychological evaluation (248)21. Psychological counseling session report (250)22. Individual counseling file (251)

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INTRODUCTION

INTRODUCTION

The present publication is the result of the experience gained during the practical assistance of over 500 elders in difficult situations from Iași city and county, assistance given by the Alternative Sociale Association’s specialists in collaboration with the public institutions and other private authorized institutions from the community.

Because during the implementation of the projects involving the assistance of the elders, the Romanian literature in this domain was relatively limited, we decided together with the project’s implementation team to elaborate a guide for presenting the theories which represent the base of the intervention, the legislation and the instruments which are specific to this type of assistance.

This methodology was built as a “tool-kit for the psycho-social intervention”1, which means that it contains the “tools” needed by the psychologist, social worker, jurist and other persons with attributions in assisting the elder found in difficult situations, in intervening and offering support for getting over difficult moments in life, socioeconomic problems, health problems, loneliness, lack of social support etc. More exactly we wish that, depending on the instrumented case, the specialist will be able to take from this publication the theory, method, instrument etc. and apply it to the situation and “fix” the problem faced by the assisted elder.

The first chapter is dedicated to the social assistance of the elders. It starts with the presentation of the theories which highlight the changes appeared in the living environment, roles, interaction with the others etc. The chapter continues with the presentation of some aspects related to the case management in assisting the elders: types of services that the elders can benefit from according to the Romanian legislation; levels, functions, stages and specific instruments in case management and aspects regarding the involvement of volunteers. For making the theoretic approach more efficient, the chapter ends with the presentation and instrumentation of a case, using the specific work instruments presented within the chapter.

The psychological assistance of the elders is the second chapter of the publication and it deals with ageing as a process which takes place at psychological level due to the qualitative modifications of the personality structures and the cerebral functions which are at the base of the psychic life. The chapter opens with the psychological theories on which the psychological assistance of the

1 The concept belongs to the psychiatrist and psychologist Şerban Ionescu, psychopathology professor at the University Paris VIII (Vincennes- Saint-Denis), director of the Research Centre “Traumatism, Resilience, Psychotherapies” in the same university, professor emeritus of Trois Riviers Univeristy in Quebec and correspondent member of the Academy of Medical Sciences in Romania.

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WORKING METHODOLOGY FOR THE PSYCHO-SOCIAL-JURIDICAL ASSISTANCE OF ELDERS

elders is based. The psychological evaluation with its sequences (objectives, particularities and stages) is briefly described and exemplified for helping the interested psychologists in using this instrument adapted to the third age’s particularities. The chapter continues with the description of four counseling themes frequently met in assisting the elders. The motivational interview, stages of change, resilience and religious coping are recent approaches which we chose to use in the assistance of the elders found in difficult situations. The chapter ends with an exemplified presentation of the instruments used for the psychological assistance.

Chapter three describes two disorders with a high risk of apparition at third age: depressive disorder and dementia. During this chapter the following aspects are briefly presented: clinical picture of these two disorders; elements of differential diagnosis; strategies for identifying depression/dementia that can be used by the caregivers before the consultation and treatment of the psychiatrist. Because the assistance of the elders affected by dementia or depression creates stress and emotional exhaustion to the caregivers, a set of suggestions and recommendations is included for them. The chapter ends with the presentation of two evaluation questionnaires of depression and the degree of the cognitive impairment.

The legislative framework which stands at the basis of the assistance of the elders is the fourth chapter of the methodology, in which there are presented the main relevant documents from the international and national legislation. The international legislation is briefly presented in the description of two international documents: the United Nations International Plan of Action on Ageing and the European Social Charter. The chapter continues with the presentation of the main Romanian legislative documents in the area of assisting the elders with the enumeration of the responsible institutions and their attributions.

Chapter five is dedicated to the juridical assistance and includes general aspects regarding the most frequent problems faced by the elders.

In the end, we want to thank UniCredit Foundation for the financial support offered in the creation and printing of this publication in both Romanian and English languages.

Cătălin LucaExecutive Director

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CHAPTER I. SOCIAL ASSISTANCE FOR THE ELDERLY


I.1. THEORIES USED IN THE SOCIAL ASSISTANCE OF THE ELDERLY

I.1.1. IntroductionThe theories highlighted by the specific literature on gerontology are results

of several studies regarding the changes that appear after retirement. These changes are related to the roles, activity, continuity or discontinuity of the personal activity, interacting with / separation from others, grouping based on cohort specific characteristics, effects produced by the social stratification and economy, and to the living environment (Hooyman & Kiyak, 1996, pp. 66-89).

The mentioned theories can help social workers to understand the contexts in which the elderly live, to identify possible reasons and explanations for the way in which the individuals adapt to the years passing by (Miftode, 2004, pp. 173-197).

Often, each role is associated to a specific age or life stage. The leading premise is that the age affects not only role expectations but also the manner in which the persons are expecting others to fulfill their roles (Hooyman & Kiyak, 1996, p. 67). The acceptance of the typical role changes as an elder is given by the way one adapts to ageing. Age standards are assumptions regarding the capacities and limits of an individual in a certain developmental stage. The standards can be formal, through social policies and laws (ex. establishing the retirement age and the possibility of continuing the economic activity after this age) and informal (through individual options when one has to decide to employ a younger person or a person over 50 years old).

The difficulty consists in the fact that such standards lead to discriminatory stereotypes promoting the idea of the lack of productivity and flexibility of the elderly. As well, beside the stereotypes promoted by other people, each individual has personal standards related to one’s behavior according to the age: when to graduate a college, when to marry, when to have kids, when to develop a career and when to retire. These expectances are created also in the cohort.

I.1.2. Role theory Ageing is considered to be more related to losing than gaining roles: the

role of being a husband/wife is lost with the death of the partner, and the role of an active person on the labor market is lost with retirement. Although some persons look to come back to a previous role – by re-marrying or identifying a new job – most elders do not tend to do so. Another dimension is losing the

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role consistency – the ambiguity of the roles is amplified by the changes of expectations and requests. Thus, some roles (as the one of being a parent) loose part of its content.

Our society has a sort of confusion regarding the roles of the elderly: on one hand the roles are associated with the adult age – dynamism, activity – on the other hand the roles are associated with helplessness. In the absence of clear role expectances or of clear norms stating conformation or deviation from standards, the elderly don’t feel encouraged to have new roles or the new roles are perceived as inappropriate.

The discontinuity between the old job responsibilities and the new ones after retiring can develop dilemmas that the elder has to handle. There is controversy in the literature stating the idea of preparing for retirement by, for example, learning to replace the job performance expectations with new ones adapted to the new retirement situation. Some of the supporters of the theory consider that retirement is not a period in which the person only looses roles, but also gains new ones (e.g. being a grandparent). Thus the role of being a “dependent person” doesn’t become inevitable as result of ageing.

Keeping the roles based on autonomy for as long as possible becomes a way of intervention in this context.

I.1.3. Activity theory

The main idea of the activity theory (Havighurts, 1968, pp. 20-23) emphasizes the importance of activity after retirement: the more a person is active, the more the person will be satisfied and adapted to the social life.

The activity theory speaks little about what happens to the persons when they don’t manage to keep on with the adult life standards. Failing to include the personality dimensions, the theory doesn’t explain why some elders are passive and happy, while others are active, but unhappy.

Another limit of this theory is the assumption that persons tend to continue the same behavioral patterns, the same activities. Many elders that were active during the middle age stage might not wish to maintain the same level of involvement and can even choose to reduce their involvement. Some elders, often when retiring, want to have time for “doing nothing”, for being solitary. A conclusion can be drawn, that the elders wish to remain active depending on life experiences, personality and needs.

In his study, Havighurst (1968) shows the importance of personality traits in foreseeing the association between the activity level and the existential satisfaction. Thus, the persons that are active, independent and oriented towards fulfillment might be satisfied if they are aware of this during the older adult stage, while the persons that are used to be passive, dependent and oriented towards domestic aspects might wish to continue this pattern even after retiring.

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I.1.4. Disengagement theoryThe disengagement theory is considered to be the first comprehensive,

multidisciplinary and explicit approach offered by gerontology behaviorists.According to Cumming and Henry (1961), the process through which

elders decrease their activity levels by looking for more passive roles, have rare interactions with others and become more and more preoccupied with their inner life is seen as being normal, unavoidable and personally satisfying, marking the beginning of a life reevaluation.

According to this theory, the elders, losing some roles and part of their energy, want to be released from social expectances of productivity and competition. Disengagement is seen as a process of adaptation that helps the elder to keep self confidence and peace, even though peripheral social roles are still met. For men, the disengagement process seems to be abrupt since they end their professional roles. For women, on the contrary, the transition from what often represents their role as parents is gradual and more moderate.

Disengagement is not only seen as useful and functional for the individual but also for the society. Each society needs organized ways of transferring the power from the older generations to the younger ones. The retirement policies, for example, are considered to be a way in which younger persons can be involved in new occupational roles. Since the elders retire from the main wave of society development, their death does not represent a danger for the normal functioning of the society. Thus, the disengagement theory says that social services shouldn’t aim to revitalize the elders but, on the contrary, to encourage their retirement.

This theory was roughly criticized for the idea that disengagement or retiring is inevitable, functional and universal.

Disengagement can manifest differently in the same individual: retiring from the social life – the individual doesn’t frequent social events, but remains psychologically active – reads and participate in discussions about current themes.

Retirement of the elders can be seen not only as an individual preference, but also as a failure of the society in offering new ways of staying involved.

Cumming reformulated the theory (1963) taking into consideration the relation between personality and disengagement. This reformulation states that not every person retires, the adapting behavior in the third age being different. The theory distinguishes two ways of interacting: influence and selection. The influencers are defined as being assertive and active in their interaction, while the selective are more passive and reserved in the relationships they develop, waiting for the others to confirm preexistent assertions about themselves. Both styles, the assertive and the passive, are seen as modalities preferred by the elders in protecting themselves from the contradictory or negative social messages, which helps them in protecting their self appreciation. The same author (1975) mentions that the misinterpretations of the disengagement as isolation, loneliness

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and passivity, overlooks the modalities in which a disengageing behavior can be adaptive.

I.1.5. Continuity theoryAnother known and discussed theory is the continuity theory. According

to this theory, the elders substitute the lost roles with similar ones, keeping the same adaptive methods for maintaining their inner balance. The premise is that each individual, no matter the age, has different personality traits and lifestyle, that the personality has an important role in the adapting and ageing processes. This justifies the diversity of ageing models when considering the former individualized styles.

The persons that have always been passive or solitary aren’t likely to become active after retiring. On the other hand, those who have always been active, assertive and socially involved, according to this theory, wouldn’t like to spend their late adulthood indoor.

This theory actually states that while the years pass by, each individual becomes more like the younger version of themselves. The central characteristics of the personality become more pronounced, and the axiological system more prominent. An individual ages successfully if he/she maintains a mature and integrated personality throughout his/her entire life, this being the condition for life satisfaction.

Continuing to be active and involved will contribute to maintaining self esteem and existential satisfaction.

One of the critics to this theory is related to considering the first developmental stages as a clue for guessing the satisfaction level in the ageing process and to the idea of maintaining behavioral patterns in life. The life style at the late adulthood is the result of several experiences, and not a continuation, a reflection of the life styles used in life.

The need for continuity can reduce self esteem at an age when limited physical strength and financial resources can lead to changes in the life style. Continuing the same type of activities can be considered maladjustment.

This need for continuation can interfere with the persons wish to renounce to roles, activities, unwanted behaviors. For example, many women adopt masculine features when ageing, while men tend to feminize (Sinnott, 1977, pp. 459 - 463). In the same article, the author emphasizes that the more satisfied elders are those who don’t rigidly comply with the traditional gender roles but instead have integrated features that are culturally associated to men next to features that are characteristic to women.

The complexity of the theory makes empirical testing difficult, since the reaction of each individual to ageing is explained by the interrelation between psychological and social changes, by keeping the same patterns etc. The way the theory was constructed is criticized: it starts the analysis from the individual,

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continues with taking into consideration the external social factors in the modifications appeared throughout the life course, all of these permitting an indulgent policy or a “live and let live” type of approach in solving the individual ageing problems.

I.1.6. Systems theory

Being developed, in the social sciences, in two forms – the general theory of systems and the theory of ecological systems – this approach marks comprehensively the interdependence between the theoretical sociology and the practical domains of the social intervention.

Malcom Payne (1997) states that this perspective is “unitary, integrated and holistic”, allowing for personal, group and community analysis, “without offering a particular method of intervention. On the other hand, it offers ways of describing things at different levels so that we can see in what manner the intervention affects the system”. Also, it permits using other theories and strategies for explaining and planning social interventions, at the level of component sublevels. The elder is in the center of attention, without ignoring the institutions preoccupied by the elder’s protection, the politics and measures that govern at central or local level.

Each subsystem becomes the target beneficiary and agent for change. The eventual distortions will be indentified at both system and inter-system level.

The systemic perspective can be used also in the institutional analysis of some components of the public system. The accents are on the relations, way of establishing them, communication among the elders, between the elders and the employees. Being an institution governed by rules, the way of establishing the relations can be subordinated to internal procedures that permit to the personnel to have control in the detriment of analysis of situations per se.

I.2. PERSPECTIVES IN ASSISTING THE ELDERLY

I.2.1. Empowerment and representation model Empowerment or offering power aims to help the clients in being able to

make their own decisions regarding their lives by reducing the effects of personal or social blockages that prevent the usage of their existing strength through raising self-confidence and capacity of using the power and trough transferring the power from the environment to the clients.

The representation aims to promote the interests of the disadvantaged clients in front of powerful individuals and social structures. Its origins come from the juridical area. Here, the term is used for describing the lawyer’s activity in front of judges and anywhere else.

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The ideology of political empowerment places the responsibility of fulfilling own needs to individuals, with the hidden goal of limiting the state’s services. Payne (1977) expresses his concern regarding the implementation of the empowerment in social interventions. Jack Raymond (1995) highlights the paradox of the empowerment, because the one offering the power – an organization or an individual – is, by the nature of the role, in a position of power. The self help groups need to take the power whilest the legislative mandate or the services manager become insignificant. Empowerment must not be confused with “making capable” – which refers to the action of the person intervening at social level when offering support to the organization to develop, to take power.

Oliver (1996) considers that social and political rights that emerge from being a citizen should be the base of power taking for the groups of disadvantaged persons. An important aspect in this sense is making the services more participative, leading to equally sharing the opportunities and cultural gains, emphasizing the “young-elders” and community resources and assuring an adequate protection of the elders.

Beresford and Croft (1993) use the concept of empowerment in the sense of facilitating the use of power by people, including through controlling own life. This means that the beneficiaries of the social services would have an important saying within institutions, agencies and situations that affects them. It would also mean they would be capable to share the power or use it for other persons. One of the objections deduced from this is that the power can only be taken, and not given. It’s easier to teach others how to gain power than trying to offer it to them.

The power is not a zero sum, so if I would have more, you will have less. It is wrong to think that empowering others, one automatically loses his/her own power. The role of the empowerment is to offer support to the person and to the intervention network through social and community development. It can be used in the protection of elders by offering access to information, by involving them in decision-making processes and by taking into consideration the client’s perspective during the assistance process.

Through empowerment, the clients are engaged in a process that changes dependence into independence with the social support of a network (Payne, 1997, p. 274).

In the social intervention, the power can be used legally to support others in anti-oppressive practices, or illegally to oppress others, but this time through a misunderstood practice. The power is also an element in life’s competition, in the fight for resources, for jobs and education (Milner & O’Byrne, 1998, p. 61).

The social workers can experience for themselves a loss of power, but the danger is when the power is used for excluding and marginalizing, for creating dependence or to emphasize vulnerability. When working with disadvantaged persons, in order to counterbalance the negative self-image, the negative life

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experiences, blocked opportunities, and physical and emotional problems, a three dimensional intervention is needed – PCS model (Thompson, 1993), where:

P – represents the personal/psychological elements, practice, prejudice;C – the cultural, common aspects, consensus and conformity;S – including the structural dimensions, social forces or political dimensions.These dimensions interact with each other, P being included in C, C being

included in S.It’s difficult to operationally define the empowerment strategies. Thus, the

intervention models based on the power and its theories are proved to be useful in social assistance. Social workers are not in the role of offering power to the people, and their goal of offering support reduces the loss of power experienced by the individuals and by the groups.

Guide and principles for empowerment and community involvementThe empowerment appears to be a process which includes:

• Developing your own point of view;• Forming your own judgments;• Negotiating with the others (Beresford & Croft, 1993, pp. 154-155)

The same authors say that for reaching this, the social worker needs to:• learn to teamwork;• openly receive the new comers, making their involvement possible,

beyond any type of barriers;• begin introducing the empowerment perspective in his own organization,

before making similar programs for others;• make sure that the organization he/she works for doesn’t reflect

discrimination and exclusion;• speak on your behalf;• resist to outside pressures coming from a process of destabilization and

minimaizing of the power and possibilities.

We can speak of three different aspects of empowerment:• Developing our own knowledge through collecting information

from experts, coming back to our own knowledge and creating new knowledge;

• Sharing practical competence – people involved in common actions learn from each other; working in small groups is more appreciated in this case;

• Working with professionals – the need for experts and professionals is important for learning from their competences, for discovering the possibility of doing things better, for supporting the involvement in decision-making process (Beresford şi Croft, 1993, pp. 141-143).

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A model of involvement differentiates amongst services oriented towards:• Efficiency – the goal would be improving the service, through

information and counseling;• New acquisitions – when there is the concern that the persons gain

something through these services: new abilities, competences and trust;• Empowerment or offering possibilities – when this is the objective, the

participants decide upon the agenda (O’Hagan, 1987, pp. 2-5).If this model is closer to a democratic approach, then distributing information

and counseling can be seen much closer to the consumerist approach.Gathering information and consultations as aspects of empowerment is

limited when concerning the involvement of persons, because:• It represents approaches that are specific to an organization and

according to its purposes;• It is controlled by the association/organization;• Is oriented mainly on its own needs which can: limit the people’s wish

to get involved; limit the development of people’s options; inhibit expressing people’s own point of views.

Empowerment is also related to a third approach:

• offering information – offering intelligence;• giving advices;• involving directly in taking decisions.

Here, people are not asked only about their points of views and opinions, but also about their involvement. They have the power to decide about what happens to them, to their neighbors and to the services they use. This is an approach much closer to the democratic one. If the consumerist approach is often associated with searching for information and consulting exercises, the democratic approach is closer to the situation of elders expressing their own point of view by letting the persons speak for themselves.

Emergent dimensions coming from analyzing the person’s involvement impose clarifying the following aspects:

• who participates;• in what process;• through what organizational forms;• at what level of power.

Possible points of view in building strategies involving the citizens could cover:

• monitoring the costs and participation in initiatives requiring involvement in order to see if the costs and effort are worthwhile;

• recognizing the existing tensions between formal and informal empowerment agreements;

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• honesty in every problem met;• identifying good practices;• starting locally but extending the actions at all levels: regional, national

and international;• identifying key allies and helpful allies;• supporting change at established periods of time, sharing the experience

to others;• having a realistic appreciation of the obstacles.

It’s wrong to have high expectations from these approaches of citizen's involvement, but it’s also a mistake not to have it. Participation is complex and subtile. Informal and consultative agreements would offer to the elders a more accentuated role in practice, comparing to the existing methods. Here, the weaknesses but also the strengths of this approach can be identified, because offering information and consultations can support solving problems, public debates, informing campaigns, publicity and gatherings of persons in order to take decisions according to their needs and expectations.

There are two key components of efficient involvement (Beresford şi Croft, 1993, p. 51):

• offering access;• offering both material and personal support;• resources and personal change constitute the core of four elements that

make involvement possible:• personal development;• practical abilities;• practical support;• offering support to persons in order to gather and work together.

The empowerment strategy doesn’t emphasize just the personal dimension,

because the starting point doesn’t include just lack of abilities, trust or resources. On the other hand, if people are not helped to participate, then they will not be able to use at a maximum the opportunities they have. This is a reason for making the difference between what people are saying formally and what they are actually saying. It also explains who takes part and how efficient is each person’s involvement. No matter the type of involvement – from gathering information to saying openly the point of view, trainings for making actions become more and more important. Supporting and facilitating the access of people are essential parts of the same empowerment process. They reflect the political and personal aspects of each citizen’s involvement.

The social problems, including the lack of resources for the poor persons, the costs and inadequate health actions, the crisis of community structures represented problems associated with the need to amplify empowerment in

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the social services. The traditional social services were criticized for their trend of focusing on the weaknesses of the clients, raising their dependence. In the process of solving problems, the strengths and clients’ potential of becoming actively involved are often neglected.

The empowerment oriented interventions engage the elder persons and their families in:

• acquiring surviving knowledge and abilities in the last part of life;• self-help and social activities supporting persons with similar problems;• participation in collective/social actions dedicated to improving the

environment they live in.This approach has similar components with the one of Gutierrez (1991) who

defined the empowerment as the process of raising personal, interpersonal and political power, so the individuals can act for improving their life conditions. The concept of empowerment has also been used as a principle that guides social practice and as a result in itself, as it appears in the vision of Parsons (1991). The practice oriented towards empowerment is based on understanding the aspects of personal, interpersonal and political problems. As a consequence, the process of solving problems includes, as a key activity, an increasing awareness process.

Because the practice oriented towards empowerment can be incorporated in all the intervention methods, using small groups of persons has been considered a very effective method (Cox, 1988). Gutierrez (1991) resumed the results of several authors’ work, which were preoccupied with the important psychological changes that occur while transferring the individual from a helplessness state to an action state, through:

• increasing personal efficiency;• developing group consciousness;• decreasing self-blaming;• assuming personal responsibility for change.

The small groups offer a context in which everyone can understand the common nature of the participants’ problems, can learn about the political aspects of their preoccupations, which leads to reducing self-blaming that contributes to their helplessness state.

I.2.2. Problem oriented intervention This approach is marked by the social constructivism, being oriented

towards awareness and solving difficult situations, exterior to the individual. This method of intervention, being behavioral and cognitive by default, is based also on social assistance practice.

To this approach have been added, after the dissertation of William Reid at the University of Chicago in 1963, the works of his team and also the cognitive psychology works of Goldman (1970) and Parad’s (1965) on intervention in crisis situations. Part of these fundamental points of problem oriented intervention is:

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• best way of obtaining what you want is to act;• the action is guided by beliefs about the world and self; these represent

the basis of a good action plan;• many psycho-social problems reflect only a temporary interruption of

the possibility to handle them;• imposed time limits motivate the users of services;• a positive experience of solving problems amplifies the ability of

handeling the difficulties that follow;• most of the difficulties are normal; they become problems only when

they start to repeat, so the affected person blocks;• we are what we do and emotions start from behaviors;• emotions/feelings represent what we think about what we want.

The problems are defined by Reid as unfulfilled or unsatisfied wishes of the user of services. The perceptions can be unclear, but more important is that an unfulfilled wish is often assigned to the potential user of services by someone else. For example, person A can say: “my partner B has drinking problems – he needs to control his problem.” This is an assignment made by person A to person B, asking help for B, so A’s problem/wish is “I have a problem with my alcoholic partner”. This is the only problem acknowledged partially. B hasn’t acknowledged any wish. He is not an “applicant”, but is the main services user.

Many people we work with are “people of reference” rather than applicants. They are reluctant considering they don’t have unfulfilled wishes to ask support for. In these situations, task focused intervention will go on only if or only when the elder will want to anowledge those wishes. How is this done? Reluctant persons can be engaged in exploring the way in which other persons see them as problems or as having problems, how this situation is affecting them, if there is something that they wish to change, if there is something that they can do to free themselves from the interferences in their life. When they become aware of wanting such things, they become “applicants”.

So, a first step in the problem oriented intervention is identifying a possible wish of the elder through questions like: “Is there something you want to change?”, “You want my support in reaching your goal?” Some persons consider they have only failures, so any support won’t be helpful. They could take into consideration the question “If you could receive an efficient support, what would it consist of?” and “From the problems listed, is there one affecting you?”

This approach doesn’t take anything for granted and uses the most basic and obvious questions, respecting the situation of the potential services user; it’s desirable to start from where the elder doesn’t see life in an undesirable way.

Epstein (1998) describes this phase as the start, when the social worker established if there are acknowledged wishes in the mind of those that need to be helped.

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The next phase is focused on the evaluation of the specificity and possibility of fulfilling the identified wishes, in the shortest time. Limited time of working is considered to be crucial for the motivation and appropriate to the current requests upon the evaluation.

Many potential service users will have more than one wish; the wishes will be selected according to priorities established during the evaluation stage but, as a general rule, more than three wishes is not acceptable.

Once accepted, these three problems become the groundwork of the intervention goals. It is established where, when and with whom these problems will be explored as well as behavior consequences. The problem needs to be understood by the person, by other significant persons and by the social context.

It follows, as a next step, a more detailed analysis aiming to look for answers to the following questions:

What needs to be done or changed?Which constrains exist?What tasks will be required to the service user and/or the social worker (but

mainly to the service user) to start making things better?For example, for two or more elders found in a situation that needs to be

solved, the answers corresponding to each relationship can be filled in:

Name What do I want from them?

My chance of obtaining it?

What do they want from me?

Their chance of obtaining

it?HusbandWifeDaughterSon

The clarification from the evaluation stage is a major part of the support. We shall not forget that the goal is to guide the elder to act. The services user becomes the main agent of change in this approach, his clarity and accord are vital. Each family or group member can be invited to participate, having the opportunity to provoke/change the wrong conceptions regarding each ones expectations in the group. In case of a group, these changes can be valuable information regarding its potential to face problems.

For this, the goals need to be clear, and the social worker to use empowerment strategies of group members.

Problem oriented intervention is efficient, in general, in 8 situations – according to Reid (1978):

1. Interpersonal conflicts – in family, at working place;2. Dissatisfactions in social relations; 3. Problems in relationships with formal organizations;

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4. Difficulties in implementing roles – as partner, as parent;5. Problems of social transition – moving from a situation to another, from

a role to another;6. Reactive emotional stress – widowhood, illness;7. Problems in assuring the adequate material resources;8. Behavioral problems.

It’s important to inter-connect the problems, e.g. connect alcoholism with the absence of an adequate place to live and with the lack of money. The social worker and the “applicant” need to decide which the first problem to be solved is.

Another way of inter-connecting problems can come from the problems between two persons – two elder spouses – for which the problem is to keep a thing. It need to be analyzed the cause of the problem and the aspects that maintain it.

A scaling of the problems is proposed, through eight identifying and exploring dimensions:

Inexistent problems

Small severity problems

Medium severity

problems

Big problems Serious problems

Interpersonal

Social relations

Formal organizations

Roles

Decisions

Emotional stress

Resources

Other

In the assessment focused on the problem, obstacles can interfere from: • The social system – family, extended family, community, formal or

informal networks, society in general; it results that the problem is outside the individual;

• Beliefs or constructs – about the world, life, self, and problem; beliefs can be factual or evaluative, and their accuracy and consistence is significant;

• Emotions – are translated into beliefs related to wishes; for example: “What I want is lost or impossible” = depression; “What I want is wrong” = guilt. Moving the feelings to the cognitive level will facilitate the intervention. For example, an elder that was abused can be helped to

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understand that he didn’t cause the behavior;• Expected solutions – or actions done, which make things go worst.

Three types of such expectations can be obstacles: • Looking for utopian goals or reaching too high;• Trying hard to do something that can be spontaneous – making a

stepson to love you; • Searching for attitude change when the services user can intervene in

the behavior or making someone want what he doesn’t really want.Selection of tasks is made by discussing them with the client, taking in

consideration: • The potential benefit from doing the tasks; • The work involved in solving the task;• Any obstacle that can make a task difficult; • What practice or guidance might be necessary; • The general plan for doing the task;• How and when a progress will be felt.

Available options in selecting the tasks:• Exploration tasks – the problem is examined or the factual beliefs are

provoked;• Intervention tasks – are made for changing or orienting something

towards solving the difficulties or fulfilling the wishes; • The tasks can be simple or complex;• Singular tasks – made by one person or mutual tasks; • Physical or mental tasks – is recommended the mental problems to be

translated into concrete as much as possible – for example making an observation list;

• Raising / improving tasks – starting with small steps and gradually increasing the difficulty;

• Alleged tasks – asking if something has changed – observing the differences;

• Reversion tasks – have the role of creating the opposite of what the client used to do to solve the problem;

• Paradoxical tasks – can be taken into consideration when all the others have failed and when they can be preceded by a positive reformulation of the problem.

The tasks need to be revised – it’s a final stage because it offers information regarding the problem as well as information on how useful the client’s motivation and capacity were, and on the time and effort required.

Reporting to the tasks to be done, we need to check if the client:

• Understood them;• Is afraid of one of them;

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• Has the necessary skills for doing them;• Has the necessary resources – money, place to live etc.;• Needs reinforcements, encouragements;• Is influenced by the social workers’ attitude.

The task focused practice can be on a shorter or a longer period of time, in a maximum of 6-12 sessions. It involves immediate involvement in action because of the limited time.

The task focused practice is meant to improve the abilities of the participants to solve problems, maintaining the idea that the respective client, within the tasks he/she assumed, has the decisive and self-directing role.

This model will empower the client if he/she understands the goal of the tasks and the way in which these will affect the target problem. So, if the acting direction is the desired one, the client will have more control in implementing the tasks, succeeding finally to develop his independent abilities of solving problems. Regarding the implementation of tasks, they can be individual or can be thought as including several persons, keeping the mutual condition.

A significant step consists in planning the details and learning the necessary abilities for implementation. For this, the social worker will ask the elder:

• How will you do this?• Who will do this?• What is needed for this task to be completed successfully?

The success of this action depends on the involvement in the previous stage of the process, the client being able to work alone or with the support of others.

The revising steps are provided from the planning stage:a) Progress is assessed – as measure of the changes made in relation with

the target actions and with the abilities of solving problems – and failure, through an empathic answer of the social worker.

b) The changes that occurred in the target actions are revised, as a constant exploration of the problems – regarding severity, frequency, client’s impression etc.

Frequent questions:• What change occurred?• Is the level of change satisfactory?• How long will the change last?• What factors influenced the change?• What task contributed significantly to the change?• Does change analysis suggest a modification in continuing the process?

If the results of these analyses will be satisfying, the final stage will follow; if not, a revised task or a new task will be taken into consideration.

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I.3. CASE MANAGEMENT IN ASSISTING THE ELDERLY

I.3.1. Definitions and observationsCase management has a very important role in social assistance, no matter

the category of beneficiaries assited; its importance increases along with the complexity of the clients’ problems.

The case management is used for the beneficiaries that have complex problems, that need to be approached from different perspectives by a puridisciplinary team of specialists; it implies using different types of resources (material, human, institutional etc.). The elders, through the nature of the faced problems, represent such beneficiaries.

Most of the definitions of the case management refer to it as being a method that, used in social assistance, involve:

The correct identification and assessment of the client’s needs and problems;Establishing realistic objectives for the assistance process; Taking decisions based on cost-benefit analysis regarding the types of

activities used for reaching the goal and objectives of the established plan of care;

The identification, involvement and coordination of the different types of resources (human, material, institutional) while the different types of services are being offered;

Empathy and offering support during the assistance process; Monitoring the assistance process with its effects and results obtained

during the implementation of the plan of are.

In the national social assistance system there isn’t an unanimous accepted definition of the case management. The only normative document that offers such a definition is Order no. 288/2006 for approving the Minimum Compulsory Standards for Case Management in Child Protection. Adapting this definition to the protection of elders, case management can be defined as ”the method for coordinating all social assistance and special protection activities developed” for the protection of elders” by professionals from different services in public and private institutions”.

The Romanian legislation doesn’t provide minimum standards regarding the case management for services addressed to elders. However, Order no. 246/2006 for approving the Minimum Specific Quality Standards for Homecare of the Elderly and for Rezidential Centers of the Elderly, talks about the attributions and the necessary involvement of the case manager which is defined2 as ”a

2 The definition was taken from the Glossary of terms, Annex 1 of Order no. 246/2006 regarding

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worker in a specialized social service that elaborates, coordinates, and monitors the implementation of the individualized plan for assistace and care, for one or more beneficiaries.”

Regarding the way of nominating the case manager and his attributions, the minimum specific quality standards approved through Order no.246/2006 specify the following:

For offering quality services and for assuring an efficient management, public and private suppliers of homecare services organize the Homecare Unit3. According to the territorial area and number of beneficiaries, one or more units will be organized. Each of them is coordinated by a program manager. The assistance given to the beneficiaries is the responsibility of the case managers.

The supplier names, from the staff involved in the care process, a case manager that is responsible for coordinating and monitoring the care process and for elaborating and respecting the individualized pland and programs for a maximum number of 25 beneficiaries; if the unit has a total number of 25 beneficiaries or less, the activity of the case manager can be done by the program manager;

The supplier, through the case manager, establishes and monitors the implementation of the Individualized Plan of Care and Assistance which includes the services offered to the beneficiary and the personnel involved; the case manager can involve, for the implementation of the individualized plan for assistance and care, more specialists, according to the particular needs of each beneficiary.

I.3.2. Services offered to the elderly, according to Law no. 17/2000Types of servicesIn order to benefit from the services provided in the legislation, according

to article 3 of the Law no. 17/2000, the elder has to be in one of the following situations:

• Has no family or support from one or more persons that are obliged to offer support according to the current legislation;

• Has no home and possibility of assuring the living conditions based on the personal incomes;

the approval of minimum quality Standards specific to the services of homecare for the elders and for the residential centers for elders.3 The Homecare Unit is defined in the Glossary of terms (Annex 1 of the Order no. 246/2006) as being „an organizational frame that assures a package of homecare services”. In other words, the Homecare Unit represents any institution with or without a legal entity, that offer this type of services (asylums for elders, nongovernmental organizations, public or private institutions or their branches and local offices).

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• Has no personal income or the income is insufficient for assuring the needed care;

• Can’t do the housekeeping or needs specialized care;• Is in the impossibility of assuring his/her sociomedical needs, due to

illnesses or physical or mental state.

Law no. 17/2000 regaring the assistance of the elderly groups the community services for the elderly in homecare services, counseling services and community services offered to elders in rezidential centers. These services are offered with the consent of the elders and according the the minimum quality standards approved through Order no. 246/2006.

According to art.8, lines 1, 2 and 3 of the Law no.17/2000, the homecare services are:

• Social services regarding, mainly, taking care of the person, preventing social marginalization and offering support for social reintegration, juridical and administrative counseling, support for paying current services and obligations, maintenance of the house, housekeeping, preparing food;

• Sociomedical services regarding, mainly, support for personal hygiene, readapting the physical and psychological capacities, adapting the living space to the elder’s needs and activating them in economic, social and cultural activities and also temporary care in day care centers, night centers or other specialized centers;

• Medical services, as medical consultations and treatments given at home or in health institutions, stomatology consultations and treatments, administering medication, offering sanitary materials and medical devices.

Part of these services can be assured also by the rezidential centers (even if homecare services are not a specific activity of these institutions), based on partnership conventions, at the request of nongovernmental organizations and with their financial support.

The costs for these services are covered by the local public budget and/or the elders, depending on their income level, types of services needed and period of time while the services are offered. More details about the costs of the homecare services can be found in the next section.

Counseling services are offered by the social workers for preventing social marginaization and for supporting social reintegration.

Also, the elders can benefit for free, at their request, no matter their income level, of juridical counseling for legal documents of donation, selling-buying or

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loans with real estate guarantees, that involve mobile or real estate goods owned by the elders in cause.

The services assured to elders in asylums4, according to Law 17/2000, art.14, lines 1, 2 and 3, are grouped as follows:

• Social services consisting in: support for housekeeping, juridical and administrative counseling, ways for preventing social marginalization and for social reintegration, according to the psychological and emotional capacities;

• Sociomedical services consisting in: support for maintaining or readapting the physical or intellectual capacities, assuring ergotherapy programs, support for personal hygiene;

• Medical services consisting in: consultations and treatments in medical facilities, in specialized medical institutions, or at the persons bed, if immobilized, care-infirmery services, assuring the necessary medication and medical devices, dental consultations and services.

Taking care of elders in asylums represents a social assistance measure from which can benefit, as an exception, persons in difficult situation, but independent. According to Law 17/2000, art. 16, line 2, the access of an elder in an asylum is assured taking into consideration the following priority criterias:

• Needs permanent special medical care, that cannot be assured at home;• Hosekeeping cannot be done alone;• Doesn’t have legal representatives or they can’t fulfill their obligations

due to helath condition, economic situation, or family responsibilities;• Doesn’t own a place to live and doesn’t have his/her own incomes.• The asylums can offer part of the care services also at home, at the

nongovernmental organizations request, based on signed conventions with the funder.

The elders contribution to the cost of servicesThe elders benefit from the services provided by law for free or by paying

a contribution. In establishing this contribution, the main factor taken into consideration is the income level of the elder and also the types of services needed (homecare services, counseling, or care in asylums).

However, if the elders’ income are insufficient for covering the minimal costs for a decent living and the costs of the necessary services, the family members have the obligation (according to article 93 of Law no. 292/2011) to assure the needed care to the elder. The financial obligations of the family are established so they don’t affect the incomes consided to be minimal for the current life of the persons obliged to assure the care and of their children. If the elder is alone or his/her family can’t afford paying, partial or total, for the care of the elder, the

4 Annex no.1, representing an institutional case study, offers a more detailed description of the services offered to elders in residential institutions.

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state intervenes by offering social benefits and services adapted to the strictly individual needs of the elder.

In the case of homecare, the social and sociomedical services offered to the elders are assured:

• For free for the elders with no income or income that is 5 times lower than the level of net income taken into consideration for a person without relatives;

• By paying a contribution established according to the types of services needed and the level of income, without exceeding the costs for the period when the services are provided.

The Local Council or the provider establish the types of services provided to an elder and the costs incurred.

The medical services provided at home are established based on the legal provisions regarding social and health insurance5.

Counseling services are provided for free, at the elder's request, no matter the level of income.

The elders (or their legal supporters) contribution to the services offered in asylums is paid monthly and it’s the equivalent of the average monthly cost of maintenance (AMC6). The elders with no incomes are excepted from paying the AMC, the costs being covered by the local councils.

The AMC is established anualy by the Local or County Councils and it doesn’t include the salaries of the personnel of asylums and the costs for medical treatments.

The AMC established for an elder in an asylum is established according to the dependence level of the person, the services needed etc. When entering in an asylum, a payment commitments is signed (based on a written agreement or by court decision) and includes one of the following ways of paying the AMC:

• 60% is assured from the personal income of the elder, but without exceeding this income and 40% assured by the legal representatives if the monthly income per family member is higher than 600 RON;

• 100% by the legal representatives of the elders, based on a payment agreement signed at the time of admission of the elder in the asylum;

• 100% by the elder, if the ACM is lower than 60% of the elder income.The costs of the medical services offered in asylums are assured according

to the social health insurance legal provisions. However, the costs that are not covered by the health insurance system, are assured by the asylum.

5 The social health insurances are regulated by the Law no. 95/2006 regarding the reform in the health domain, with its ulterior modifications and completions.6 AMC represents the average monthly cost and is applied only for the elders assisted in asylums.

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I.3.3. Social benefits for the eldersThe new Law of social assistance no.292/2011 mentiones the main categories

of social assistance which the elders can receive and the situations in which they are offered.

So, line 1 of article 94 from the mentioned law, states that “the social benefits are given to the elders found in vulnerable situations”. These situations are the following:

• when the elders don’t have personal incomes or their incomes or of the legal supporters are insufficient for assuring a decent life and a sure living environment;

• when the elder can’t do on his/her own the basic daily activities, can’t keep a household and need assistance and care;

• don’t have a place to live or the possibility of assuring themselves the living conditions based on their resources etc.

The same article, at line 2, mentions the main types of social benefits offered to the elders:

• the social benefits for preventing and combating poverty and the risk of social exclusion;

• allowances for care, given according to the legislation;• allowances or contributions for assuring the quality of the social services,

destined for covering the costs of food in social canteens, in residential care centers and for maintaining some nutritional supplements;

• facilities regarding the urban and interurban transportation, telephone, radio and TV, food, tickets for spa treatments or relaxation and other services;

• support for situations that put in danger the life and safety of the elder and for preventing the institutionalization;

• in-kind support like food, shoes, clothing, medicine, medical devices, construction materials and others.

I.3.4. Stages of intervention in case managementA presentation of the stages to be followed and the instruments used in each

stage in case management can be done schematically. Such a sheme was done by Rothman (Rothman & Thomas, 1994, p. 216). Figure 1 represents an adaptation of this scheme to the Romanian legislation regulations.

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Inter-institutional level: Institutional level: Team level:

1. ACCESING THE SERVICES based on self-referral, referral or self-notification.

Instruments:• Request for services• Initial file of the case• Contract of assistance

2. EVALUATION OF INDIVIDUAL NEEDS will include the material, medical, social, psychological, juridical etc.

situation.

Instruments:• Social evaluation• National grid for evaluating the elders• Medico-social evaluation grid

3. ESTABLISHING THE OBJECTIVES OF IPCA based on the identified resources (personal and institutional) and

problems. The objectives will be established on short and long term.

Instruments:• Genogram• Eco map• Force field analysis• Life cycle matrix• Individualized plan of assistance and care• Program and schedule of the activities done at the

beneficiary’s home• Medicine administration table• Individualized plan of recovery• Social integration program

4. IMPLEMENTATION OF IPCA will aim to reach the objectives established in the previous stage.

Instruments:• Meeting/phone conversation report• Donation document

5. ENDING THE SERVICES when the proposed objectives are reached or when the beneficiary doesn’t collaborate.

Instruments:• Plan for ending the services• Decision for ending the services• Final report

6. MONITORING the case aims to see the evolution of the case even afetr the services ended. In case new problems are

identified, the assistance will be restarted.

Instruments:• Monitoring report

Inter-institutional coordination

(based on the institutional politics and the signed partnerships)

Coordinating and monitoring the team involved in the assistance of the beneficiary.

The services offered to the elders can be grouped in:• social;• socio-medical;• medical.

And based on the specialty:• social;• psychological;• juridical;• medical etc.

The services will be offered through activities of:• counseling;• therapy;• advocacy.

Fig.1 Levels, functions, stages and instruments used in case management(adaptation made by Dana Pîrvu, 2011)

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1. The identification and admittance of the beneficiaries are done mainly based on self-referral or referrals from legal representatives and relatives. Also, the beneficiaries can be identified directly by the providers of social services, when assisting similar cases, or by referrals from other institutions as: hospitals, police, nongovernmental organizations and other institutions and persons in contact with elders in risk situations.

According to Law no. 17/2000, article 27 ”the social assistance is offered at the request of the interested person, of the legal representative, of the Court, elders’ organizations, cultural institutions recognized in Romania, or of the nongovernamental organizations that offer social assistance to elders.”

This stage consists in verifying the eligibility of the interested elders that need social assistance, based on the selection criteria, the needs and the services offered by the social assistance institutions, mentioned in the admittance specific procedure. The admittance procedure will be sent to the public social assistance institutions.

Based on the preliminary information obtained from the beneficiary, a case initial form (model in Annex 3) that will include identification data of the beneficiary and preliminary information about his situation.

At this stage the contract for assistance (model in Annex 4) is signed by the provider of social services and the elder, or legal representative. In case the elder doesn’t have the capacity of expressing his agreement due to health conditions, the services could be offered also with the agreement of the first dregree relatives or other family relatives. The contract for assistance will be done in 2 hard copies (one for each partie) and will be according to the current legislation7.

Also, in this stage, the file of the case will be created and it will include the following documents:

• request form (model in Annex 2) for the social services;• a copy of the identification document of the beneficiary and, in case, of

the legal representative;• written recommendations regarding the dependence and the services

needed by the elder;• contract of assistance.

2. Needs assessment is done according to Law no.17/2000 art.4 “through a social assessment (model in Annex 5) that is elaborated based on the data regarding the diseases that need special care, the capacity to do the housekeeping and daily basic activities, the living conditions and the existing or potential incomes considered to be minimum for assuring the daily life necessities.”

7 The format of the contract was approved through the Order of the Ministry of Labor, Social Solidarity and Family no. 73/2003 for approving the model of the Contract for offering social services, signed by the providers of social services that are accredited according to the legislation and by the beneficiaries of the social services.

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Art.28, line 2 of the same Law states that “the social assessment is done by a team of 2 social workers from the Local Council or from the County Labor, Social Solidarity and Family Department. In case of dependent elders, the team will compulsory include the personal specialized doctor.” The team mentioned before “can also include representatives of the elders organization, cultural institutions recognized in Romania or other nongovernmental organizations that assist elders.” (Law no. 17/2000, art. 28, line 3).

According to the minimum quality standards for homecare, the assesment can be done by only one person, if the elder was already assessed by the public services and included in a degree of dependence.

In the case of elders that are about to loose partially or totally their autonomy, their needs (that can be medical, sociomedical, psycho-affective) are assessed according to the the national grid for assessing the elders needs (model in Annex 6), that includes the criteria of including the person in degrees of dependence. Law no.17/2000, art. 26 states that this grid can be revised annually and, compulsory, every 3 years. This instrument was adopted at national level through the Government Decision no. 886/2000.

The assessment is done even if the elder was already evaluated by the medical expertise commission for including the person in degrees of disability. The re-evaluation of the elder by the expertise commission is done periodically or at request, if the autonomy of the person decreased.

The person responsible for the assessment will create an assessment form that will be filled in by all the members of the evaluation team mentioned before.

3. Establishing the individualized plan for care and assistance (IPCA) (model in Annex 9) is based on the analisys of the social, economic and medical situation, through the social assessment. Thus, social assistance measures will be proposed justified by the actual situation (Law no.17/2000, art. 28, line 4). IPCA will be established by the case manager which will also decide upon the human and other resources needed for implementing it. In establishing the IPCA, instruments that are specific to the social assistance can be used: genogram (model in section I.4.7), eco map (model in section I.4.8), analysis of the field of forces (model in Annex 7), life cycle matrix (model in Annex 8) etc.

If part of the services are subcontracted from other providers, these services will be mentioned in the IPCA along with the details related to how the assistance activities are going to be coordinated between the providers. The IPCA will be revised every six months and anytime needed.

The case manager will give to the assisted elder or to the legal representative a copy of the IPCA (when established and revised) and the needed explanations, so the information included in the IPCA would be accessible and understood by the beneficiaries. With this purpose, a program and schedule of the activities done at the beneficiary’s home (model in Annex 10) will be established and

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signed by the case manager and the elder. This program will be included in the personal file of the beneficiary and will be revised anytime needed with the agreement of the parties involved.

IPCA will include the following aspects related to the elder’s situation (according to the minimum quality standards):

- personal care through homecare services for support in daily basic activities (ex. personal hygiene, taking colthes on / off etc.);

- supervising and maintaining health by assuring the access to the services of the family doctor or of the specialized physician, and by a permanent collaboration for medical counseling, periodic evaluation of the health etc.; the case manager will create the medicine administration table8 (model in Annex 10); in case the beneficiary dies during the assistance process, the remaining medicines will be kept until establishing the cause of death;

- recovering the skills for self-care, personal care and housekeeping based on specific activities that will be mentioned in the individualized plan of recovery (IPR) (model in Annex 12); IPR is based on the evaluation of the functional autonomy and on the recommendations of specialists; it will be revised periodically; for preventing the institutionalization of elders, the case manager will notify the family or the local authorities about the need of adjusting the living space of the elder;

- social integration and participation aims to support the beneficiary in maintaining the statute of a complete and active member of the community; the social integration program (model in Annex 13) will be elaborated and revised periodically and it will include the following types of activities:- promoting leisure activities, cultural events or any other public initiative

in the community;- accompanying the beneficiary or facilitating his/her transportation to

community social events or to the local public institutions and services;- information and counseling regarding the community services;- promoting activities that encourage the development of the relationships

with family and community members;- facilitating communication (e.g. special telephone services) etc.

All the programs and plans subordinated to the IPCA will be elaborated and implemented only with the active participation of the beneficiary, his/her family or of the legal representative.

8 This form is filled in for both beneficiaries that can administer their medication on their own, and the ones that need assistance for this activity.

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4. Implementing the individualized plan of care and assistance represents the stage in which the elder receives the services, according to the plans made in the previous stage and mentioned in the IPCA and in it’s subordinated programs and plans.

Depending on the services offered, the provider is responsible for assuring the necessary resources for implementing the IPCA: personnel, materials, equipments etc.

The case manager will monitor the implementation of the IPCA and the activity of the personnel involved. For an efficient monitoring, it is recommended to use meeting/phone conversation reports (model in Annex 13) after each important meeting or phone conversation of any member of the team working with the beneficiary. This offers the possibility to quickly identify any change that occurred during the assistance and it’s causes.

For the services that include material support, also donation documents (model in Annex 15) will be used. The case manager can use it to monitor the total amount and frequency of the material support.

During IPCA implementation, in order to prevent the abuse and neglect of the beneficiaries, the supplier will keep a register in which the responsible staff will record the special situations and the measures that were taken.

Any special incident9 will be recorded and, depending on the nature of the incident, the interested factors will be informed in written in maximum 24 hours.

During the assistance process, the elders have the right to make notices and complaints. The provider will establish it’s own procedures and personnel to solve complaints. The complaints will be monitored for identifying the main causes and for promptly taking the necessary measures.

The beneficiary, his/her family or the legal representative will be informed regarding the procedure of solving the notifications and complaints, including the procedures provided by the current legislation10.

In this stage, the case manager will coordinate the assistance process and, based on the results, will re-adapt the IPCA to the beneficiary’s situation and needs.

5. Ending the services is done when the elgibile criteria is no longer

met. According to Law no.17/2000, art. 35 “if the period in which the social assistance given to the elder is temporary, but no longer than 6 months, the social assistance services are ended through a justified decision of the partie which established this right. Ending the social services or benefits is done based on a social assessment”.

9 Through special incident we understand any aspect or event that can have a negative impact on the beneficiary.10 Law of administrative litigation no. 554/2004, published in the Official Monitor of Romania, Part I, no.1154 on 6 March 2007.

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Decision for ending the services (model in Annex 16) is communicated to the beneficiary or his legal representative and, if necessary to the social assistance public institution/the Mayor’s Office at least 30 days before. The decision to end the assistance is accompanied by informing the client about the posibility of addressing to other providers. If the situation requires, a plan to end the services is established 90 days before before the actual end.

Especially in the case of elders without family support, it is recommended that the case manager, at the end of the assistance, offer to the beneficiary the contact details of institutions that can offer support in emergency situations.

For each colsed case, a final report (or closing case form – model in Annex 17) is completed, and it will include information such as: date of ending, reasons for ending the assistance, the contact person that could offer information regarding the beneficiarie’s evolution.

The file of the beneficiary will be kept also after the assistance process ended. The beneficiary or legel representative and the public social assistance institution will receive a copy of the file.

6. Monitoring the cases is the stage in which the case manager, with the support of the involved professionals, verifies the “sustainability” of the assistance process. A verification is needed to see if the situation of the leder hasn’t changed or improved since the services ended. In case the situation worsened, the assistance process can start again, with a re-evaluation of the beneficiary’s situation, establishing a new plan of care and assistance etc.

Monitoring includes visits to the beneficiary’s home, telephone conversations or other situations and occasions that offer information about the client’s situation. At the end of this stage, the case manager will complete the monitoring report (model in Annex 18) that will include information about the beneficiary’s evolution and recommendations for improving the elder’s situation.

The legislation doesn’t provide information about how long the case shoud be monitored, but this period should be established based on the complexity of the problems faced by the elder, the period of assistance (there is the risk that the beneficiary becomes dependent of the services received), and the risk level of facing new problems.

I.3.5. Involving the volunteers in the elders’ assistance according to Government Decision no. 1317/2005

The volunteers represent an important resource for the community. Although in Romania volunteering needs to be promoted, it can be found in many areas: social services, protecting the environment, business, research etc. Such an example is assisting the elders.

Due to the vulnerability which is a characteristic of this category of beneficiaries, in 2005 the Government Decision regarding volunteering in

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homecare of the elders no. 1317 was adopted. This governmental decision mentions the types of activities that the volunteers can do, and describes the selection, coordination and rewarding process.

1. Who can get involved as a volunteer in homecare services for elders?Article 2 of the Government Decision states that volunteering activities in

homecare services for elders can be done by persons that are trained in social assistance and that express their free consent. This condition is limiting the selection process of the volunteers because not every person that wants to offer support to elders has a social assistance education. Also, the elders that live in regions/localities where few persons have such an education are disadvantaged because their right to equal chances is not respected.

Thus, the same decision states in art. 6, line 1 that the volunteer has the right to benefit from specialized training courses and from coordination from the social services provider. Art. 4 lists the conditions that pupils and students need to fulfill for becoming a volunteer for homecare services for elders. Because pupils and students don’t represent persons trained in social assistance, and the volunteers can benefit from specialized trainings, we can conclude that any person can become a volunteer in homecare services for elders if having a social assistance education and/or if benefiting from a specialized training, before starting the activity.

2. Types of services in which the volunteers can get involvedArticle 5 of the Government Decision no. 1317/2005 states that from the

types of homecare services for elders, the volunteers can offer socio-medical care, of social nature11. More exactly, these can be:

• Basic services: support for personal hygiene, taking the clothes on/off, feeding and hydration, transfer and mobilization, interior walks, communication;

• Support services: support in preparing or delivering the food, shopping, housekeeping, accompanying the elder in means of transportation, facilitating the exterior walks, company, administrative and management activities, leisure activities.

Acoording to the level of education of the volunteers, these services can be completed with others, based on the types of problems faced by the elder, by respecting the current legislation and with the approval of the person that coordinates and supervises the volunteering activities.

3. Which are the volunteers recruiting and selecting procedures?

11 The socio-medical services of social nature are mentioned in art. 35 line (2) of the Government Ordinance no. 68/2003 regarding the social services, approved with modifications and completions through Law no. 515/2003, with its further modifications and completions.

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The recruitment is done by the provider of the homecare services, based on an internal procedure that is done according to Law no. 195/2001 of volunteering.

Due to the high level of vulnerability of the elders to different types of abuses and frauds, it’s important that the selection of volunteers be done very carefully. Acording to art. 4, line 2, the application for registration should be accompanied by:

• Copy of identity documents;• Curriculum vitae of the applicant;• Letter of motivation;• Proof of professional training and level of training or, in case, school

certificate attesting the educational grade for pupils and students;• Recommendation from the practice trainer in the educational institution

where the pupils and students learn, that attest their seriosity;• Medical certificate from the family doctor that attest that the aplicant is

capable to activate in this area;• Criminal record.

The actual selection of the volunteers will be done by the homecare services provider, based on the information from the documents that accompany the application for registration, on the institutional principles and specific and on the beneficiaries needs.

At the end of the selection process, a volunteering contract will be signed by the volunteer and the provider. A contract model is provided in Annex 1 of the Governmental Decision no. 1317/2005.

Before starting the activity, the social services provider has the obligation to give the volunteer an identification card that attests the quality of the volunteer. The model of this identification card is provided in Annex no. 2 of the Government Decision no. 1317/2005.

4. Volunteer’s rights and obligationsThe rights of the volunteers involved in homecare activities for elders are the

following:• To benefit from trainings in the area of intervention at the beginning

and during the activity;• To receive guidance from the services provider during the activity;• The homecare services offered to elders to be recognized, as well as the

experience and aptitudes developed during the activity; this recognition is made through a nominal certificate12 given by the social services provider;

• To receive the necessary materials, equipments and other resources,

12 The model for the nominal certificate is provided in Annex 3 of the Government Decision no. 1317/2005.

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depending on the type of activities carried out and the provider’s possibilities.

The responsibilities of the volunteers involved in homecare activities for elders are the following:

• To notify the social services provider, in the shortest time possible, about any aspect observed during the activity, that might have a negative impact on the beneficiary;

• Not to pretend from the assisted elders material interests, no matter the nature of these interests;

• To respect the program established in common with the social services provider and with the assited elders;

• To periodically notify the provider of the social sevices about the activity carried out.

I.4. CASE STUDY: PRESENTATION AND INVESTIGATION13

This section includes a model of specific instruments that are used in the social assistance for elders. Regarding the instruments used in the psychological assistance, those are presented in chapter II, section II.6.

I.4.1. Flavian. Abandon, dependence and vanity Aged 60, Flavian is married for 25 years with Margareta, aged 55. Margareta

left to Italy since 2006 to work as a housekeeper; she comes back once a year, in August. His wife left due to the financial difficulties of the family, the lack of a stabile job and family conflicts.

The couple has two children: Mădălina, 30 years old (married to Cătălin, with whom she has a 3 years old boy; they live in Iași) and Ioan, aged 25 (not-married, left to work in England since 2008).

Starting with 2005 Flavian’s health has deteriorated; he has several medical problems, being diagnosed with: diabetes type II, hyper blood pressure and herniated disc L4-L5. In 2007 he suffered a surgical intervention for the herniated disc. From this intervention, his medical condition aggravated and he was diagnosed with lateral sclerosis, spastic paraparesis and operated back discopathy. In the present, Flavian is on medical treatment for the above mentioned diagnosis; he also undertakes medical procedures for post-surgical recovery to stabilize his medical condition.

13 Personal identification data of the persons presented in this working methodology are fictive due to confidentiality issues.

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We need to mention that Flavian doesn’t have a medical insurance, doesn’t have any kind of income and all the costs for his treatments and interventions are covered by his wife’s income.

From the financial point of view, the beneficiary doesn’t have any income, all the money he spends is coming from his wife working in Italy. The money is administered by their daughter for utility costs, medical treatments and basic food. Many times, the money sent by his wife is insufficient to cover all the costs.

Flavian and Margareta own a house with 3 rooms and modest utilities. In this house that doesn’t have heating or hot water, Flavian lives alone since his wife and son left to work abroad.

The relationship between the two is tense since she left to work abroad. Flavian disagreed with his wife’s leaving. The communication between them is poor. They talk on the phone once a month and discuss only about the payment of the monthly bills. Flavian asks his wife to abandon her job in Italy and come back home.

The client has a positive relationship with his daughter that visits him and offers him support in daily activities. His son calls him about once a month and occasionally, when needed, he sends home around 100 Euros.

Due to his medical problems, Flavian has a reduced mobility, being able to walk only on small distances and with the help of walking sticks. Outside his home and on longer distances, he needs assistance from another person. Due to his limited mobility, the social interactions are reduced, being unable to visit his relatives and friends. The client finds little resources to cope with the problems (medical situation, insufficient income, loneliness).

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I.4.2. REQUEST FOR SERVICES

Dear Sir,

I, the undersigned, Popovici Flavian, resident in Iaşi, 5 Florilor street, with the identity card serial G.R, number 532xxx, I kindly request to approve my application for receiving support through the following psycho-social services offered by Alternative Sociale Association for free:

social assistance

psychological counseling

legal support

socializing activities

accompanying / visits of volunteers

mediation between myself and other institutions

material support

Date: Signature:

To the attention of Alternative Sociale Association’s CEO.

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I.4.3. INITIAL FILE OF THE CASE

Type of request: verbal n / telephonic / written Date: 19th June 2009Solicitant: No.2 Police Department, IaşiINFORMATION ABOUT THE BENEFICIARY:First and last name: Popovici Flavian Age: 60 yearsPersonal Identification Number: 1490104xxxxx1, Identity document Serial: G.R No. 532xxxActual domicile: 5 Florilor street, IaşiLegal domicile: 5 Florilor street, IaşiActual situation: Mr. Popovici lives alone in a 3 room house, which he owns, doesn’t have

a pension nor medical insurance since 2005. Due to the medical condition, he had to leave his job. Because he doesn’t meet the eligible criteria (legal age) for receiving a pension, the client doesn’t have any official income.

Mr. Popovici’ wife has left to work in Italy since 2006. They have 2 children, a boy (left to work in England) and a girl that lives in the same city.RESOURCE PERSONS:

First and last name: Popovici Margareta, age: 55 ani relation: wifeFirst and last name: Popescu Mădălina, age: 30 ani, relation: daughterFirst and last name: Popovici Ioan, age: 25 ani, relation: son

RELEVANT INFORMATION ABOUT THE ELDER AND OBSERVATIONS: • Elder that lives alone, without an income;• Owns the house he lives in, which has modest utilities, without hot

water and heating; • Many medical problems related to the spine and feet;• He walks with difficulty on very small distances (inside the house);• The family offers little support, excepting the daughter that tries to help

him in daily activities.

Case taken by social worker: (first and last name) Signature:

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No. 73 / 27.06.2009

I.4.4. SOCIAL ASSISTANCE CONTRACT

CONTRACTING PARTIES1. Alternative Sociale Associationnamed social services provider, with the office in Iaşi, fiscal identity code 9xxxxxx, bank account no. ROxxxxxxxxxxxxxxxxx opened at Bank: ________, accreditation certificate with serial X, no.: xxxxxxx, represented by Mr./Mrs. ____________ having the role of ________________and2. Popovici Flavian, named Beneficiary, personal identification code: 1490104xxxxx1 with the legal domicile in Iaşi, 5 Florilor Street, identity document serial: G.R. no. 532xxx, released on the: 20th February 1973 by Iaşi Police Department.Taking into account:

- The complex evaluation made on the 25th June 2009- The individualized plan of assistance and care no.73/ 29.06.2009

Agreed upon the following:1. Definitions1.1 The social assistance contract: is the juridical document signed between a person or a public or private institution, accredited according to the law to offer social services – named social services provider – and a person found in risk or difficult social situation – named social services beneficiary – that express their agreement regarding the offering of social services.1.2. Social services supplier: person or public or private institution, accredited according to the law to offer social services (article 11 of the Government Order no. 68/2003, with the later modifications and adding).1.3. Social services beneficiary is the person at risk and in social difficulty together with his/her family needing social services, according to the intervention plan established and revised after the complex assessment. 1.4. Social services represent an aggregate of measures and actions taken to fulfill the individual, familial and group social needs, in order to prevent and overcome difficult situations, vulnerability or dependence and to maintain the person’s autonomy and protection, to prevent marginalization and to improve the quality of life, according to the Government Order no. 68/2003, with the later modifications and adding.1.5. Reassessment of the beneficiary’s situation represents the compulsory activity of the provider to assess the situation of the beneficiary after a period of time when he/she has received social services.

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1.6. Revising or creating the individualized plan of assistance and care represents the modification or completion brought to the individualized plan, based on the results of the reassessment of the beneficiary’s situation.1.7. Beneficiary’s contribution represents a share part of the total cost of the service / services offered by the provider, depending on the type of service and the material situation of the beneficiary, and can consist in money, services or in kind.1.8. Beneficiary’s obligations represent the total duties assumed by the beneficiary through the contract and fulfilled by the beneficiary improving at maximum the psycho-physical potential.1.9. Minimal quality standards: is a total of requests regarding the organizational and material framework, human and financial resources for reaching the compulsory level of performance for every specialized social services provider, approved according to the legislation. 1.10. Modifications of the social assistance contract are the modifications caused by a normative document that have been added to the social assistance contracts, independently from will of the parties’.1.11. Force majeure - an event beyond the parties’ control, that is not caused by their mistake or guilt, that couldn’t be foreseen when the contract was signed, and makes the contract execution and fulfilling impossible. 1.12. Initial evaluation represents the activity of identifying/determining the causes, the actual social development and integrity state of the beneficiary and their prognostic through specific methods and techniques used in social professions, by the social services provider. The goal of the evaluation is to know and to understand the problems faced by the beneficiary and to identify the first steps needed to establish the initial plan of the intervention. 1.13. Individualized plan of assistance and care includes adequate and individualized measures and services according to the social needs identified after the compex evaluation: a program of the social services, the responsible personnel and the procedures that need to be followed.1.14. Complex evaluation represents the activity of investigation and analysis of the actual state of social development and integration of the beneficiary, of the causes that generated and maintained the difficult situation in which the beneficiary is found and their prognostic, by using standardized instruments and techniques specific to the social, psychological, educational, medical, and juridical assistance domains.

2. The subject of the contract2.1.14 The subject of the contract is offering the following social services:

• psycho-social services for elders

14 The list of the social services that will be accredited can be annexed to the contract, with the agreement of both parties.

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2.2.15 The description of the social services offered by the social services provider3. The costs of the offered social services and the contribution of the beneficiary 3.1. The total cost of the offered social services is of xxx RON. 3.2.16 The beneficiary’s contribution for the received social services is, as described below:

• for the social assistance and home care services for the elders the contribution is of 0 RON (cash/in kind)

3.3.17 The contribution of the beneficiary will not influence offering the social services and will not hinder the possibility of the beneficiary to overcome the difficult situation.

4. Duration of the contract4.1. The duration of the contract starts from the 19th June 2009 until the 19th September 2009.4.2. The duration of the contract can be extended with the parties’ agreement and only after evaluating the results of the services offered to the beneficiary, and, if applicable, after revising the individualized plan of assistance and care, through additional act to the contract.

5. Steps in offering the social services5.1. Implementing the measures included in the intervention plan and in the individualized plan.5.2. Reevaluating the beneficiary’s situation. 5.3. Revising the individualized plan of assistance and care for adapting the social services to the needs of the beneficiary.

6. The rights of the social services provider6.1. To check the truthfulness of the information received from the beneficiary.6.2. To stop offering the social services to the beneficiary if it’s proved that the beneficiary offered wrong information; 6.3. To use, according to the law, denominated data for statistics and for developing social services;

7. The obligations of the social services provider7.1. To respect the fundamental rights and freedoms of the beneficiary while offering the social services and also the rights of the beneficiary presented in this contract;

15 The description of the offered social services can be annexed to the contract, with the agreement of both parties.16 The value of the beneficiary’s contribution is established after the complex evaluation process.17 The costs of the services can be annexed to the contract, with the agreement of the parties.

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7.2. To offer social services included in the individualized plan of assistance and care, following it and the minimal quality standards for social services;7.3. To make the necessary procedures in order to ensure the beneficiary of the continuity of social services in case of contract termination as described at point 12.1 and 13.1 letters a) and d). The continuity of the services will be assured by subcontracting and transferring of the social services.7.4. To be receptive and to take into account all the efforts of the beneficiary in fulfilling the contractual obligations and to consider that the beneficiary fulfilled his/her obligations only after full engagement has been shown; 7.5. To inform the beneficiary about:

• the social services content and the conditions for offering the services; • opportunity of receiving other social services;• lists at local level with accredited social services providers;• internal procedures; • any modification of the contract.

7.6. To reevaluate the beneficiary’s situation periodically and, according to the case, to complete and/or revise the individualized plan of assistance and care, exclusively in the beneficiary’s interest; 7.7. To respect, according to the law, the confidentiality of the data and information related to the beneficiary; 7.8. To take into consideration the objective wishes and recommendations of the beneficiary, regarding the social services;7.9. To use the beneficiary’s contribution exclusively for covering the costs related to offering the social services;7.10. To inform the responsible public service of social assistance in the area where the beneficiary lives, about the identified needs and services proposed to be offered.

8. The rights of the beneficiaries8.1. In the process of offering the social services described at point 2, the social services provider will respect the fundamental rights and freedoms of the beneficiary.8.2. The beneficiary has the following contractual rights:

a) to receive the social services described in the individualized plan of assistance and care;

b) to be assured with the continuity of the social services, while the conditions that generated the difficult situation are maintained;

c) to objectively refuse receiving the social services;d) to be informed in due time and using accessible terms, about:

- social rights, legal protection measures and risk situations; - modifications intervened while receiving the social services;- opportunities of receiving other social services;

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- local list of accredited social services providers;- internal procedures.

e) to participate in the evaluation of the received social services and to participate in taking decisions regarding the appropriate social intervention, having the right to choose from different types of intervention, if they exist;

f ) the right to have access to the personal file;g) to express the dissatisfaction related to the offered social services.

9.18 The obligations of the beneficiary9.1. To participate actively in the process of receiving social services and in the reevaluation and revision of the individualized plan of assistance and care;9.2. To offer correct information regarding the identity and familial, medical, economical and social situation and to grant the social services provider the possibility of checking the truthfulness of information provided; 9.3. To respect deadlines and clauses established in the individualized plan of assistance and care;9.4. To contribute to the payment of the received social services costs with a share part from the total cost of the service/services offered by the provider, according to points 3.3 and 3.4.9.5. To announce any modification to his/her personal situation that occurred while receiving the social services; 9.6. To respect the behavior regulations, working schedule, contact persons etc.

10. Complaints10.1. The beneficiary has the right to complain verbal and/or in writing about the process of offering social services.10.2. The complaints can be addressed directly to the social services provider or through any other person from the team that is implementing the individualized plan.10.3. The social services provider has the obligation of analyzing the contents of the complaints, consulting both the beneficiary and the professional involved in the implementation of the individualized plan of assistance and care and to give an answer in maximum 10 (ten) days since the complaint was received.10.4.19 If the beneficiary is not satisfied with the way the complaint has been answered, he/she can address it further, in writing, to the Social Mediation Commission of the Iași county that will clarify the divergences between the parties or, if the case requires, to the competent Court of Justice.

18 The beneficiary’s obligations will be filled in, depending on the case, with other obligations specific to the types of services included in this contract.19 The provider will have internal procedures where it will be stipulated the procedure regarding the complaints addressed by the beneficiaries, respecting points 10.1-10.3.

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11. Litigations11.1. The litigations related to ending, executing, modifying and stopping or other claims coming from this contract will be subject of a prior procedure of amiable solving.11.2. If, after 15 days from starting these unofficial procedures, the Social Services Provider and the beneficiary don’t manage to amiable solution a contractual divergence, each of the parties can ask for support from the Mediation Commission or can address to the competent courts.

12.20 Contract termination12.1. The following represent reasons for ending the contract:objective refusal of the beneficiary to receive social services, expressed directly or through a representative, in writing and signed; breaching by the social service provider of legal provisions regarding the social services if the action is invoked by the beneficiary;the withdrawal of the functioning authorization or the accreditation of the social services provider;the limitation of the activity for which the social services provider was accredited, if this affects the social services offered to the beneficiary; changing the activity field of the provider, if this affects the social services offered to the beneficiary.

13. Ending the contractEach of the following represents a reason for ending the contract:the period for which the contract was signed ended;the mutual agreement of the parties involved to ending the contract;the goal of the contract was reached;lack of necessary funds for supporting the contracted social services at an optimum level;force majeure, if invoked.

14. Final clauses14.1. The contracting parties have the right, in the contracting period, to agree upon contract’s clauses through additional documents, only in circumstances that harm the legitimate interests of the parties that could have not been foreseen when the contract was signed.14.2. The provisions of the contract will be completed with the ones of the national legislation which applies to this field.14.3. The governing language of the contract is Romanian.14.4. The contract will be interpreted according to the Romanian legislation.

20 Depending on the nature of the social services offered, the contract parties can renegotiate the damages to be paid by the responsible parties.

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14.5. The social services supplier is responsible for monitoring and evaluating the offered social services.14.6. The measures taken for implementing the individualized plan for assistance and care will be communicated to the Social Assistance Department, according to the legislation.14.7. Based on the report regarding the results of the implemented individualized plan of assistance and care, the Social Assistance Department will monitor the activity of the social services provider.14.8. The beneficiary expresses its approval for giving one copy of this contract to the Social Assistance Department, without any violation of the right to confidentiality.

This contract for social services was signed at the provider’s office / beneficiary’s domicile in 2 (two) copies, one for each contractual party.

A copy of this contract will be sent to the Social Assistance Department by the social services provider.

Place: IaşiDate: 27.06.2009Social services provider, Alternative Sociale Association

Social worker, Beneficiary,(name of the person/persons authorized to sign) (first and last name of the person)

Popovici FlavianSignature: Signature:

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I.4.5. SOCIAL EVLUATION

Completed by social worker(s): __________________________Place and date: Iaşi - 20.06.2009Persons that were present: Popovici Flavian- beneficiary, (first and last name) – social worker and (first and last name) – social worker.

A. Beneficiary’s identification data First and last name: Popovici FlavianPlace and date of birth: Victoria village, 01.04.1949Personal identification code: 1490104xxxxx1 Serial and no. of ID document: G.R. 532xxxLegal residence: 5 Florilor street, IaşiActual residence: 5 Florilor street, IaşiCivil status: marriedStudies: high school Occupation: no occupationEthnicity: Romanian Religion: orthodox

B. Data about the family:Data about the husband/wife:First and last name: Popovici MargaretaPlace and date of birth: Rediu village, 05.03.1954Personal identification code: 2540305xxxxx2 Serial and no. of ID document: M.N 600xxxLegal residence: 5 Florilor street, IaşiActual residence: ItalyCivil status: marriedStudies: high school Occupation: housekeeperEthnicity: Romanian Religion: orthodox

Data about children:

No. First and last name Age Occupation Residence Observations

1. Popescu Mădălina 30 seller Iaşi Main resource person for Mr. Popovici

2. Popovici Ioan 25 Construction worker England Left approximately 2

years ago

Data about other persons living at the same address: - Mr. Popovici lives alone.

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C. Social history of the beneficiaryThe client was born in Victoria village, in 1949. In 1979 he married Popovici

Margareta. From their marriage, two children were born: Popescu Mădălina, 30 years, married to Popescu Cătălin that lives in Iaşi (they have a boy aged 3) and Popovici Ioan, 25 years, not married, left to England 2 years ago.

The client worked as a salesman in a private firm until 2004 when medical problems occurred. Also in 2004, the couple tried to start their own business: a small shop.

Due to big financial problems, the shop’s bankruptcy, Mrs. Popovici decided to go to work abroad, without her husband’s approval.

Now the beneficiary lives alone and is being helped in administering the household by his daughter (housekeeping, buying food, paying bills etc.) The client’s wife offers financial support: sends about 200 Euros monthly to cover housekeeping costs and client’s medical treatments.

D. Medical situation Since 2005, the client’s medical condition worsened, being diagnosed with

diabetes type II, blood pressure and herniated disc L4-L5. In 2007 he undertook a surgical intervention for the herniated disc.

After the intervention, his medical condition aggravated and he was diagnosed with lateral sclerosis, spastic paraparesis and lumbar discopathy for which has been operated. At the moment Mr. Popovici is on medical treatment for the mentioned diseases.

The client doesn’t have medical insurance due to his lack of income, thus all the costs for his treatments and interventions are supported by his wife.

E. Material/financial situationHomePersonal property: n yes no Number of rooms: 3n Electricity n Current water Heating n TelephoneHygienic condition: n Satisfying UnsatisfyingCultivated land (type of culture): - not applicableAnimals: Not applicableOther properties: a house in Rediu village, Iaşi County Income:Stabile: 200 Euro – sent by his wife from Italy. Occasional: 100 Euro – sent in emergency situations, by his son.

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F. Relations with the family and communityFamily relations:

The couple relationship is tensed since Mrs. Popovici left to working in Italy. From that moment, the communication frequency lowered: now they speak almost once a month.

The beneficiary has a good and positive relationship with his daughter which visits him often, 3 times per week, and helps him in daily activities. The client does not have a good relationship with his son-in-law thus he rarely visits the client.

The client’s son keeps contact by phone about once a month, and in emergency cases sends him money.

Community relations: Due to his reduced mobility, Mr. Popovici has very few social interactions,

which consist in speaking on the phone with his daughter (daily), wife and son (monthly). The interactions with the neighbors are very poor and are limited to a simple “hello”. The client refuses to ask the neighbors’ support for small shopping services or other types of services and doesn’t attend other social groups.

The client finds little inner resources to face the problems he has (medical situation, poor material resources, and loneliness after separation from his wife and son that left to work abroad).

G. ObservationsThe client develops jealousy of his wife, suspecting her of having an extra-

marital relationship in the country where she works.There are situations when the client refuses the daughter’s support.

H. Conclusions and recommendationsIn order to improve the client’s situation we recommend:Offering material support for food taking into consideration that the elder

doesn’t have his own income; Informing the elder regarding how to obtain a medical insurance;Supportive counseling for treating depression caused by loneliness; Juridical counseling for obtaining the disability pension; Visits from volunteers.

Social workers: (first and last name, signature)

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I.4.6. NATIONAL GRID FOR ASSESING THE NEEDS OF ELDER PERSONS

Socio-medical evaluation file(geriatric)

File no. 73Date when taken in evidence: 19.06.2009Date of evaluation: 25.06.2009

I. ASSESSED PERSONName: Popovici E. First name: FlavianDate and place of birth: 01.04.1949, Victoria village, Iaşi CountyAge: 60 years Address: 5 Florilor Street, IaşiTelephone: 0232/xxxxxx Fax: not the case; Email: not the caseProfession: salesman, Occupattion: unemployedStudies:

no studies primary school gymnasiumn high school university

Identity document serial: GR no. 532xxx Personal identification code: 1490104xxxxx1Pension coupon (pension folder) no.: the person doesn’t receive pension.Folder (coupon) for disability pension no.: doesn’t receive such a pension.Health insurance card no. and serial: doesn’t have a health insurance.Gender:

femininen masculine

Religion: OrthodoxCivil status:

not marriedn married in 1979 widow(er) since: ___________ divorced since: ___________ separated since: 2006

Children: n yes no

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If yes, write the first and last name, address and telephone of the children1. Popescu Mădălina – Iaşi, 0332/ 7xx xxx2. Popovici Ioan- England

II. LEGAL REPRESENTANTIVE - Not applicable.Name :First name: Relation with the beneficiary: husband/wife son/daughter relative other personsDate and place of birth: _________________ Age: _____Address: ____________________________________________________________Locality: _________ County: ___________ Postal code: _____________________Telephone: _________________; Fax: ____________; E-mail: __________________

III. CONTACT PERSON IN EMERGENCY SITUATIONSName: Popescu First name: MădălinaDate and place of birth: 03.05. 1979, Iaşi Age: 30 yearsAddress: 3 Narciselor street, IaşiTelephone: 0332/ 7xxxxx Fax: not the case; Email: not the case

IV. SOCIAL EVALUATIONA. Living place housen apartment other situations

Situated: first floor n superior floor- 8n elevator

Composed of:• no. of rooms: 3 • kitchen [x] bathroom [x] shower [x] • toilet n situated in the interior situated in the exterior

• heating: n without own system with wood/coal

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gas liquid fuel

• current watern yes non cold hot other situations

Living conditions: • Luminosityn adequate inadequate

• Humidityn adequate dampness

• Hygienen adequate inadequate

The home has:n stove, coking machine n refrigerator washing machinen radio/tv vacuum cleaner

Conclusions regarding the environmental risk:The risk is low because the elder’s mobility is low, and there are no

environmental modifications to adapt the environment to the reduced mobility needs of the elder.

The furniture is old, but tidy. It is not modified for the elders needs, as it is supposed to be: with wheels for easy moving, the bed should have a mobile side for the person to be moved or lifted.

The apartment has electronic devices: TV, radio, telephone. It also has large windows which assure an appropriate luminosity.

The bathroom is next to the sleeping room, and has a shower, a sink at middle level, without any other facilities or modifications for the elder to have quick access to the personal hygiene objects.

B. Family network The person lives: n alone since: 12.05.2006 with wife/husband since: ________

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with children since: __________ with other relatives since: _______ with other persons since: ______

List of persons the elder lives with - the client lives alone.(first and last name, relation, age): Compatible yes [ ] no [ ]Compatible yes [ ] no [ ]Compatible yes [ ] no [ ]

• one of the persons the elder lives with is: ill with disabilities/ handicaped alcoholic

• receives family support: yes [x] no [ ] money food house keeping

• the relations with the family members are: good - with the son with problems – the relations are tensed with the wife, daughter and

son-in-law no relations

• neglect risk: yes [] no [x] • abuse: yes [ ] no [x]

If yes, offer details:________________________________________________________________________________________________________________________________________ C. Friends, neighbors network

• Had relations with friends: yes (with a friend, by telephone) no visits support relations

• The relations are: permanent rare (he is visited once a month by his friend, Ionescu Vasile)

• Frequents: a social group the church other

Specify: ________________________________________________________________________________________________________________________________

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Write the names of the friends and/or neighbours that have good and supportive relations with the elder, groups of support:

Ionescu Vasile – former work colleague an older friend.

• is helped by friends, neighbours for: shopping housekeepingn walks outside the home (rarely)

• participation to: community activities recreational activities

• the community offers support: yesn no

If yes, specify: _____________________________________________________ V. EVALUATION OF THE ECONOMIC SITUATION

• personal monthly income, represented by: social public insurance pension _______________________ agricultural pension __________________________________ i.o.v.r. pension21 ______________________________________ pension for disability ______________________

• other income: 200 euro/month from his wife and 100 euro from his son (in emergency situations)

• total income: 200 Euro• other goods owned: the apartment is a personal property, with 3 rooms and

utilities.

VI. EVALUATION OF THE HEATH SITUATIONA. Present diagnoses

1. Diabetes, type II2. Hyper blood pressure3. L4-L5 hernia4. Lateral sclerosis5. Spastic paraparesis6. Operated lumbar discopathy

B. Present health situation:• relevant family antecedents: inexistent• personal antecedents: surgical intervention for the disc hernia.• teguments and mucous (ulcerations, plagues etc.) - inexistent.

21 Pensions offered to war invalids, orphans and widows.

57


• locomotory organs (including the mobility and walking disorders): very low mobility after the surgical intervention for the disc hernia, walking disorders.

• breathing organs (breathing frequency, cough, expectoration, dyspnea): dyspnea.

• cardiovascular organs (blood pressure, stroke, pulse, pains, dyspnea,breath rhythm disorders, edema, peripheral bloodstream disorders etc.): hyper blood pressure, pains in the heart, rhythm disorders, peripheral bloodstream disorders, dyspnea.

• digestive organs (dentition, nausea, pains, intestinal transit disorders etc. - also includes the nutrition state): not present.

• urogenital organs (pain, urination disorders – urinary incontinence, genital problems etc.): not present.

• sense organs (hearing, seeing, taste, smell, tactile): eye disorders.• neuropsychiatric examination (information about reflexes, equilibrium

disorders, motor and sensorial deficits, jacksonian crisis etc.): sometimes equilibrium disorders and motor deficit.

C. Relevant para-clinical investigations (data from the medical documents of the elder):

Hospital Exit Note from the local Emergency Hospital no. 25601/ 2005, Hospital Exit Note from the local Rehabilitation Hospital F. O. 12073/ 2006, Hospital Exit Note from the local Emergency Hospital no. 78673/2006, Hospital Exit Note from the local Emergency Hospital no. 60254/2007, Hospital Exit Note from the local Rehabilitation Hospital F. O. 9030/ 2007, Medical tests sheet no. 6045/ 2009, Hospital Exit Note from the local Emergency Hospital no. 19674/ 2009, Hospital Exit Note from the local Rehabilitation Hospital no. 61209/ 2009.

D. Recommendations from specialists regarding the hygienic, therapeutic and recovery treatment (data from the medical documents of the person – medical letters, family doctor, treatments etc.):

Recommendations: treatments according to the received medical treatment, diet with no salt and fats, physiotherapy, kinetic therapy and hydrotherapy. Not recommended: effort, walking on long distances and on bumpy field, exposure to cold weather and humidity.

58


VII. EVALUATING THE DEPENDANCE LEVEL

Inclusion criteria for dependence levels Doesn’t need

care, support.

Needs temporary / partial care and support.

Needs permanent care.

Evaluation of the autonomy 0 1 2A. Evaluation of the functional statusA.I. Daily basic activities

1 Corporal hygiene (general, intimate, special washing)

Independent

0Partial support. Only with support.

2

Getting the clothes on/off (the possibility of getting dressed/undressed, of cleaning oneself )

Independent

0

Independent and/or partially independent for dressing; needs support for taking the shoes on.

Only with support.

3 Nourishment (possibility of self serving and feeding)

Eats independently

0

Needs support for cutting the food. Only with support.

4 Elimination hygiene (continence)

Independent

0

Occasional incontinence. Incontinent

5

Mobilization (moving from a position to another – standing-sitting, sitting-lying etc.)

Independent Needs support.

1

Unable to leave the bed

6

Walking inside the house (inside the room, with or without a stick, wheel chair etc.)

Independent

0

Walks with partial support. Can’t walk without

support.

7Walking outside the house (walking without means of transportation).

Independent Walks with partial support.

1

Can’t walk without support.

8

Communication (using long distance means of communication in order to alert: telephone, alarm, bell etc.)

Normal use of communica-tion means.

0

Doesn’t use spontaneously the communication means.

Unable to use means of commu-nication.

A.II. Instrumental activities

59


1Preparing food (capacity of preparing the food independently).

Prepares and eats normally.

Needs partial support for preparing and eating.

1

The meals are prepared and served by another person.

2

Housekeeping activities (maintaining, cleaning, washing clothes, washing dishes etc.)

Does all the housekeeping alone.

Does simple activities partially.

1

Unable to do housekeeping activities, no matter the type of activity.

3

Budget and goods administration (able to administrate the own goods, budget, knows how to use the money etc.)

Administrates independently the personal funds.

0

Needs support for more complex financial operations.

Unable to administer the goods and to use money.

4Shopping (the capacity of buying the necessary things for a decent life).

Independent shopping.

Limited shopping and/or needs assistance.

1

Incapable of shooping.

5

Respecting the medical treatments (possibility to conform to the medical prescriptions).

Takes the medicine correctly (doses and rhythm).

0

Takes the medicine if the pills are prepared separately.

Incapable of administering the treatments.

6

Using means of transportation (capacity to use the means of transportation).

Uses the public transportation or drives his/her own car.

Uses the public transportation only if accompanied.

Limited transportation, only accompanied, by taxi or by car.

2

7

Leisure time activities (cultural, intellectual, physical activities etc. – alone or in group).

Done frequently. Rarely, without

spontaneous participation.

Doesn’t take part in such activities.

2

B. Evaluation of the sensorial and psycho-emotional status

1 Visual acuity

Good enough for reading, writing, manually working etc.

Distinguishes faces, sees good enough for orientation and avoids obstacles.

1

Sees only shadows and lights: blindness.

60


2 Hearing acuityHears well.

0

Hears only strong voices or only with the help of a prosthesis.

Deafness or hears sounds but doesn’t understand the words.

3 Speaking deficiencyWithout Dysphasia,

substitution voice etc.

Aphasia

2

4 Orientation Time and space oriented.

Disoriented in time.

Disoriented in space and/or related to other persons.

5 Memory

No memory disorders

0

Presents medium disorders, benign.

Presents severe disorders, malign.

6 JudgmentIntact

0Reduced Severe alteration

7 CoherenceTotal kept

0Partially kept Incoherence

8 BehaviourNormal

0

Presents medium disorders (hypoactive, hyperactive etc.)

Presents severe disorders.

9 Affective disorders (depression)

Without Medium depression Major depression

2

NOTE: For each evaluated activity there are three possibilities: 0 - activity done without any help, regularly and correctly; - doesn’t need supervision or support. 1 - activity done with partial help and/or less correctly; - needs temporary supervision and/or partial help. 2 - activity done only with help; - needs permanent supervision and/or integral support. The evaluation of the functional and psycho-affective status is done taking

into consideration the compulsory condition of assuring the physical and mental integrity for making it able to do basic daily activities.

VIII. RESULTS OF THE EVALUATION Autonomy: 14 points;Dependence: I-6 points;

61


II - 8 points;A. Identified needs:1. Functional status needs: - needs of partial support and temporary supervision in:

• Making the instrumental activities: shopping, housekeeping. - needs for integral support in:

• Leisure time activities;• Using the means of transportation.

2. Needs of the sensorial and psycho-affective status:• Visual acuity (wears glasses);• Speaking deficiency;• Major depression.

B. Level of dependence:• level IIIA - persons that walk without support inside the house, eats and

dresses alone, but needs support regularly for the daily activities; if these persons are sheltered in a special center for elders, they are considered independent.

IX. SOCIAL AND SOCIO-MEDICAL SERVICES (OF CARE) THAT ARE APT TO RESPOND TO THE IDENTIFIED NEEDS:

• Services for assuring food and nutritive supplements (preparation, serving and distributing the food).

• Medical services.• Psychological counseling and information for the family and for the

assisted persons regarding the social aspects (psychological problems, familial problems).

• Cultural, educative and socializing activities.• Involvement in the religious activities in the community.

X. THE WISHES OF THE ELDER – To stay home (not to be institutionalized).

XI. THE WISHES OF THE CAREGIVERS FROM THE INFORMAL NETWORK (RELATIVES, FRIENDS, NEIGHBOURS). The daughter considers that the best thing for her father is to receive care at home.

XII. THE LOCAL SERVICES CAN COVER THE FOLLOWING IDENTIFIED NEEDS:

• Institutions with temporary assistance services can offer medical services for general problems, but also specific ones, according to the clients’ medical problems.

62


• The public social assistance services (Community Assistance Department) – offers financial support in crisis situations.

• General Department for Social Assistance and Child Protection (DGASPC) – offers social services for adult persons in difficulty and medical expertise services;

• County Department for Pensions and other Social Insurances – offers medical expertise services and services for obtaining the invalidity pension;

• NGOs that respond to the beneficiary’s needs: medical services, socializing services, psychological counseling, juridical counseling and housekeeping services.

XIII. CONCLUSIONS The socio-medical evaluation of the elder shows the IIIA level of dependence, so he needs to be assisted at home. The client doesn’t have a medical insurance; the health situation is precarious, walks hardly on short distances and doesn’t have a personal income. The wife is the one that offers material support and the daughter helps him with daily activities.The client refuses to ask for help from neighbors for basic shopping or for other services and doesn’t go to other social groups. The client is visited occasionally by an old friend.

Evaluated person: Popovici Flavian Signature: ________________

Family: Son/daughter: Popescu Mădălina Signature: ________________

XIV. EVALUATION TEAM • Medic (first and last name, specialist in, unit he/she works in, address,

telephone, signature); • Social worker (first and last name, specialist in, unit he/she works in,

address, telephone, signature);• Social worker (first and last name, specialist in, unit he/she works in,

address, telephone, signature);• Other persons in the evaluation team (first and last name, specialist

in, unit he/she works in, address, telephone, signature).

63


I.4.7. THE GENOGRAM

Legend:

- male;

- female;

- deceased male;

- deceased female;

- transitory relationship (concubines)

- marriage.

60 55

30

33

3

25 22

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I.4.8. THE ECO MAP

Legend:

Equilibrated relation

Strong relation

Stressful relation

Unilateral relation

Bilateral relation

Tensioned relation

+ positive relation;

– negative relation;

+ - neutral relation.

P.F/M/ 60 years

Church + -

Police + -

Family - +

His family of origin +

Wife’s family - Rel. with

son in law -

Neighbours +

Rel. with friend +

Rel. with medic +

Rel. with health ins. syst. +

Rel. with health syst. +

Rel. with public syst. of S.A. +

Rel. with private syst. of S.A. +

65


I.4.9. FORCEFIELD ANALYSIS22

(+) Positive forces

(-) Negative forces

- Financial support from his wife and, in emergency situations, from his son;

- Daughter’s involvement in administrative and housekeeping activities;

- �e daughter visits him constantly, minimum 2 times per week;

- Visits of a friend; - Owns the house he lives in; - Good relation with the family

doctor; - Goes periodically to medical

consultations; - Walks on long distances if

accompanied and with a mean of transportation;

- �e involvement of professionals from NGOs;

- �e involvement of specialists coming from the public social services, for offering material support if urgent;

- Going to the hospital for medical investigations;

- Obtaining the disability pension.

- Bad material situation; - Doesn’t have any personal

income; - Doesn’t receive any material

benefits or social insurance; - He lives alone; - His wife works in Italy; - Tense relations in the family:

with his wife and son-in-law; - �e home doesn’t have a

constant source of heating, has modest utilities, and it’s not adapted to the beneficiary’s needs;

- Needs new medical and specialized consultations;

- Doesn’t have a medical insurance; - Walks with difficulty using

walking sticks on short distances; - Events that involve spending a

large amount of money; - Misunderstandings with his

daughter; - New responsibilities that

interfere with the implementation of the assistance plan;

- �e financial impossibility of the wife to offer the necessary material support;

- New medical problems; - �e difficult process for

obtaining the rights within the social insurance system.

22 Another instrument for strategic analysis, flexible and easy to use is the SWOT analysis. It permits evaluating the environment, for identifying the strengths and weaknesses, the oppor-tunities and the risks. The SWOT analysis aims to offer support in establishing a strategic plan or in finding a solution to a problem, taking into consideration the internal and external factors (Pivniceru & Luca, 2007, p. 60).

66


Conclusions of the force field analysis:In the table of the force field analysis made for Mr. Flavian it can be observed

how the negative forces (problems: financial, social, medical, psychological and juridical) are countered by the positive forces (resources: financial support from the wife and son, involvement of the daughter in the daily activities, socializing with a friend, the existence of a family doctor, involvement of the specialists from the social domain) for preventing the social marginalization of the client and for his social reintegration aiming to improve the quality of life.

I.4.10. LIFE CYCLE MATRIX

Family members ageFamily

members 0 - 1 2 - 4 5 - 7 8 - 12 13 -17 18 -22 23 -34 35 -60 61 -75 76-85

P.F. (client)X n

rP.M.

(wife) X nr

P.M.

(daughter) X nr

P.I

(son) X nr

P.C.

(son in law) X nr

P.V.

(grandson) X nr

Legend: X – developmental stage n – needs r – resources

P.F. (client) (35 - 60)- needs: financial, material, socializing, affective, medical, support in housekeeping activities and preparing food;- resources: wife, children, extended family (son in law), social services, medical services.

67


P.M. (wife) (35 - 60)- needs: financial, medical, achievement;- resources: a job abroad;

P.M. (daughter) (23 -34) - needs: financial, moral support, affection, achievement, spending time with her family; - resources: family, friends, social services, medical services, job.

P.I. (son) (23 -34) - needs: financial, moral support, affection, achievement;- resources: family, friends, social services, medical services, works abroad, his girlfriend;

P.C. (son in law) (23 -34)- needs: financial, moral support, affection, achievement, spending time with his family;- resources: family, friends, social services, medical services, job;

P.V. (grandson) (2-4)- needs: material, educational, spending time with his parents, grandparents and peers, affection, medical services;- resources: family, parent’s friends, social services, medical services, educational institutions, allowance for raising the child.

68


I.4.11. INDIVIDUALIZED PLAN FOR CARE AND ASSISTANCE (IPCA)

Date created / revised : 29.06.2009Case registration no.: 73/19.06.2009

INFORMATION ABOUT THE CASE• First and last name: Popovici Flavian• Date of birth: 01.04.1949 • Age: 60 years • Personal identification number: 1490104xxxxx1• Legal representative and relation: Doesn’t need a legal representative.• Address: 5 Florilor street, Iaşi• Reason for making/revising the plan of services: Preventing social

marginalization of the elder and his social reintegration for improving his life quality according to Law 17/ 2000.

• Case manager that assures the methodological coordination of the person responsible for the case: (first and last name)

• Person responsible for the case: (first and last name)• Team members and the institution they come from: (first and last name)

MATERIAL BENEFITS

Type Value / quantity Local authority/ Institution/ NGO

Starting date Period

Material support for food, consisting in

social tickets400 RON Alternative Sociale

Association 02.07.2009 Once

69


SERVICES PROVIDED

Type Responsible institution

Specific objectives

Starting date

Period of im-plementation

Respinsible person

Psychologi-cal counsel-ing

Alternative Sociale Associ-ation

Counseling for depression.

25.06.2009 25.06.2009

19.09.2009

Psychologist

___________

Mediating the daugh-ter-client relation


Accepting the support coming from the daugh-ter.

22.06.2009 June- October 2009

Social worker ___________

Mediating the relations with the public social services


Obtaining a ma-terial support for paying the temporary med-ical insurance.

22.06.2009 June- October 2009


Juridical counseling

Lawyers office

Juridical coun-seling for ob-taining the dis-ability pension or other social rights.

25.06.2009 June- October 2009

Jurist ___________

Health


Family doctor

Informing the daughter and client about the procedures for obtaining the medical insur-ance.

Reevaluation of the health con-dition through new medical in-vestigations.

20.07.2009

July - October 2009


Family doctor ___________

70


Socializing


Weekly visits from a volun-teer.

26.07.2009 26.07.2009- 19.09.2009

Volunteer coordinator ___________


OBSERVATIONS regarding the progress achieved: • The collaboration of the beneficiary makes the assistance process much

easier.• Reaching the objectives will be influenced by the health state of the

beneficiary.• There is a possibility of delaying the established deadlines, due to the

fact that the plan involves working with institutions that have a legal period for answering requests.

• The needed financial and human resources are available. • Family support for reaching the objectives.

Person responsible for the case (name and signature):

Team members (name and signature):

71


I.4.12. PROGRAM AND SCHEDULE OF THE ACTIVITIES DONE AT THE BENEFICIARY’S HOME

Activity Time period Responsible person Period of implementation

Week 10th August – 16th August 2009

L M M J V S DPsychological counseling

10:00-11:00 Psychologist,

________________

Visits from the volunteers

14:00-16:00 Volunteers coordinator,

________________Administrative activities (cleaning, cooking, clothes washing)

11:00-14:00 Daughter of the beneficiary,

________________

Visit to the family doctor

15:00-16:00 Daughter of the beneficiary,

________________

Date: 07.08.2009

Case manager (name and signature):


Beneficiary (name and signature):

72


I.4.13. MEDICINE ADMINISTRATION TABLE *

Month Day Yes/ No*(2)

Medicine Responsible for administering the

medicine

Signature of the

responsible person

Week 1*(1)

Monday

Insulin

Beneficiary

Daughter of the benefi-ciary

TertensifBilobilKetonalFurosemid

Tuesday

Insulin Beneficiary



Wednesday

Insulin Beneficiary


Beneficiary


TertensifBilobilKetonal

Thursday

FurosemidInsulinTertensifBilobilKetonalFurosemid

Friday

Insulin Beneficiary



Saturday

Insulin Beneficiary



Sunday

Insulin Beneficiary


TertensifBilobil

73


* The medicine administration table is done for both beneficiaries that are able to self administer the medicine and beneficiaries that need assistance for this.*(1) The table is the same for every week of the month.*(2) If the medicine is administered in that day, the correspondent checkbox will be marked.

74


I.4.14. INDIVIDUALIZED PLAN OF RECOVERY (IPR)

Objectives Activities Period of implementation

Responsible person

Recovering the beneficiary’s mobility

Kinetic therapy, medical gymnastics.

25.06.2009- 19.07.2009

25.06.2009-19.09.2009

Specialized personnel

Adapting the living conditions to the elders’ needs

Removing the interior doors of the apartment. Adapting the furniture in the client’s room: modifying the bed for an easier lifting; adding wheels to the table for an easier handling and moving. Modifying the bathroom to avoid accidents: installing a shower cabin, installing a metal handrail.

25.06.2009-19.09.2009

Beneficiary

Daughter of the beneficiary

Wife of the beneficiary

Contracted firm

Improving the mobility outside the home

Buying a wheel chair. 25.06.2009-19.12.2009

Beneficiary

Daughter of the beneficiary

Wife of the beneficiary

National medical insurance department

Date: 23.06.2009

Case manager (name and signature):


75


I.4.15. SOCIAL INTEGRATION PROGRAM

Case registration no.: 73/19.06.2009First and last name of the beneficiary: Popovici FlavianPerson responsible for the case: (first and last name)

Activity (es)

Responsible institution

Specific objectives Starting date


Responsi-ble person

Party for the elders

Alternative Sociale Association

Sharing life experience with the other benefi-ciaries.

Interacting with peers with the purpose of overcoming the difficult situations.

18.12.2009 18.12.2009 Social worker

_______

Visits from volunteers


Socializing with younger persons. 26.07.2009 26.07.2009-

19.09.2009

Volunteers coordina-tor

_______

Social worker

_______

Other ac-tivities


Identifying cultural ac-tivities and campaigns in which the el-der wishes to participate.

26.07.2009 26.07.2009- 19.09.2009

Volunteers coordina-tor

_______

Social worker

_______

This annex was drawn up in two hardcopies, one for each side, with the beneficiary’s agreement.

Date: 29.06.2009 Person responsible for the case: Beneficiary:

76


I.4.16. DECISION FOR ENDING THE SERVICES

Alternative Sociale Association, with office situated in Iaşi, adress _____________________, through (first and last name) _______________, social worker and person responsible for the case, hereby informs you that the psycho-social services will end for Popovici Flavian, case registration no.: 73/19.06.2009, according to the following details:

Date of ending the services: 19.09.2009.

Reasons for ending the services: • Reaching the objectives established with the client in the plan of services;• Offering material support consisting in social tickets with a total value

of 400 RON;• Reaching the objectives of the psychological counseling;• Mediating the relation to the public social services didn’t lead to receiving

an emergency material support due to the fact the client receives money from his wife on a monthly basis;

• The medical insurance has been obtained; • Medical investigations in the hospital have been completed;• Juridical counseling for obtaining the deficiency pension and other

social rights;• The file for obtaining the deficiency pension has been submitted;• The client participated in socializing activities.

This decision was made in two copies, one for each side.

Date: 19.09.2009 Person responsible for the case: Beneficiary:

77


I.4.17. FINAL REPORT

I, the undersigned, (first and last name), social worker and responsible for the case, propose ceasing the assistance for Popovici Flavian, beneficiary of psycho-social services.

The client received the following services: • Support for a period of 3 months, while he received material support

consisting in social tickets with a total value of 400 Ron.• Psychological counseling for: depression;• Juridical counseling: for obtaining the deficiency pension and other

social rights; • Mediation: public social services for obtaining support in emergency

situations – not achieved because the client was not eligible.• Other services: Socializing – weekly visits from a volunteer of Alternative

Sociale Association.

The assistance is ceased due to:n Reaching objectives – the elder will be monitored for 3 months. Client refused further assistance. Referred to similar services Client’s lack of cooperation Changing the legal domicile of the client Other situations: _______________________________________________

Contact person for following the case evolution: Popescu MădălinaContact address: 3 Narciselor street, IaşiTel: 0332/ 761xxx; Fax: not the case; Mobile: not the case;E-mail: not the case.

Date of final report: 19.09.2009Social worker, responsible for the case: (first and last name) Signature:

Supervisor: (first and last name) Signature:

78


I.4.18. MONITORING REPORT

Case registration no.: 73/19.06.2009Name: POPOVICI First name: FLAVIANDate for starting the assistance: 19.06.2009Date for ending the assistance: 19.09.2009

Observations regarding the development of the case: During the monitoring visit, the following things were concluded:

• The client still lives alone, being visited by his daughter ; • He obtained the deficiency pension, of 500 Ron;• With daughter’s support and the financial support of the wife, the client

submitted the file for obtaining an electric wheelchair, with partial material support from the state;

• With the newly acquired wheelchair, the client is able to do shopping alone, walks on long distances, being able also to go to institutions in order to solve his situation; he is glad that he can do these things without any support from other persons;

• Socializing – after obtaining the wheelchair, the client started to go visit his friend;

• Health situation – the health situation has worsened, especially regarding the feet and muscular system, but he takes the treatment prescribed and goes to periodical medical visits;

• Relation with his wife – from his statement, the relation has not improved but his wife still offers financial support to the client although he has his own personal income;

• Relation with his daughter – is positive; she remains the resource person for the beneficiary, although now the beneficiary is able to pay some of the bills and do little shopping on his own using the wheelchair for mobility reasons;

• Relation with his son – is positive, maintained by telephone; they speak around three times per month.

Proposals: Closing the assistance due to the fact the objectives of the intervention plan were achieved and the elder’s evolution is good; the medical condition remains an issue but it has to be taken into account the fact it cannot be improved significantly, but controlled.

Date: 15.10.2009Person responsible for the case: (first and last name)Signature:

79


BIBLIOGRAPHY:

1. Achenbaum, W. & Bengtson, V., „Re-engageing the disengagement theory of ageing: On the history and assessment of theory development in gerontology”, in The Gerontologist, no. 34 (6), 1994;

2. Beresford, P. & Croft, S., Citizen involvement. A Practical Guide for Change, Macmillan Press LTD., Houndmills, 1993;

3. Blau, P., Exchange and power in social life, John Wiley and Sons, New York, 1964;

4. Cox, E., „Empowerment of low income elderly through group social work”, in Social work in groups, no. 39, 1988;

5. Cumming, E. & Henry, W., Growing old. The Process of Disengagement, Basic Books, New York, 1961;

6. Cumming, E., „Further thought on the theory of disengagement”, in International Social Science Journal, no. 15, 1963;

7. Cumming, E., „Engagement with old theory”, in Ageing and Human Development, no. 6, 1975;

8. Dowd, J., Stratification among the aged, Brooks Cole, Monterey, 1980;9. Epstein, L., Helping People. The Task Centred Approach, OH: Merrill,

Columbus, 1988;10. Estes, C. & Binney, E., „The biomedicalization of ageing: Dangers and

dilemmas”, in The Gerontologist, no. 29, 1989;11. Gîrleanu-Şoitu, D. T. & Rădoi-Ciurlică, M., Sisteme de acţiune socială,

Editura Fundaţiei Academice AXIS, Iaşi, 2008;12. Gîrleanu-Şoitu, D.T., Vârsta a treia, Editura Institutul European, Iaşi, 2006;13. Goldman, A.I., A Theory of Human Action, NJ: Pretince Hall, Englewood

Cliffs, 1970; 14. Gubrium, J., The myth of golden years: A socio-environmental theory of

ageing, Charles C. Thomas Publisher, Springfield, Illinois, 1973;15. Gutierrez, L., DeLois, K. & GlenMaye, L., „Understanding empowerment

practice: Building on practitioner based knowledge”, in Families in Society, no. 76, 1995;

16. Hagestad, G. & Neugarten, B., „Age and the life course”, in Binstock, R. & Shanas, E., (ed.), Handbook of ageing and social sciences, Second edition, Van Nostrand, New York, 1985;

17. Havighurst, R., „Personality and patterns of ageing”, in The Gerontologist, no. 8, 1968;

18. Hendricks, J. & Hendricks, C., Ageing in mass society: Myths and realities, Mass. Winthrop, Cambridge, 1981;

19. Homans, G., Social behavior: Its elementary forms, Houghton Mifflin Harcourt, Brace and World, New York, 1961;

20. Hooyman, N. & Kiyak, A., Social Gerontology. A multidisciplinary perspective, Fourth edition, Allyn and Bacon, Boston, 1996;

80


21. Irimescu, G., Tehnici specifice în asistenţa socială, Ed. Universităţii „Al. I. Cuza”, Iaşi, 2002;

22. Jack, R., Empowerment in Community Care, Chapman and Hall, London, 1995;

23. Kahana, E., „A congruence model of person-environment interaction”, in Lawton, M.P., Theory development in environments and ageing, Wiley, New York, 1975;

24. Kiyak, H., „A multidimensional perspective on privacy preferences of institutionalised elderly”, in Rogers, W. & Ittelson, W. (coord.), New directions in environmental design research, University of Arizona Press, Tempe, 1978;

25. Kuypers, J. & Bengtson, V., „Social breakdown and competence: A model for normal ageing”, in Human Development, no. 16, 1973;

26. Lawton, M. & Nahemow, L., „Ecology and the ageing process”, in C. Eisdorfer & Lawtn, M. (coord.), Psychology of adult development and ageing, APA, Washington, 1973;

27. Lee, D. & Markides, K., „Activity and mortality among aged persons over an eight year period”, in Journal of Gerontology, no. 45, 1990;

28. Lemon, B., Bengtson, V. & Peterson, J., „Activity types an life satisfaction in a retirement community”, in Journal of Gerontology, no. 27, 1972;

29. Lewin, K., Field theory in Social Science, Harper and Row, New York, 1951;30. Maddox, G., „Lives through the years revisited”, in The Gerontologist, no. 34

(6), 1994;31. Martin, J., „Power, dependence, and the complaints of the elderly: A social

exchange perspective”, in Ageing and Human Development, 1971;32. Miftode, V., Fundamente ale asistenţei sociale, Ed. Eminescu, Bucharest,

1999;33. Miftode, V., Tratat de asistenţă socială. Fundamente teoretice şi metodologice,

Ed. Fundaţiei AXIS, Iaşi, 2003;34. Miftode, V., Tratat de metodologie sociologică, Ed. Lumen, Iaşi, 2003; 35. Miftode, V., Sociologia populaţiilor vulnerabile. Teorie si metodã, Ed.

Universităţii „Al.I.Cuza”, Iaşi, 2004;36. Milner, J. & O’Byrne, P., Assessment tin Social Work, Macmillan, London,

1998;37. Murray, H.A., Explorations in Personality, Oxford University Press, New

York, 1938;38. Neamţu, G., Tratat de asistenţă socială, Ed. Polirom, Iaşi, 2003;39. Neamţu, G. & Stan D., Asistenţa socială, Ed. Polirom, Iaşi, 2005;40. O’Hagan, B., „Efficiency, enrichment and empowerment”, in Journal of

Community Education, vol. 6, no. 1, 1987;41. Oliver, M., Understanding Disability: From Theory to Practice, Macmillan,

London, 1996;42. Palmore, E., „Predictor of successful of ageing”, in The Gerontologist, no. 19,

1979;

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43. Parad, H.J., Crisis Intervention: Selected readings, FSA of America, New York, 1965;

44. Parsons, R.J., „Empowerment: Purpose and practice principles in social work”, in Social. Work with Groups, no.14, 1991;

45. Payne, M., Modern social work theory, Palgrave MacMillan, 1997;46. Pivniceru, M.M. & Luca, C., Elemente de management judiciar, Editura

Hamangiu, Bucharest, 2007;47. Raymond, J. (Ed.), Empowerment in community care, Chapman & Hall,

London,1995;48. Rădulescu, S., Sociologia vârstelor, Ed. Hyperion, Bucharest, 1994;49. Reid, W.J., The Task-centred System, Columbia University Press, New York,

1978;50. Riley, M., „Social gerontology and the age stratification of society”, in The

Gerontologist, no. 11, 1971; 51. Riley, M., Johnson, J. & Foner, A., Ageing and society: A sociology of age

stratification, Vol. 3, Russell Sage Foundation, New York, 1972;52. Rose, A. & Peterson, W., Older people and their social worlds, F.A. Davis,

Philadelphia, 1965;53. Rothman, J. & Thomas, E.J. (ed.), Intervantion Research. Design and

Development for Human Service, The Haworth Press, Inc., New York, 1994;54. Schwartz, A. & Mensh, I., Professional obligations and approaches to the

aged, Charles C. Thomas, Springfield, Illinois, 1974;55. Sinnott, J., „Sex-role inconstancy, biology, and successful ageing: A dialectical

model”, in The Gerontologist, no. 17, 1977;56. Smale, G., Tuson, G. & Statham, D., Social work and social problems.

Working towards Social Inclusion and Social Change, Macmillan Press Ltd., Houndmills, UK, 2000;

57. Stern, G., „Student Ecology and the college environment”, in Journal of Medical Education, no. 40, 1965;

58. Thompson, N., Theory and Practice in Health and Social Welfare, Open University Press, Buckingham, 1995;

59. Thompson, N., Anti-Discriminatory Practice, Macmillan, London, 1993;60. Williams, R. & Wirths, C., Lives through the years, Atherton Press, New

York, 1965;61. World Vision Romania, Manual de bune practici în asistenţa socială

comunitară, Iaşi, 2003;62. Wright, K., Haycox, A. & Leadman, I., Evaluating Community Care Services

for People with Learning Difficulties, Open University Press, Buckingham, 1994.

LEGISLATION:1. Government Decision no.886 since 5th October 2000 for approving the

national Grid of assessing the needs of the elders, published in the Official Monitor of Romania, Part I, no.507 since 16th October 2000;

2. Government Decision no. 1317 since 27th October 2005 regarding the support

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of voluntary activities in the area of homecare services for elders, published in the Official Monitor of Romania, Part I, no. 997 since 10th November 2005;

3. Law no.17 since 6th March 2000, regarding the social assistance of the elders republished in the Official Monitor of Romania, Part I, no. 157 since 6th March 2007, with its following modifications and completions;

4. Law no.554 since 2nd December 2004 of administrative litigation, published in the Official Monitor of Romania no.1154 since 7th December 2004, with its following modifications and completions;

5. Law no.292 since 20th December 2011 of social assistance, published in the Official Monitor of Romania, Part I, no. 905 since 20th December 2011;

6. Order no.180 since 27th May 2003 of the minister of labor, social solidarity and family regarding the approval of the Grid for the medico-social evaluation of the persons hospitalized in units of medico-social care units, published in the Official Monitor of Romania, Part I, no. 382 since 3rd June 2003;

7. Order no.246 since 27th March 2006 of the minister of labor, social solidarity and family regarding the approval of the minimum quality Standards specific for the homecare services for the elders and for the residential centers for elders, published in the Official Monitor of Romania, Part I, no. 637 since 24th July 2006;

8. Order no.288 since 6th July 2006 of the state secretary of the National Authority for the Protection of Children Rights for approving the minimum compulsory Standards regarding case management in the area of protecting children’s rights, published in the Official Monitor of Romania, Part I, no. 637 since 24th July 2006;

9. Government Ordinance no.68 since 28th August 2003 regarding the social services, published in the Official Monitor of Romania, Part I, no. 619 since 30th August 2003.

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CHAPTER II. THE PSYCHOLOGICAL ASSIATNCE OF THE ELDERS

CHAPTER II. THE PSYCHOLOGICAL ASSISTANCE OF THE ELDERS

„ The child laughs:« My wisdom and love is the game».

The young man sings:« My game and wisdom is the love.»

The elder is silent:«My love and game is wisdom.»”

(Blaga, 2008, p. 37)

Idealized and respected, or considered a fragile period of life (Șchiopu & Verza, 1997, p. 330), third age has been studied from different disciplinary points of view, which brought important psychological contributions that were related to the unavoidable physiologic regress. Ageing is a process that affects also the psychological level, representing a qualitative change in the personality structures due to the deterioration of the cerebral functions that are the basis of the psychological life (Gal, 2001, p. 64). This transformation is influenced by both internal, intrinsic factors and external ones, represented by the socio-cultural environment and individual life events.

Approaching the psychological state of the elders is a complex step that is part of their assistance process. The intervention starts with observing the age specific challenges that the elders face. While ageing, individuals are moving from independence – earned in the first half of their life – to interdependence and even dependence. Also, some elders face specific psychological disorders that need investigations and evaluation.

The psychologists as well as other social and mental health professionals need to know the transformations that the elders meet and the main obstacles they have to face. The role of the mental health professionals is to support the elders in living this time of their life with dignity and to optimize their psychological state (Crose, 2003, p. 280).

The psychological assistance of the elders is rooted in an ample theoretical framework that aims to understand ageing from the perspective of changes that occur at psychological level. The main theories are presented in section 2.1. of this chapter in order to frame the limits in which the third age should be approached.

The actual psychological intervention, structured on theoretical models that will be listed, will be described with its main aspects, starting from the psychological evaluation (presented in section 2.2) and continuing with possible counseling themes (developed in section 2.3). These can be illustrated through

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a series of specific working instruments that will be presented in section 2.5. of the chapter and will include:

• Counseling contract, as a commitment between the psychologist and the client (model in Annex 19);

• Psychological evaluation report that includes the main synthesized data following the completion of the psychological evaluation (model in annex 20);

• Psychological counseling session report which presents the contents of the counseling session (model in annex 21);

• Individual counseling file of the client with information about the proposed objectives and details about the sessions (model in annex 22).

Starting with a well defined theoretical framework, the psychological assistance of the elders should materialize in a psychological intervention that will broaden the classic counseling limitations. The assistance will also move the psychological practice outside the counseling office, so the psychologist becomes involved in all aspects of the elders’ life, aspects that the psychologist will integrate in the counseling process (Ibidem).

II.1. PSYCHOLOGICAL THEORIES

II.1.1. Third age challenges

The third age covers a long period of the human life, which reckons different psychological problems for each stage. The limits that separate these stages as well as adulthood from the third age vary from a culture to another and can’t be drawn clearly (Şchiopu & Verza, 1997, p. 344). We will recall the three stages classically accepted: the younger old (from 65 to 75 years old), the older old (from 75 to 85 years old) and the oldest old – over 85 years.

Psychological theories about ageing argue against generalization created by the usage of stereotypes for a long time. The psychological model suggests that, while we are ageing, we become more are more different as personality, because our life experiences are cumulated in specific, particular ways (Antonuci et al., 2000, p. 80). So, discussing the third age from the psychological point of view should take into consideration the individual life experiences.

In support of this comes Baltes theory (1978), which considers personality as a synthesis of three types of factors, as follows:

• Of age category, being determinants associated to the biological age that the individual has no influence;

• Of the historic periods, known as the cohort effect;

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• Of personal history, consisting in un-normative influences that are related to autobiography and are of particular, individual nature.

At the third age a big influence is noticed from the age category factors and the un-normative ones, ageing becoming “an individualization process” (Fontaine, 2001, p. 97).

The psychological assistance of the elders is based on understanding their individuality, the specific challenges in each life stage, the social context in which the persons live, and the way in which the person is adapting to the inherent transformations during life.

Although the problems of this stage vary and differ from a situation to another, the elders face common events and contexts, which involve specific modalities of psychological adjustment.

a) At biologic level the third age involves a gradual degradation, in different proportions, of the biological functions and a series of medical disorders, often chronical and possibly immobilizing. In time and in different degrees, the elder needs to adapt to the progressive loss of physical strength and to the inability of doing tasks that were easily done before. Biological decline can lead to their dependence on others and can determine thoughts related to helplessness, fear, anxiety, but also excessive preoccupation for own health.

b) At occupational level the third age is often equivalent to retiring, although the last decades imposed a trend of increasing the age limit when the person retires from the professional activity. Ending the labor and professional preoccupation can be found unacceptable by the active persons, who don’t find a substitute for spending their free time. These persons can feel useless in their family, in the community and socially. If not correctly managed, this transition can be associated to depression and specific clinical manifestations. Good couple relationships, raising grandchildren, or preoccupation with hobbies can facilitate the transition of the elder to the retiring period and can represent a way of substituting the professional life.

c) At family level the third age, at least in its first stage, can constitute a favorable context for rediscovering family relationships: relation with the life partner, with the children that became adults and with the grandchildren, when the grandparents become involved in their education. Also, the couple relationship can also mean passing through the stages of mourning and adapting to living alone, when one of the partners die.

d) At social relations level an ambivalence of the elders can be noticed. On one hand, they wish to spend more time with the significant persons in their life, to maintain the social contacts developed during life and to be active, and on the other hand, not to be socially engaged (Gal, 2001, p. 65).

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e) At spiritual level the elders have interests related to the inevitable life ending, thus intensifying their religious preoccupations. Fear of death, uncertainty regarding the future, anxiety caused by a possible decrease of the physical and mental power can determine a closeness of the elders to religious practices, in which the elders find the necessary resources for getting through this life stage.

II.1.2. Psychological theories about the third ageThe nature of the modifications that appear in the third age, but also the

possibilities of manageing them were psychologically explained through the following major theoretical perspectives:

a) the life-span perspective, inspired from psychoanalysis, proposed by Carl Jung in 1933 and completed with new aspects through the socio-emotional selectivity model conceived by Laura Carstensen in 1933;

b) the psycho-social approach through the researches done by Eric Erikson in 1982, Jane Loevinger in 1976, Daniel Levinson in 1978 and Bernice Neugarten in 1968;

c) the socio-cognitive model proposed by Stacey Whitbourne in 1987.

These perspectives that will be detailed below are constructed on three defining components for the third age: the external rules that influence the human development, the internal pressures that are related to the personal identity and also the negotiation done by the individual in life transitions (Antonuci et al., 2000, p. 81).

a) The Life-span perspectiveCarl Jung contributed to studying the third age, being the author of the

approach that today is known as life-span. This theory presents the human development as a continuous process during the whole life, not only in certain moments of the existence (Gal, 2001, p. 65). Although inspired by the psychoanalysis, Jung considers – in opposition to Freud – that the important transformations of personality take place outside childhood and adolescence, and not in these stages.

So Jung becomes interested in the old age, which includes specific opportunities for development. Starting from adulthood and continuing with the third age a reverse of trends can be observed, which will bring the individual balance. This change will be produced on two human defining dimensions: extraversion – introversion and feminity – masculinity. If adulthood is characterized by the wish of self-affirmation and a strong manifestation of extraversion, the third age is a period in which introversion is increasing along with analysis of life and feelings, and meditation about the end of life.

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At the same time, Jung considers that in the second part of life masculine or feminine tendencies, that were repressed in the first part of life, are released, due to pressures from stereotypes. Ample empirical research suggested that, while getting older, the gender differences tend to diminish. This phenomenon, called androgyny, is more present at the level of representations (Fontaine, 2001, p. 83).

b) The Psycho-social perspectiveThe main psycho-social contribution regarding human development is the

one described by Eric Erikson, which aims to explain the gradual transformations that appear at psychological level in each life stage, as a result of the social interactions (Fontaine, 2001, p. 83).

In Erikson’s perspective, there are eight stages of human development. Each of them is characterized by an identity crisis, governed by psycho-social factors and determined by the gradual solicitations from the social environment which are becoming more complex. The identity crisis, depending on the personal capacity of adapting to new challenges, can end with an optimum result or an unwanted one, having a bipolar character. So, the way in which transition is passed through, can leave unfinished challenges that the person will have to face in the next stages or can bring new personal acquisitions (Iacob, 2005, p. 1).

The acquisitions, from Erikson’s point of view, concern the following aspects: trusting others in the infant period, autonomy in early childhood, initiative in the preschool stage and diligence in the school period, personal identity sense in the adolescence, intimacy with the partner during youth, and during adulthood the generativist which is related to profession and involving in raising the children (Antonuci et al., 2000, p. 81).

Personal integrity is the optimal result of the identity crisis in late adulthood, the last of the eight stages. This is achieved based on previous acquisitions and through reflecting to the past. In this way, the life balance can indicate for the elder that the personal objectives were reached, leading to a state called by Erikson “wisdom”, which is rare and represents successful ageing (Fontaine, 2001, p. 88).

The opposite of personal integrity is despair (Verbraak, 2000, p. 10). This is determined by all individual transformations that end with losing autonomy and with the inevitable death. Psycho-social obstacles appear when the elder doesn’t adapt to the faced environmental or personal changes (Gal, 2001, p. 65). Disappointment or despair are lived through the perspective of near life end, when the persons feel looking in their past that what they’ve realized in their life doesn’t represent them; they have regrets and can’t accept themselves.

Jane Loevinger deepens the contribution brought by Erikson, considering personality as a mental life integrator, having the role of structuring the relation between the individual and the social constraints. So, there is a specific way in which the individual reports to social norms in each life stage, depending on

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the way in which the person organizes the interaction with the social norms and values. Getting through the eight stages defined by Loevinger is optional because the individuals can remain in an intermediary stage (Fontaine, 2001, p. 88).

The last six stages proposed by this approach are dedicated to the adult life and the old age. During these periods, the social norms are approached through the following perspectives:

• conformist level, in which the person is totally compliant to the social rules because there is a strong wish of being accepted by the society;

• conscientious-conformist level, during which the individual distinguishes between the social norms and individual needs, continuing to comply to the rules;

• conscientious level, in which the person understands the importance of critical thinking and personal standards;

• individual level, characterized by the assertion of individuality;• autonomous level, which supposes understanding the complexity

of the reality in which the individual lives and developing respect for other’s opinions;

• integrated level, corresponding to old age in the Eriksonian stages, characterized by solving all internal conflicts through accepting the course one's life so far. (Idem, p. 89).

Another psycho-social approach is the one created by Bernice Neugarten, which proposes understanding the third age through the normative constraints that the person lives reported to a “social clock”. This represents the normative time, imposed by the social context, for all specific life stages: going to the nursery school, to school, marriage, getting a job, retiring etc. Essentially, from the psychological point of view, is the way in which the person is situated, reported to this time imposed by the society. So, the individual clock may be right, forward or behind, depending on the way in which the person subjectively evaluates the life moment (Antonuci et al., 2000, p. 81).

For example, an adult reaching the retirement age can consider that the time is right and natural for becoming a grandfather. He bases his consideration on the elements of the social context in which he lives – all his colleagues that retired at the same time have grandchildren. Moreover, there are also trans-generational elements for confirming the normality of his expectations: his parents, at his age, were already grandparents. But if the grandchildren don’t come, from various reasons related to the specific family context, the adult can develop thoughts of inadequacy.

A social clock perceived by the person as being forward or behind can lead to anxiety, stress, and frustration. When the events take place in the moment

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expected by the individual, his adaptation will be optimum (Neugarten, 1996, p. 90).

In the third age, accepting the new social role of the individual will be done without psychological conflicts if the component elements of this stage are seen by the person as coming naturally.

An important contribution, at the confluence of Erikson’s and Neugarten’s ideas, is the one proposed by Daniel Levinson. It sugests understanding the individual development through the life structure concept, which is built and broken in a cyclic rhythm given by the life stage in which the person is found (Antonuci et al., 2000, p. 81).

Life stages alternate between stability and transition, especially in the case of adults. Specific developmental tasks are associated to stress, determining transitions at predictable ages. Passing from a life stage to another determines the demolition of the personal structures of the individual, gained in an anterior stage and their reconstruction according to the specific requests of the next stage (Ibidem).

At the third age, the life structure involves a retrospective visualization of successes and failures, but also their evaluation through the personal values perspective. This structure has the role of assuring the psychological stability of the elder which can be done through the elder’s acceptance of the actual development stage and through a harmonious use of the resources gained through the years.

The socio-emotional selectivity theory, proposed by Laura Carstensen, is one of the most recent life-span approaches. The major contribution of this theory consists in the accent on human motivation, as a determinant factor for the behavior modifications at third age.

Motivation is strongly related to the way in which the individuals perceive time. When time is considered unlimited, as it happens during youth, knowledge is the priority although the gained information is not relevant in short term. When time is considered to be finite, as during the third age or when the context starts the perspective of life fragility, the emotional satisfaction becomes central and not the informational one23.

Information can be obtained also through social contacts but while years pass by, through repetition and routine, they will offer less development opportunities for the individual. Taking into account the preference for emotional satisfaction, but also the fact that at informational level the social contacts will have a limited potential, the elder will restrict the circle of relationships (Carstensen, 1992, p. 332).

23 http://issues.org/23.2/carstensen.html, accesed at 30th March 2010.

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So, the limitation of interactions with others can be based on the deliberate choice of the elders for safe and significant relationships in their life that maximize the emotional comfort and minimize the risks in the detriment of establishing new relations, due to the consciousness of near life end24.

c) Socio-cognitive perspectiveCombining the social influences with the cognitive patterns, Stacey

Whitbourne considers the identity construction as being defined through the existence of two components: the life scenario and story. Life scenario refers to the way in which an individual reports to his future, to the experiences he is going to live. The life story includes the past with what the person has already lived. These components are not necessarily consciously defined by the individual. They are created at cognitive level, determining the person’s adaptation to the lived social realities (Fontaine, 2001, p. 91).

The major contribution of this approach is bringing in discussion some cognitive mechanisms that function during the whole life period, without being constrained by strictly delimited human developmental stages.

II.1.3. Conclusions Although they represent different orientations, psychological theories on

human development at third age converge in describing this life period. The third age is described as a stage in which the individual looks retrospective for harmonizing his personality and for integrating the gained life experiences.

These theoretical marks led to understanding the third age, because they cleared important aspects of human development steaks. Nevertheless, they are only general guiding lines, because there is a great variability in individual's life experiences.

A short presentation of the discussed theories can be found in the following table, which synthesizes the main three psychological approaches of the third age.

24 Ibidem.

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Table of third age psychological theories

ORIENTATION THEORY MAIN POINTS

PSYCHO-ANALYSISLife-span theory, developed by C. Jung in 1933

The development covers the whole period of human life and, from the personality perspective, it includes two essential axes of the orientation towards the world: introversion – extraversion, masculinity – femininity. At the third age the introversion and androgyny are accentuating.

PSYCHO-SOCIAL

Development in stages, proposed by E. Erickson in 1982

Human development has eight successive stages, each one having a bipolar nature. The last stage of human development involves the integrity crisis vs. disappointment and has as main acquisition the wisdom, as a result of solving the crisis.

Personality development in adulthood, proposed by J. Loevinger in 1976

The third age is corresponding to the integrated stage of human development, in which the individual solves his own interior problems and accepts the road chosen in life, remaining open to new experiences, but renouncing at unrealizable ideals.

Life structure theory, developed by D. Levinson in 1978

In each developmental stage, the individual reconstructs his life structure depending on the requirements of the stage in which he is found. At the third age, the life structure means the retrospective analysis of life and the stability given by the acquisitions from the previous stages.

Social clock theory, conceived by B. Neugarten in 1968

For each event in life there is a time imposed by the social norms. When the individual feels that these events take place in the expected and anticipated moment, he will adapt.

The socio-emotional selectivity theory, model proposed by L.Carstensen in 1993, and revised in 1999

The third age involves the preservation of positive emotions. That’s why the elders, at affective, relational and even retrospective levels, will prefer the positive feelings. At the same time, the relationships with the near significant persons are foreground.

SOCIO-COGNITIVE

Life scenario and story, developed by S. K.Whitbourne in 1987

Life scenario and life story represent the way in which the individual reports to his past and future, being general modalities that don’t depend on age and stage, but on the conscious or unconscious cognitive processes.

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II.2. CONSIDERATIONS REGARDING THE PSYCHOLOGICAL EVALUATION

II.2.1. Objectives of the psychological evaluationThe psycho-social assistance of the elders also includes cases where it

is necessary to make clinical assessment of the client. According to Finn and Tonsager (McIntire & Miller, 2010, p. 499) there are three models of evaluation used in the clinical practice, depending on the purpose of the assessment:

a) Gathering information model refers to the standardized comparison among individuals, based on psychological testing, that helps the clinician to make predictions on the client’s behavior;

b) Therapeutic model is understood as obtaining information regarding psychological aspects that are important to the client, that will help him act for his development;

c) The differentiated treatment model is specific to the research domain and includes situations where the efficacy of the therapeutic intervention is being assessed.

In the context of counseling, the goal of the elder’s assessment is closer to the therapeutic model (Idem, p. 503) and doesn’t consist in gathering sterile data, but in accessing useful information for understanding the person and for solving the specific problems faced by the client.

The main objectives of the elder’s psychological assessment can be:• outlining the main obstacles that the elder might face and their

psychological repercussions (the typology, intensity and causes of the different patterns and affected psychological functions);

• highlighting some elements of the personality structure and characteristics that are related to perception, affection, cognition, memory and attention;

• pointing family relations and analyzing the close relationships of the elder;

• illustrating the way in which the elder reports to the third age and to the specific problems of this period.

II.2.2. Particularities of the third age psychological evaluation The psychological assessment in the context of the third age needs to be

adapted to its particularities, taking into consideration the characteristics of the person who is assessed, the specific instruments used and the relationship between the elder and the psychologist.

Regarding the elder’s characteristics, the psychologist will take into consideration the decrease of the fine motor functions (drawing, writing) and the

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increase of the reaction time to stimulation. These manifestations can often be associated to cognitive and sensorial deficits (Wahl & Lehr, 2003, p. 63). Because tiredness, attrition, boredom are easily met in the third age, it’s important that the assessment is adapted to the client’s level of motivation and to his capacity of participation.

Concerning the instruments used, the psychologist will use valid scales, built specifically for the assessment of the elders. The clinician will choose the instruments depending on the psychological process or the symptom that is under investigation, which will be corroborated with the clinical interview. The instruments necessary to a psychologist can include personality tests, some of it with a wide applicability no matter the client’s age, and the specific tests for different psychological processes and functions. A list of these instruments used in the geriatric psychological assessment can be consulted in table 3.125.

When the person being assessed is an elder, the self-administration scales are often applied by another person (psychologist or others), which might bring a major modification to the testing situation. The instruments often need to be simplified and it’s indicated that the possible answers do not exceed 5 categories of a Likert scale (Ibidem).

When the psychologist finds disorders that are not of his competence, he will guide the client to a specialized doctor, psychiatrist or neurologist. These specialists use a series of specific tests to assess the cognitive functions and patterns that are age specific.

Regarding the relationship with the psychologist it’s important that the assistance process start with the understanding by the client of the psychologist’s role. For the elders, the psychologist profession can be something new, that’s why a first step in the relation with the beneficiary should be defining the psychological counseling and assessment in accessible terms. Moreover, it might be useful to differentiate psychology from psychiatry, the latter being often associated to social stigmatization and to using specific medication which are not professional competences of the psychologist (Marnat, 2009, p. 49). Trust is a compulsory component of the therapeutic relation and it can’t be gained when the client is not familiar to the psychologist’s role and deontological norms respected.

The client’s expectations also influence the evaluation process. The elder might be reserved, having fears about self-disclosure and might also refuse to cooperate with the clinician. That’s why the psychologist will take into account the elder’s suspicions and will assure a comfortable climate for the beneficiary. The psychologist’s actions will aim to present to the client the assessment as a way of self-understanding and as an opportunity to self-development. A

25 Part of these instruments is standardized also for the Romanian population. A list of these tests can be consulted on the following links: http://www.testepsi.ro/cuprins/ and http://www.sistempsi.ro/index.php?page=teste-psihologice-etalonate.

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presentation of the counseling relationship can be found in the section 2.3.1 of this chapter.

II.2.3. Stages of psychological assessment The psychological assessment of the elder is a complex process in which the

different chronological stages must be planned with care (Westhoff & Kluck, 2009):

a) Establishing the counseling relationship with the client is the first step that the psychologist must undertake. Surpassing this phase, the intervention will not have optimal results. This can be done through an emphatic attitude that doesn’t intimidate the person and through an open and secured environment that doesn’t scare the beneficiary.

b) The clinical interview includes the presentation of the purpose of evaluation and the conditions in which it will take place, making the client’s anamnesis and pointing out the important information by semi-structuring the intervention. At the same time observing the client’s behavior will be used and corroborated to observing the client in his living environment or other contexts, if possible.

c) Using specific psychometric tests is the next step of the assessment. These instruments focus on psychological processes and personality aspects of the elder, reported to the identified problems. When the obtained information is insufficient, the psychologist will discuss with the other team members or with other persons from the elder’s informal network in order to obtain more relevant information.

d) Interpretation of the obtained data will be synthesized through the creation of the psychological evaluation report which will include the psychologist’s notes and recommendations for the client. The report is useful for both psychologist and other team members with which he/she collaborates (Luca & Azoiţei, 2007, p. 58). For a model of a psychological assessment report, please see Annex 20.

e) Giving a feedback to the client is the last step of the psychological assessment and will be given in accessible language and terms, in a clear and professional way (Marnath, 2009, p. 49).

Taking into consideration the confidential nature of the psychological assessment, both evaluation process and its results must be guided by ethical and deontological norms and must respect the client’s rights. This includes the informed agreement of the client, the qualification of the persons that make the assessment, using valid instruments, confidentiality of the results and interpretation.

The professional standards at international level impose certain rules regarding the goal, methods and results of the clinical assessment for protecting

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the persons that use psychological services. Taking into consideration the ethics the psychologists must respect, above all, the elder and his welfare.

Recommendations of instruments in working with third age clients,adapted from Wahl & Lehr, 2003

Area of assessment Instrument Observations

COGNITIVE COMPETENCE Raven test, conceived

by J. Raven in 1936

Raven is a nonverbal intelligence test that measures the general intelligence or the level of mental development. The test has more than one version, from which the Standard Progressive Matrices can be used for assessing the intelligence of adults and elders. It contains 5 sets of 12 items and is applied in a limited time.

PERSONALITY

NEO revised Personality Inventory (NEO PI-R), developed by Costa and McCrae

The inventory aims to assess the 5 dimensions of the personality from the Big Five model and permits the identification of 30 facets of the adult personality.The self-assessment version includes 240 items, requiring a long period to complete.

DEPRESSION

Hamilton Depression Scale, proposed by Max Hamilton in 1960

Used as a reference for other similar instruments on different age categories. Some authors suggest that certain items aren’t appropriate for elders, because the questions related to somatic symptoms can lead to over-diagnosing depression (Linden et al., 1995, p. 150). Nevertheless, it’s used on a large scale at this age category1.

Geriatric Depression Scale (GDS-15), proposed by Yesavage in 1982

Inventory for assessing depression with yes/no type items. Can be applied without an ample advance training of the evaluator.The scale has many versions, the 15 items version being the most used (Ladea, 2000, p. 82).

Beck Depression Inventory (BDI), developed in 1961

Was not especially conceived for elders, but it’s often used in assessing depression in elders and in caregivers of persons diagnosed with dementia (Ibidem).

ANXIETY

State-Trait Anxiety Inventory (STAI, adult version), conceived by Spielberger in 1983

The test measures the anxiety as a characteristic and as a state through 40 items and it has many clinical applications.

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COGNITION, MEMORY

Mini Mintal State Examination (MMSE), scale conceived by Folstein et al. in 1975

Applying the test lasts approximately 10 minutes, but it won’t be useful for detecting subtle memory loses, especially of the patients with a high level of education (Tombaugh & McIntyre, 1992, p. 922).

Rey Memory Test, conceived by A. Rey in 1964

The test is useful in measuring the capacity of the memory to store, keep and update information. The test has 6 phases, 5 of them based on reproduction and 1 on recognition. The version most used is the one with 15 items. (Răşcanu, 2003, p. 36).

II.3. COUNSELING THEMES IN THE PSYCHOLOGICAL ASSISTANCE

II.3.1. Counseling relationship We speak about counseling relationship when we refer to the connection

established between the psychologist and his client, the person to whom counseling is being applied. Lambert and Barley (Lambert and Barley, 2002, pp. 17-32) concluded that the positive result of the therapeutic process (including counseling) is due: 40% to extra-therapeutic factors, 30% to the therapeutic process, 15% to expectations, and 15% to techniques employed.

In other words, the success of the counseling process is predicted mostly by the quality of the relationship established between the psychologist and his client. This quality is determined by both counselor’s characteristics and the perception of the counseled person with regards to the counseling process. Due to the different bio-psycho-social contexts, elders can bring into the therapy anxiety regarding the interpersonal relationships, distrust and unrealistic expectations.

Counselor’s characteristics:• Authenticity, honesty;• Unconditional acceptance;• Empathy;• Agreement upon the counseling’s goal and objectives.

In the case of counselor’s characteristics, we speak of fixed characteristics (age, gender etc.) and interpersonal qualities and resources involved in the counseling process.

Regarding the client’s perception on the relationship we refer to the feelings towards the counselor (trust, respect, closeness, dependence, collaboration, friendship, worries about the way in which the therapist perceive himself etc.) and to what the client feels during counseling (the ability to discuss different things, acceptance, misjudgment, comfort, capacity to express emotions – even

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crying, capacity to understand, security, support, importance and valorization from the therapist, capacity to follow the working agenda).

It is concluded that the client’s perception of the counselor is more important at the beginning of the relationship. That’s why in the first session it’s important to give special attention to constructing the counselor - client relationship.

II.3.2. LonelinessMrs. S. is a 71 years old woman. She became a widow 9 years ago. One year

earlier, her only son emigrated to a western country. Soon, her medical problems aggravated. Although she had a sister living in the same city, Mrs. S. started avoiding her and asking her not to visit. At the same time, the relationships with her neighbors of the same age significantly diminished. At the beginning of the assistance process Mrs. S. used to express herself using an aggressive tone, accusing the close persons that they tried or are trying to take advantage of her and crying because she is lonely and helpless.

In most cases, loneliness can be at a certain point, a choice through which the elder tries to face the specific situations as: retirement, illness or losing the life partner. As time passes by, the natural need of communication within relations appears. As the time period between the moment when one chooses to be alone and the time when one re-starts his/her relationships is longer, the difficulties of initiating contacts with other persons are higher. These difficulties are related to the poor interpersonal communication, determined by the lack of exercise or an excessive focus on the personal needs/losses or the diminishing capacity to initiate and develop relationships.

Unsuccessful attempts to initiate contacts with other persons lead to strengthening the beliefs that lower the self esteem. Loneliness can evoke the feeling that “everybody has friends and I don’t”. Such thoughts lead to loosing trust in other persons, reluctance to change or to try new things due to the fear of being rejected by others.

Poverty, illness, addiction to medical drugs represent factors that contribute, gradually, to self-isolation. Due to the absence of a person to talk to, wish of “not disturbing” the children who are occupied with their own families or feeling misunderstood, the elders significantly diminish their contacts with other persons and withdraw in the loneliness of their home.

Loneliness is often felt as soul emptiness, being associated with the feeling of being unwanted and not important. In many cases the elder’s social withdrawal is a symptom for depression, which is emphasized sometimes by the absence of the significant persons from their life.

In order to assess the level of loneliness felt by the elder, we need to differentiate between the number of human contacts that the elder has and the quality of those contacts. During the counseling interview we find out that the person meets periodically with the family doctor, salutes the neighbors, talks to

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the salesman etc. But, all these interactions remain at a superficial level, without exploring emotions.

One of the most efficient ways of treating loneliness is through therapy focused on:

• Unconditional acceptance. This is a positive attitude of understanding a person without judging or agreeing with what the client expresses. It is the trust that the counselor offers to his client, of having the capacity and potential of taking decisions and assuming his own life (e.g. “You said that you don’t like talking with other persons. Should I understand that you feel best when you stay with your own thoughts?”).

• Empathy. It involves listening to the elder, understanding him, focusing on the problem and on his feelings, and communicating this understanding so the client starts to know himself better (e.g. “You feel abandoned because both your daughter and nephew haven’t called for three weeks…”).

• Assessing the level of loneliness (e.g. “Describe a usual day. What do you do from the time you wake up till you go back to bed? Do you meet other persons? Who are these persons? What do you talk about?”)

• Understanding the cause of the problem. Referring to loneliness, the greatest challenge is making the elder aware of the fact that loneliness is a personal problem. Most often it’s not only one cause that – once discovered – can be approached in the counseling process, but a variety of factors: misunderstandings with family members, lack of communication skills, illness, elder’s personality structure etc. Identifying loneliness as a problem and the causing factors is followed by exploring each factor in terms of thoughts, feelings and attitudes.

• Reversing negative thoughts, feelings, and attitudes (e.g. The elder: “Everybody has friends and I don’t.” Counselor: “How would your life be with more friends?”)

• Exploring the resources of the elder to approach to the present in positive terms (e.g. “In your situation, which are your strengths that could help you in establishing a relationship?”)

• Developing the interpersonal communication skills. Working for developing these skills starts with establishing the “strategy” for change (e.g. “What would you say to X? How would you react in situation Z?”).

II.3.3. Losses in the elder’s lifeMaria is a widow of 73 years old who showed symptoms of depression after

the death of her husband, two years ago. In the first interview Maria stated that after this event, her medical problems started to worsen, food seemed tasteless and she started losing weight constantly, from 56 kg to 44. During the anamnesis, every subject was presented from the point of view of an organic suffering most

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of which had no medical diagnosis. Her husband’s death was presented through the perspective of two years spent taking care of him while he was unable to move.

Throughout the life course, inevitably, any person is confronted with different loses: things, friends, house, rights, jobs, dignity, health, important persons, family roles etc. The way in which these loses are handled depends on the developed self image, on the way in which people learned to look at themselves and on the relationships with the others. According to the psychology of the self concept (Shavelson & Bolus, 1982, pp. 3-17), self image is formed starting with the first months of life and during the years it develops and changes depending on the repeated different life experiences, regarding especially the relationships with significant persons.

The elders face loses differently than young persons, because the level of attachment to the lost thing/person increased through time and because the limited perspectives on the future, which causes reluctance in imagining the future and “hanging” on the past.

A way of working with the elders who faced loses is to ask them what they feel regarding the loss. It’s very important to listen and respect their emotions, no matter what they feel: regret, anger, relief, guilt etc. The next step is to focus on the present through exploring the internal and external resources and guiding them to the future.

II.3.4. Preparing for deathThe reactions of a person regarding his own death are different depending

on the personality structure of the individual and the formed attachments, on the illness state and on the relation with God.

So, the values and beliefs of a person about himself and about the world can favor the process of accepting the imminence of death or, on the contrary, makes the person reluctant in admitting it. Individual values like respecting the dignity of each person, honesty, truth or justice reflected in behaviors during life contribute to the feeling of peace with himself at the old age. At the same time, life experiences that are contrary to the values promoted by the family (including the person in cause) bring in the memory of the elder certain frustrations and possible regrets that maintain the person in specific moments in the past which makes the idea of separation impossible.

Another factor that can influence the process of understanding that death is inevitable is represented by the elder’s attachments, especially the new attachments: grandchildren. They can represent a dignified, peaceful way through which the elders project a farewell, by seeing in the grandchildren a continuation of their own person. At the same time, the grandchildren can be a barrier in accepting death, when the elders feel the need to solve their own frustrations through them.

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The severity of the elder’s illness can also impact on the preparation for death. The illnesses that cannot be cured, that are long lasting and that have a significant family impact (cancer, paralysis, heart diseases etc.) influence the process of accepting death. In many of these cases saturation appears, the elder stating that he/she wishes to “get over with it”, feeling tired and guilty for the family situation.

In the case of religious elders, the relationship with God is found through praying and the religious rituals/symbols, in the way in which they perceive God’s role in their life. Through prayers, the dying person expresses his/her own fears, hopes and even anger. At the same time the prayer is the way through which the elder takes God as a witness and attendant in the process of accepting death.

Counseling for the preparation of the elder for death must take into consideration the completion of five stages for reaching the feeling of acceptance (Kübler-Ross, 2009, pp. 31-111): (a) denial, when the person tries to block the thoughts related to the imminence of death; (b) anger – when the feeling of injustice appears and the person feels that dying is unfair; (c) negotiation – attempts of delaying death through promises to himself or through trying a way to make a deal with God; (d) depression – the reality of death imminence is perceived in an acute way; (e) acceptance – the person reaches a resigned and reconciled understanding of the death imminence. These stages of acceptance aren’t predictable sequences. Several stages might be felt at the same time and the progress from one stage to another doesn’t have a certain order: the person can pass from one stage to another more rapidly and, at the same time, the stages can be lived over and over again. The way in which a person faces the process of acceptance is different from an individual to another, as shown above.

II.3.5. Addiction to medical drugs

Addiction is the trend of finding help and protection from someone else, of letting someone else to take any decision as a result of losing maturity and autonomy (Larousse, The Great Dictionary of Psychology, 2006, p. 322).

Dependence appears due to a need, most often an affective one, as result of a low self-esteem or an emotional trauma that generates suffering. This need is the start point of the cycle of dependence. Once the need is satisfied through surrogates (persons or different substances), the person calms and suffering disappears. In this way, the surrogate that satisfies the emotional need becomes a form of dependence. Because the calming effect is temporary, the “doses” become higher and higher. The person reaches the stage in which his/her whole existence is built around this dependence, neglecting relationships, profession, getting isolated from the rest of the world. Difficult relationships and the inevitable consequences of this lifestyle (stealing, lying, violence etc.)

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becomes a new trigger of pain and the dependence cycle starts again (Hemfelt et al., 1989, pp. 21-22).

Helen, aged 62, suffers from nefrotic syndrome. Until the moment she was diagnosed, Helen spent two years trying several treatments, most of them selfadministrated as a result of advice coming from magazines or different persons. Now she takes 16 pills daily. Most of them are for combating the negative effects of the previous treatments taken for diabetes, hipercholesterol etc. She says there are days when she forgets to take the medicine she usually takes after lunch and this annoys her very much, as the image of the cabinet where she keeps the medicine. She feels like being the prisoner of the pills she has to take and the family doesn’t understand her suffering. That’s when she decides not to take any pill.

Along with getting old, the vulnerability to diseases and illnesses increases. Most often the elder suffers from different ilnesses at the same time, situation which leads to an increased number of pills and to a changed lifestyle: some medicine is taken when getting up in the morning, some after lunch or dinner etc. Easily the feeling that the life is governed by the medicine schedule appears. More than that, once the ilnesses progress, there is the need for family support and the elder becomes dependent on the help coming from other persons for different things such as going out for a walk or shopping.

When the elder is asking for counseling and the psychologist identifies one of the problems being saturation of medical drugs, the counselor’s role is to raise the client’s awareness regarding the continuation of life. The dependence to medical drugs cannot be changed, but the elder’s perspective on it, can. The behavioral changes that appear as result of the counseling process involve continuation of the treatments and periodically going to the doctor, who will confirm or will change the medication. Reaching these results differs from a person to another and involves going through several stages:

• Becoming aware of the need to continue the treatment (the counselor offers support to the elder in creating a list with the pros and cons of the medical treatment);

• Raising the motivation for continuing the treatment (the counselor helps the client identify the internal and external resources that make the elder be an active person and/or be present in the family life. Example: “Which are the things that you planned to do in your life and succeeded to do so far?”; “Which are your strengths that can help you succeed?”; “Is there a person or persons that you feel close to?”);

• Identifying and practicing different strategies to face the possible situations in which the elder feels discouraged by the addiction.

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II.3.6. Religious coping Coping, defined as thoughts and behaviors used for responding to the

internal and external demand in situations felt as being stressful (Folkman, Moskowitz, 2004), is subject of scientific researches since the ’60 when the work of Richard Lazarus, Psychological Stress and the Coping Process (1966), appeared. Most researchers wanted, by approaching this concept, to explain why some persons face stressful situations while others don’t.

Studies led to including the coping strategies in cognitive-behavioral intervention programs in which developing these strategies lead to constructing and orienting the person toward solutions involving mobilization of resources and raising confidence in success.

On the other hand, another theme related to the way in which persons cope with stress and/or traumatizing events in their life, is religion and being religious. Despite the difficulties met in defining the religion construct, many researches indicated positive associations between religion and positive adaptation and between religious beliefs and practices and emotional wellbeing (Ross, Handal, Clark, Vander Wal, 2009).

Pargament et al. (1988, apud. Kolchakian, Sears, 1999) identified three religious coping styles:

a) Delaying – the individual counts on God for coping with stress and stressful events;

b) Collaborative – the individual and God understand having a common responsibility and working together for reaching a solution;

c) Self-orientation – is an active approach in which the individual counts on himself in order to cope with stressful situations, but at the same time keeps a certain religiosity level.

Researchers have shown that adults especially prefer the religious coping as a defense mechanism especially in very stressful situations. At the same time positive correlations were identified between collaborative style and self-esteem and negative ones between delaying and competencies (Pargament et al., 1988, apud Kolchakian, Sears, 1999).

In a study developed by Bosworth, Park, McQuoid, Hazs and Steffens (2003) on a population of 114 elders over 60 years old and suffering of depression, the authors tried to see how the religious coping influences the evolution/regression of the illness. For this the religious coping was defined as being positive or negative. The positive religious coping was highlighted through the following declarations “I’m thinking of how my life is part of a greater spiritual force”, “Me and God work as partners”, “I’m leaning on God for power, support and guidance”. The questions that explained the negative religious coping were “I feel God punishes me for my sins or my lack of spirituality”, “I wonder if God abandoned me” and “I’m trying to figure out how things are and to decide what

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I want to do without God’s help”. The results have shown that (a) religiosity and religious coping correlate to depression; (b) the positive religious coping have long time influences on the depression levels; (c) the negative religious coping correlate to severe symptoms of depression when the illness starts, but there aren’t correlations with the effects of depression six months after the illness starts.

These results are consistent with other studies that highlight the importance of religious coping in the process of adapting to stressful or traumatic situations. Also, an important result of the studies in this domain is the identification of factors that mediate between religious beliefs and practices and mental health. Some of these mediating factors are mentioned below (Jones, 2004):

• Many religious practices lead to “relaxing responses” that contribute to reducing the activity of the sympathetic nervous system, the muscular tension or decreasing arterial tension.

• Religion contributes to reducing the involvement of the individual in unhealthy behaviors such as: alcohol abuse, smoking, drug abuse, unprotected sexual contacts, suicide attempts etc.

• Religious practice correlates positively with high social support, fact that has consequences on physical and mental health.

• Religious persons comply more easily to medical treatments and doctors’ advice.

• Religion contributes to an increased feeling of coherence and life significance in hoping for a better future.

The mediation factors described above are at the same time motivational variables in the counseling process. That’s why, when working with elders it’s important to assess the perceived importance of religion in their lifes for encourageing the development of the religious coping strategy when confronting stressful situations and events related to ageing.

II.4. MOTIVATIONAL INTERVIEWING

Doctors William R. Miller and Stephen Rollnik are professors of Psychology and Psychiatry at the University of New Mexico, respectively within the Department of General Practice at the University of Wales College of Medicine. Beside the numerous publications, the professional experience includes many years dedicated to the domain of addictions through clinical researches and direct work with affected persons.

Motivational interviewing as a clinical approach raised a huge interest from its first edition, in 1991. Confronted with many requests for clinical training, the authors trained 300 persons that afterwards put the basis of a training network that was reunited in an international organization visible through the website www.motivationalinterview.org. Extending the applicability of this clinical

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method from addictions to other domains such as social working, mental health in general, penal justice etc. led to re-editing the book in 2002, at Guilford Press, New York. A short introduction in the motivational interviewing is presented bellow.

II.4.1. Definitions and terms Motivational interviewing is not, as suggested through its name, an

interview with standard questions and quantifiable answers, but a directive counseling method, centered on the client, which focuses on raising the intrinsic motivation of the person to change through exploring and solving ambivalence.

There are some terms used in explaining motivational interviewing which reflect the principles on which this method is based:

• Ambivalence is a normal aspect of human nature. It reflects insecurity related to a certain situation. We wish or want to do a certain thing, but at the same time we refuse to act for different reasons. The ambivalence becomes pathological when the person is blocked in insecurity (to quit alcohol, drugs, to make a significant change in his life etc.) and frustrations, regrets and intensity of emotions become an impediment for his psycho-social functioning.

• Decisional balance is an instrument used by the counselor to reflect to his client the benefits and costs of two opposite behaviors that are the object of the ambivalence: the harmful behavior (e.g. use of alcohol by dependent persons) and the healthy behavior (e.g. quit drinking). So, for illustrating the example above, a file of decisional balance is used, and it includes the main two ”themes”, each one with its benefits and costs as they are perceived by the client: theme 1 – ”continue to drink alcohol” benefits (”is relaxing”, ”I can say what I feel”, ”I’m with my friends” etc.) and costs (“family rejects me”, “I’m trembling the next day”, “I can’t focus”, “I take pills that make me feel worse” etc.); theme 2 – “quit drinking” benefits (“family is beside me”, “I feel better physically” etc.) and costs (“I can’t say what I think”, “I won’t have an ally to help me forget”, “friends are judging me and leave me” etc.).

• Expressing empathy through a respectful attitude, accepting the person and his ambivalence. Empathy is a technique through which the counselor perceives the internal reference of another, accurately, with all its emotional components and meanings that are ”just as” being the other person, but without losing the ”just as” condition (Carl Rogers, 1959, apud Gherghinescu, 2001, p. 27). Accepting the person and his ambivalence includes active and reflexive hearing without making judgments, without critics or blaming, and with admitting the reticence to change as a normal manifestation of the process.

• Developing discrepancy between the present behavior and the client’s

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values. Raising the motivation to change involves a process in which the client becomes aware of the importance of change through the arguments brought by the client, arguments that sustain the contradiction between expressed behavior and what the client values in life (e.g. the client values honor, but realizes that in all life aspects he lies).

• Fighting with resistance seen as a way through which the counselor, facing the client’s resistant answers, helps him formulate the arguments for change that are not directly given to the client, but rephrased (ex. Client: “I feel I don’t have any more power. I just don’t think that I could change at my age.”, Counselor: “You work very hard to change.”)

• Promoting an optimistic attitude and confidence in own capacities (self-efficiency). This principle includes on one hand the confidence that the counselor invests in his client as having the necessary resources to change, so this turns into self-fulfilled prophecy, and on the other hand the client’s confidence that he can change, as a motivational factor.

II.4.2. Stages of motivational interviewing Motivational interviewing as a method is structured by its authors (W.

R. Miller şi S. Rollnick, 2002) in two stages, depending on the client’s level of readiness to change: building the motivation for change and strengthening the commitment to change.

1. Building the motivation for changeIn this stage, a special importance must be given to the way in which the

client perceives change: to what scale this change is seen as being a priority and how much confidence is given to success. Both the perceived importance and confidence in success can be evaluated during the interview with the help of numeric or percentage scales where 0 is “not important at all”/”totally not confident” and 100% is “”very important”/“very confident”.

This beginning creates the premises for the speech about change and at the same time can represent a way of monitoring progress during sessions.

During this stage, the client’s resistance is inevitable. It doesn’t have to be perceived as one of the client’s ways not to cooperate to the counseling process, but as a natural and normal answer in the assistance process. Actually, the resistance includes a signal that the client gives to the counselor telling him that he isn’t ready or the rhythm is too fast. An example of resistance can be the case in which the diabetic elder seems not to understand the importance of diet. So, although the counselor uses medical information through which he explains the risks to which the person exposes when eating sweets with sugar, the elder answers through “I know, but the sweets for diabetics are expensive” or “You don’t know how it is to restrain yourself all the time and crave…then…my family

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got used to asking me to make them cookies and I like cooking for them”. The answers to this type of resistance include using specific counseling techniques:

• Reflection (“It is difficult to imagine that someone could understand how it feels craving all the time and not being allowed to taste…”);

• Changing perspective (“I’m glad that you know about all these things. Tell me, how was it the last time when you ate sweets?”);

• Rephrasing (“Abstinence is indeed frustrating and the thought that something is forbidden creates discomfort… How do you feel this discomfort?”);

• Putting accent on assuming responsibility (“The decision to eat sweets is yours. All I can do is to tell you what are the advantages and disadvantages of doing so, but you decide if you respect the diet or not”).

Raising the confidence for change is another component of building motivation to change. This component includes the client’s own resources using a series of techniques such as:

• Evocative questions through which ideas to solve problems are stimulated by discovering personal qualities (“What obstacles do you think you will meet in your attempt to give up sweets and how could you get over them?”);

• Scale of confidence (“What would involve for you to go from 4 to 6 on the confidence scale?”);

• Going through successful events in the past (“In the past, did you have moments in which you refrained from sweets? How did you succeed?”);

• Hypothetic change (“Let’s suppose you’ve succeeded in respecting the diet and it makes you feel good about yourself. If you’d look back, what do you think would have functioned then?”).

2. Strengthening the commitment to changeThis phase of motivational interviewing is one of the actions in which the

client and the counselor collaborate for building a strategy to change, using the decision to change and the resources previously identified.

Although the stage of strengthening is more active, it must include the same principle of collaboration and understanding the nature of change: the ambivalence won’t disappear completely after taking the decision and that’s why the counselor must be aware of the fact that there might be relapses in which the client doubts the balance of the decision to change. In this case, the counselor’s reaction must be supportive through discussing again the advantages and disadvantages of changing the problem behavior, but keeping at the same time the attitude of focusing the responsibility of change on the client. This reaction from the counselor prevents also the risk of prescribing the plans to change: from too much enthusiasm, the counselor might come with ideas about what and how the clients must do, diminishing the activation of the client’s own resources. At

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the same time, too little involvement from the counselor is not indicated: the second stage of the motivational interviewing is a negotiation of the alternatives identified by the client for himself with the help of the counselor.

The process of negotiation, characteristic at the beginning of the second phase, is related to establishing goals as a result of two progresses obtained in phase 1: change is a decision taken by the client and he is aware of his internal and external resources. The counselor’s task in this stage is to facilitate for the client the formulation of specific, measurable, achievable, realistic and t i m e d goals. This SMART approach will contribute to creating a coherent change plan. Practically the counselor must avoid the expert’s trap in which he proposes solutions without taking into consideration the client’s option. Questions that might help in such a phrasing: “What would you like to change?” (the answers must be related to specific behaviors and not general or abstract notions like “my life”, “marriage”, “being at peace with myself” etc.), “How do you see things different from now?”. The supportive questions will be centered on specific: “What exactly would you like to change in your life/marriage?”, “How would you behave if you were at peace with yourself?”. The measure of the wanted behaviors is their frequency (ex. “To bring flowers to my wife at least once a month”, “To ask for forgiveness to the persons that suffered from my alcohol abuse” etc.). It is indicated to find answers that reflect the client’s own resources, which makes the goal reachable and realistic at the same time. From this point of view, a special importance must be given to the principle of self-efficiency when the responsibility for change is on the client and not on other persons in his life. The behaviors followed in phrasing the goals must include actions done by the client and not by other persons. Change is possible for your own person. The responsibility for change is on the client and not on other relevant persons in his life.

After establishing the goals, the options to change must be considered. These options refer to the strategies that will be used for change: internal resources, social support. This is a more creative step when brainstorming can be used for creating a list of possible strategies to reach the established goals. It’s important to underline for the client that all ideas are welcomed and that afterwards those are going to be evaluated and compared so, at the end, only some of the ideas will be selected. Another method involves creating a list of possible solutions that were useful for other persons that faced similar problems, and present this list to the client which can select the wanted solutions and adapt them to his own person.

Once the goals are established and the list of strategies is created the plan for change is established. This step needs the same flexibility characteristic to motivational interviewing. Starting with the results obtained before, the counselor will formulate opened questions to stimulate as much as possible the client’s option (“What do you plan to do?”, “Which is the first step?”, “How do

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you plan to act?”). Negotiation is the basic principle at this point, the counselor having the task to summarize each negotiated strategy for assuring both client’s acceptance and counselor’s understanding of the plan.

When a common understanding is reached, in order to stimulate the commitment to change a plan of change sheet will be created, having a structure proposed by the counselor and approved by the client. This structure reflects especially the summary of the previous step, and the phrasing will use first-person, singular forms and will include:

Plan of change sheet

1. The most important reason for making this change is: …………………………….

2. My main goals in making this change are:a. …………………….b. …………………….c. …………………….

3. I plan to do the following changes for reaching my goals:

Specific action: When?

4. The persons that can offer me support are:

Person: How can s/he offer me support?

5. Obstacles in my process of change and how can I overcome them:

Possible obstacles: How can I react?

6. I will know my plan functioned when I will see the following results:a. …………….b. …………….c. …………….

This plan aims to clarify as much as possible the steps to be followed by the client. Its functionality depends on the verbal agreement of the client to follow it. The counselor must take into consideration the fact that it’s possible that the person in front of him is not prepared yet for taking action. It shouldn’t be insisted in this case. A good thing to do in this case might be suggesting the client to take this plan back home and meditate on it until next meeting.

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II.4.3. Motivational interviewing and stages of change. Case presentationMotivational interviewing can be used for different behavior problems, from

addictions (of drugs, alcohol, medicine etc.) to life situations that involve taking decisions (changing residence, behavior, family doctor etc.) At the same time, motivational interviewing is applicable also in other theoretical methods such as the Trans Theoretical Model (MTT –proposed by Prochaska and DiCelemente in 1983 and revised in 1994).

This model offers an integrative frame of behavioral change, involving progressively going through six different stages: pre-contemplation (the person doesn’t think s/he has a problem), contemplation (admits that s/he has a problem and thinks to take change into consideration, the person is ambivalent), stage of preparation (the person is ready to take action within one month), stage of action (the person takes the decision to change), stage of maintenance (the person maintains or not the action to change), stage of relapse (the person gives up change, fails or – in some cases – comes back to the problematic behavior).

The model proposed by Prochaska and DiClemente (1983, 1994) is a circle, which supposes that the individual goes through the process/stages several times before making a stable change. The motivation to change in this approach must be understood as the probability stage of some behaviors or the stage in which the person is found as being prepared to change. The counselor’s understanding of the moment in which a person facing a problem is, facilitates the counseling process and the specific intervention.

Using motivational interviewing in this model also depends on the place in which the client is found on the circle of change. So, the first step of the motivational interviewing, building the motivation for change, corresponds to the precontemplation and contemplation stages, when the counselor’s task is to make the client aware of his problem and to collaborate with him for solving ambivalence. The second phase of motivational interviewing, strengthening the commitment to change, corresponds to the stages of preparation, action and maintenance. In the sixth stage, relapse, the principles and techniques used in motivational interviewing are essential in offering the needed support to the client, now being very vulnerable: normalization of the situation, absence of judgment, raising motivation for repeating the stages in the circle of change: contemplation, preparation, action and maintenance.

For a practical illustration of using of motivational interviewing in the Trans Theoretical Model we will take the case of Mrs. C., 73 years old which lives with her son, Mr. M, divorced, without children, no occupation, aged 46. Mrs. C. has a complex medical situation, suffering from intermittent claudication, cataract, perforated ulcer and hypertension. With a pension of 410 lei, she can’t face the monthly costs. However, when she receives her pension, the first thing that Mrs. C. is thinking is to give money to her son “(…) to buy what he wants. Poor him, he doesn’t even have what to wear.” Once a month, Mr. M. gets out

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with his friends to drink. When he comes back home, be becomes violent with his mother: verbally, sometimes pushes her and shouts for hours. When asked about how she feels about her son’s behavior, she excuses him by saying that “he was drunk”.

Precontemplation stage. In this stage there are four types of answers that

are translated through reticence in connection with the existence of a problem: reluctance, revolt, resignation and rationalization. Depending on these answers, the counselor can have different reactions. It is important in the precontemplative persons to induce the idea that there is a problem related to a specific behavior instead of directly telling this.

• Reluctant persons are more often passive, aren’t aware of the fact that they have a problem. Their motivation needs time, careful listening and empathy. Mrs. C. will be listened regarding her medical problems and the difficulties faced with her son that asks her money all the time. Reflecting answers (e.g. “… you also go out of money for medicine…”) can contribute to facilitate the awareness, with the condition that the questions don’t insist on revealing the problem.

• Revolting persons are aware of their problematic behaviors and even invested a lot of energy in them. Mrs. C is a mother extremely preoccupied by her son’s welfare and she encourages him permanently when he confronts an uncomfortable situation (he can’t find a job, feels bad after a night of drinking etc.) Mrs. C’s answer to the idea that her son is a problem for her would most probably be “You can’t tell me how to behave with my child!” The best approach of the counselor in this situation is to accept this point of view “For sure, you know best when it comes to your relationship with your son and I have no intention to change your opinion on this”. Such an answer contributes to decreasing the intensity with which the mother defends her son.

• The resigned persons are those who seem without energy in approaching the topic of the problematic behavior. Mrs. C’s answer in this situation would be “He’s my own child. He’s everything left for me to have.” The message is that it’s too late to try doing something for changing the relationship with her son. The counselor’s answers must restore/inspire hope. In this case the counselor shouldn’t get caught in the trap of seeing the source of all “bad things” in her son, but the questions must focus on the mother’s need to change through re-framing the perception of how her relationship with her son could be. This change of perception in the precontemplation stage can be introduced through the question “How did you use to imagine, when Mr. M was a child, your relationship with him today?”

• Rational precontemplative persons are also energetic by being

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permanently preoccupied to bring arguments to the reasons showing that the problematic behavior shouldn’t be changed. If Mrs. C were such a person, then probably she would tell the counselor about the fact that although her son came home drunk and behaved badly, his friends are guilty. She will talk about the economic crisis and the difficulties of finding (and keeping) a job, about the employers that exploit the employees etc. The arguments involve more cognitions and less emotions and most of the time are external blames that tend to lead the conversation outside the counseling process. Mrs. C’s relation with her son can be brought back in discussion through exploring her emotions related to her son: “How do you feel about your son?” (questions will be addressed about both positive and negative aspect of the relationship). This exploration aims to place, in a decisional balance, the pros and cons of the relationship status.

The contemplation stage is the moment in which the client admits that he has a problem and starts thinking of how to solve it. The counselor’s task in this stage is to facilitate, through the decisional balance, taking a decision to change. It can be interpreted that once a problem is admitted and there’s a will to change, action can start. However, ambivalence is characteristic in this stage. Taking the decision to change is a long-term process, with progresses and failures. The counselor, by offering information, feedback, empathy, attentive listening, summarizing and raising the client’s responsibility, must tilt the balance in favor of change. This can be made through exploring the benefits of unwanted behavior and the positive thoughts related to the behavior proposed for change.

In our case, Mrs. C realizes the fact that tolerating her adult son’s irresponsible behavior makes her feel bad about herself. However, Mr. M is her only son and can’t just give up the way in which she treated him all her life and she can’t throw him out of the house. But Mrs. C doesn’t have to do this in order to feel good. The counselor can think that the things listed by the elder are possible solutions for her or can imagine that a reevaluation of the relationship with her son is the best thing to do. Actually, the only person that knows which is the best solution is Mrs. C. So, trying to define the state of satisfaction as perceived by the client can be the premises to start in building the decisional balance. So, Mrs. C’s state of satisfaction can be both imagining a more decided attitude to her son regarding his contribution to the monthly costs (wanted behavior) or the satisfaction perceived when she manages to support her child with some money (present behavior). Actually, the case of Mrs. C is not about only one behavior that could be changed for creating the state of satisfaction, but a whole perception of her relationship with her son. Defining the state of satisfaction from Mrs. C’s point of view is very important from two points of view: on one

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hand the counselor is making sure that he will work with “the client’s material” and not with his own perceptions and on the other hand this definition helps to operationalize the concept of “satisfaction” in specific behaviors that afterwards will be approached separately for change.

Stage of preparation supposes that the decision to change has been taken.

However, the direct transition to action is not yet the best choice. In this stage ambivalence is not completely solved. That’s why it is necessary to make a good evaluation of the strategy to change before acting. This strategy can be built using brainstorming or suggesting a list of options that the client can choose from and adapt to her own person.

For Mrs. C changing the perception on the relationship with her son is complex. As shown above, this change involves several other changes, but this time of concrete behaviors. After creating the list of behaviors that define the state of satisfaction (in the contemplation stage), it’s important to recreate the order of these behaviors, based on their priority. The counselor can consider that most important for Mrs. C is to identify a resource person to help her during the changing process, but for Mrs. C it is also important to be able to take the monthly medication. This can be done if Mrs. C won’t give money from her pension to her son anymore and announce her son she will do so. Leaving from this specifics, a plan of change is created (it’s important that this plan is established in the language used by Mrs. C):

Plan of change sheet

1. The most important reason for which I want to make this change is to feel better about myself.2. My goal in making this change is to make my son be more aware of the importance of my medication.3. I plan to do the following changes for reaching my goal:

Specific action:a. To talk with my son about my illnesses and what can happen to me if I don’t take my pills;b. To announce my son that I won’t be able to give him money anymore.

When?Tomorrow, after lunch.

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The persons that can offer me support are:

Person:Mrs. X, my neighbor from the 4th floor that helps us with food.

How can s/he offer me support?Can show my son the last medical letter from the hospital and to read what my doctor recommended.Can tell him what can happen to me if I don’t take all the medication prescribed.

Obstacles in change and how can I overcome them:

Possible obstacles:My son won’t talk to me.

Mrs. X can’t come tomorrow at lunch.

My son gets angry and blames the state for not helping me.

How can I react?I insist it’s important for me to have a discussion.I ask her to make an effort and if not, I plan another day when she can be present.I will tell him that until the state will help me, I have to help myself.

I will know my plan succeeded when I will see the following results:Mrs. X accepts to help me; my son understood that I want to take care of

myself and that I must take all my medication; my son starts looking for a job.

Action stage is the one in which the client gets into action. The counselor’s task is to offer support and feedback while the client implements the change. At the same time, the counselor stimulates the client’s self-efficiency, makes a reevaluation of the level of motivation to change and facilitates raising awareness of the fact that the successes are due to his capacity of interiorizing the reason to change.

Mrs. C talks about how her discussion with her son went, how she felt when telling him about her decision. Discussions about the way in which the decision was communicated, the difficulties faced etc. may occur.

Maintenance stage includes actions that refer to strengthening the

successes, being at the same time a process of preventing relapse. The authors of the Trans Theoretical Model talk about going several times through the stages of change before making the definitive change. That’s why, in this stage, the counselor’s task is, again, the reevaluation of the motivational level and to offer support in the appreciation of new obstacles. Reevaluations of the plan to change may occur in this stage.

Mrs. C feels proud for the success of talking with her son and for the fact that she can buy all the medication she needs. However, she is afraid of the possible

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reactions of her son. It’s normal that after a lifetime in which she offered financial and moral support to her son, to feel afraid to suddenly quit doing these things. The counselor’s task, besides strengthening the success, is to introduce new themes, depending on what Mrs. C feels: practicing assertive communication with her son regarding her will to change and “how will Mrs. C react when she will feel the need to help her son” (which are the clues that report Mrs. C’s wish to give money to her son; how will she react – specific behaviors – when she will feel this need (the behaviors must not be suggested, they need to come from the client): she will go talk with Mrs. X, she will say a prayer to feel stronger etc.)

Relapse stage is a normal stage in the change process. Internal factors like

habit or addiction to bad behaviors or external factors that can’t be controlled by the client (the supportive person is not available at the moment, changes in the social and family life etc.) lead to going back to the previous behavior. The counselor’s task is to offer support. In the previous stages the client invested a lot of energy: physical and especially emotional, hopes. Failing can be extremely painful; feelings of guilt and disappointment appear, depression can set easily. It’s important that these reactions are normalized and to show that the experience is an occasion to learn from and not a failure.

Mrs. C’s son arrives home depressed. He tells his mother that he won’t ever find a job: he doesn’t even have shoes and something to wear at an interview or in a discussion with an employer. Mrs. C thinks that if she gives him clothes and shoes, he will find a job and both will be satisfied: she gives him money. Mr. M comes home few hours later, drunk. Mrs. C doesn’t have money for her medication in the current month and endures the injuries of her child. Everything is like before. The counselor’s empathy and reflection constitute the initial support for normalizing the feelings felt in present; by rephrasing, going again through the change stages is induced, with the reevaluation of the motivation and the plan of change (ex. “The fact that you succeeded for so long to keep your decision shows you are a strong person. Scientists say that for making a definitive change we must be able to pass through such experiences because they help us learn what to do so we don’t repeat them. What do you think you have learned from giving up your money for medication?”).

The examples above illustrate just certain situations that can occur when working with elders, in which motivational interviewing and the Trans Theoretical Model were used. The elders’ problems are extremely various and the way in which the counselor facilitates change of behaviors using the techniques of motivational interviewing and other learned techniques and theoretical models depends not only on the capacity to structure theoretical information, but on the counselor’s creativity and capacity to realize that the expert in the client’s problem is the client himself.

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II.5. ELDERS RESILIENCEII.5.1. Theoretical perspectives

Resilience is considered to be a personality characteristic that moderates the negative effects of stress and promotes adaptation (Richardson, 2002, apud Wells, 2010). Although the concept of resilience is not new, it entered the social and human sciences in the ’70 when studies and researches focused on differences of people’s way of coping with similar traumatic events (Munteanu, Muntean, 2011). It was proved that in the presence of the same stress factor, some people manage to face problems through adopting coping behaviors (face the problem using internal and external resources) while other persons fail, adopting self-destructing behaviors (deny the existence of the problem or run from it, start drinking alcohol or using other substances to forget etc.)

The concept of resilience represents a new approach which is not centered on the identification and analysis of an individual’s problems, but on identifying internal and external qualities that help him overcome different life situations. The question to which an answer was sought when constructing the concept was “What different characteristics have the persons who overcome certain difficult life situations from the persons who adopt destructive behaviors in similar situations?” (Richardson, 2002).

Most cited study regarding the resilient qualities is the one made by Emmy Werner (1982) and her colleague R. Smith (Werner & Smith, 1992), who reported the results of a longitudinal research, started in 1955, having as main subject a multi-racist children population predicted to be at risk due to four environmental factors. Approximately 200 from the 700 investigated children were at risk because of perinatal risk, poverty, daily instability and serious mental health problems of the parents. The results have shown that 72 from the 200 children had very good progresses, despite the risk factors. Werner categorized the resilient qualities in personal characteristics: to be a woman, robust, socially responsible, adaptable, tolerant, oriented towards achievement, good communicator and with high self-esteem. Also, the study underlined the influence of the environment on the way in which the young people faced the difficult situations. Other authors (Michael Rutter, 1979, 1985; Garmeyz, Masten and Tellegen, 1984) completed the list of resilient qualities: positive school climate, dexterity, self-efficiency, planning abilities, close and warm relation with an adult, high expectancies, internal locus control, self-discipline, positive perspectives, abilities to constructively solve problems, critical thinking, and humor.

The positive psychology (Selligman and Csikszentmihalyi, 2000) added to the resilient qualities: happiness, subjective state of wellbeing, optimism, faith, self-determination, and creativity, being moral and having self-control, gratitude, forgiveness, hope, and humbleness.

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Identifying the individual qualities allowed the development of the resilience theory which is seen as a process in which the qualities considered to be resilient are reached through a law of interruption and reintegration (Flach, 1997). Throughout life, a person lives different events and for facing them s/he develops resilient qualities so the events become routine and don’t block the life course. People learn to administrate their household, to take care of the personal needs, to cook etc. without perceiving these things as being a rupture in their personal life (Richardson, 2002). Most times the factor that can determine the interruption is given by life events that involve change. People tend to prefer events and situations that make them feel comfortable, that are familiar. Choosing the high-school, getting a job, marriage, changing jobs, retiring – all these events have personal development potential. But these are events that can trigger emotions and insights. Resilient reintegration involves personal development through the changes that occur in a person’s life. Dysfunctional reintegration appears when the person starts to take drugs or alcohol and to exhibit other dysfunctional and/or self-destructing behaviors. Life aspects that can become risk factors are thoughts, feelings and experiences that weren’t experienced before or – if they were experienced – weren’t solved in a constructive manner.

The process through which the resilient qualities are developed and integrated is not only the result of personal characteristics, but especially of the way in which these characteristics are influenced by familial, environmental and cultural factors. So, resilience appears as a dynamic concept in which the family, social networks and society in general are intersecting with the personal characteristics in the process of coping and adapting. In a given situation, the absence of individual qualities can be suppressed by the way in which the family members understand to be next to the person that experiences a difficult period, by the presence of an efficient system of community services, or even by the specific societal humor.

A person’s resilience depends mostly also on the life stage the person is crossing. The successful integration of previous stages specific to human development (childhood, puberty, adolescence, youth, middle age, late adult age) represents a protection factor that guarantees the integration of present events. However, an individual can be resilient to one problem and less resilient to another life event. For example he can face successfully the failure of a school exam, but later he collapses when losing a job. Which were the factors that contributed to overcoming the first event and weren’t activated when confronting the second one? The qualities that helped the person to overcome school failure can be transposed to the situation of losing a job? Which other internal or external resources has this person? These are questions that led to extending the concept of resilience to the assistance domain, under the name of assisted resilience. The concept of “assisted resilience” introduced by Şerban Ionescu (2010) refers to interventions made by professionals in mental health in

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order to help persons, families, communities and societies to face risk situations (Munteanu, Muntean, 2011).

II.5.2. Protective factors approachable when working with elders Ageing is a process that involves many risk situations and stressful events,

from the alteration of cognitive and sensorial and motor functions to losing dear persons, or incapacity to maintaining the level of activism. The complexity of physical and psychological problems of elders makes the process of evaluation to be the first thing to do before understanding the needs of the person assessed (Kivnick & Murray, 2001, apud Langer, 2010).

The studies regarding resilience of elders show positive correlations between strong social relations and high levels of resilience (Wells, 2009) meaning that, if the elder has more friends and strong friendships he will be more able to face problems related to ageing. At the same time, Wagnild (1990) found a positive relation between life satisfaction and resilience and other qualitative studies confirmed that the predictors of a high level of resilience are optimism, self-esteem, number of days spent with friends, and low level of depression (Easley & Schaller, 2003; Hinck, 2004; Kinsel, 2005 apud. Wells, 2010).

The results of the mentioned studies draw attention on the variables that we wish to develop in the counseling relationship. Wagnild and Young (1990) identified five themes that describe the successful coping with ageing (apud. Langer, 2010). These are:

1. Calm – offers the possibility to take into consideration a wider range of experiences, to consider stressful events by accounting for failures and successes, and to make a balance between those before giving an answer to a given situation.

2. Perseverance – illness, losing a partner, incapacity to face the needs of grandchildren can discourage any person; the capacity of being constant in the will to overcome the life situations contributes to reaching the proposed objective.

3. Confidence in your own strengths – getting over past experiences in a successful manner favors confidence in the capacity of counting on its own strengths when other painful events appear in the life course.

4. Existential loneliness – this concept refers to those experiences from which a person has learned to face problems alone and chosen not to share it with anyone. It’s an internalized feeling won in front a painful event.

5. Significance – becoming aware of the fact that, despite the adversities, life has a goal; the capacity to give significance to the events experienced represents an internal protection factor that can be approached in the counseling process.

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Without being limited to the research findings, the assisted resilience represents an approach in working with the elders. Of course, each individual is unique and must be treated accordingly. Although most problems are age common, we must not forget the fact that each person develops, during the life course, different defense mechanisms and coping strategies and benefits from different protective factors depending on individual characteristics, characteristics of the family in which s/he was raised, of the family s/he built, of the friendships, of the community in which s/he managed to integrate, and of the society s/he decided to live in. Working with the elders means exploring these variables for highlighting the positive aspects and including those in building a new approach of the situations faced.

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II.6. INSTRUMENTS USED IN THE PSYCHOLOGICAL ASSISTANCE26

II.6.1. CONTRACT FOR PSYCHOLOGICAL ASSISTANCESigned between __________________,as psychologist, working at Alternative

Sociale Association and Flavian Popovici, as beneficiary of the counseling sessions offered as part of the psycho-social services addressed to elders. This annex includes:

Considerations regarding the psychological services: 1. The frequency of the sessions: the sessions will take place once a

week.2. A session lasts 50 minutes.3. The objectives established with the client and approved as such are

the following: a. Restructuring the clients old beliefs that have a negative

influence in his life;b. Self-discovery for understanding the mechanisms that cause

depression;c. Reducing the depressive symptoms.

Psychologist’s responsibilities regarding confidentialityAs psychologist for client Flavian Popocivi, I will respect the

confidentiality of all information accessed during the counseling sessions, with the following exceptions:

1. The client’s statements show that his life was/is/can be in danger;2. When the client endangers another person’s life;

Also,3. Some information received during the counseling sessions can

represent the subject of scientific works or communication sessions between professionals, but without the disclosure of the clients identity, which will remain anonymous;

4. Some information received in the counseling sessions can be transmitted to the members of the multidisciplinary team for the client’s wellbeing.

Client’s responsibilitiesAs beneficiary of the psychological services, I will respect the following:1. The program of the counseling sessions established in this annex;

26 The identification data of the persons used as example are fictional.

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2. I will announce if, from various reasons, I can’t come to one or more sessions;

3. I will collaborate with the psychologist for reaching the objectives established for the counseling sessions.

This annex was printed in two copies, one for each party and was created with the approval of the beneficiary.

Date: 27.06.2010

Beneficiary, Flavian Popovici Psychologist, _____________

______________________ _________________________

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II.6.2. REPORT OF PSYCHOLOGICAL EVALUATIONCase registration number: 73/19 June 2009.Name of the beneficiary: Flavian PopoviciAge: 60 years old.Education: high-schoolPsychological evaluation made by: ____________________, psychologist

at Alternative Sociale Association.Number of sessions conducted: Two sessions were conducted with the

client Flavian Popovici, on the 27th June and 3rd July 2009.Evaluation methods used: For making the psychological evaluation, two sessions took place and the

following psychological tests were used: Geriatric Depression Scale (GDS-15), A. Rey Test based on words, Raven Progressive Matrices Test, Neo PI-R.

Psycho-medical characteristics of the elder:• Family: Client’s marital relationship is tensed. Mr. Popovici

communicates rarely, by telephone with his wife, Margareta, aged 55, who went to Italy three years ago to work as a housekeeper. Their two children are Ioan, 25 years old, established in the United Kingdom, and Mădălina, aged 30, who lives in Iaşi. The client keeps contact with Ioan by telephone and Mădălina visits him daily.

• Material situation: Flavian Popovici lives alone in a three room apartment, with modest utilities. The client has no income and the monthly costs are covered with the money received from his wife and administered by their daughter.

• Health situation: Mr. Popovici receives monthly treatment prescribed by the specialist doctor for diabetes and other affections that need medical treatment. Also, he has mobility limitations due to a surgery in the lumbar spine for herniated disc. Mr. Popovici respects the treatment.

• Social relations: The client doesn’t keep close contacts with friends or neighbors which help him occasionally.

Behavior characteristics:During sessions, Mr. Popovici had a clean aspect but showing also a little

negligence. Initially, he was reluctant to participating in sessions. Afterwards, his reluctance diminished and he became more willing to know himself better and to get over the emotional crisis.

Evaluation of cognitive-intellectual functions:The psychometric data indicate a medium level of intelligence. Memory

is normal on both recognition and reproducing functions. At the level of self-biographical memory, Mr. Popivici doesn’t show dysfunctions.

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Evaluation of the emotional dimension:Emotionally, according to the psychometric data and observation, accentuate

depressive tendencies were identified, manifested through the loss of appetite, repeated insomnia, the recurrence of negative cognitions about his own person, about his future and his actual situation. These symptoms started about two weeks ago. Mr. Popovici refuses to leave his home, doesn’t prepare any food and avoids contacts with other persons. According to his statement, he cries often because he is suspicious about his wife’s fidelity and feels abandoned by her. The client is also negatively influenced by his reduced physical abilities, which limit the range of activities that he can do and offers him a long period of time for thinking about negative thoughts. Mr. Popovici has depressive antecedents and testifies the suicide ideation without suicidal attempt that he had after his economic failure in 2004.

Aspects related to the psychological profile:The psychometric data and the clinical interview highlight the following

aspects in the client’s psychological profile:• Suspicion: the client is mistrustful, is very suspicious about the intentions

of the persons around him and seeks for contextual elements to confirm his suspicions even if evidences are contrary to his assumptions.

• High capacity of self-control: this characteristic of the client determines behavioral rigidity, low capacity to relax, accumulating internal tensions. A strong emotional inhibition is also observed, which censors emotional manifestations in front of strange persons.

• Introversion: Mr. Popovici has a rich affective universe and the tendency to self-analysis. These are related to his lack of involvement in relationships with persons around him, the client preferring solitaire activities and to withdraw.

• Client’s self-esteem is oscillating due to the discrepancy between past results, more exactly between the successes in his adult life and his actual social situation, which is strongly contrasting with the memories from the period with professional success. Also, his image about himself is affected by the separation in fact from his wife, who doesn’t keep contact with him.

Ways of reporting to third age problems:The client finds few resources for coping with the faced problems (material

needs, loneliness, feeling abandoned by his wife). Mr. Popovici considers his actual situation a dificult stage, that can’t bring him satisfactions and joy. The client often expresses the regret of not being young again, together with his wife and children.

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Recommendations:Taking into consideration the aspects shown by the psychological evaluation,

I recommend the following:• A protective family climate and support from his children;• Psychiatric consultation;• Psychological counseling for overcoming the depressive episodes, along

with the treatment prescribed by the psychiatrist;• Maintaining contact with neighbors and friends and avoiding social

withdrawal.

Date of completion the report: 4th July 2009

Psychologist,_________________

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II.6.3. PSYCHOLOGICAL COUNSELING SESSION REPORTCase registration number: 73/19 June 2009 Name of the client: Flavian Popovici

Present persons: • __________________, psychologist of ____________________• Flavian Popovici, beneficiary of the social services offered by

___________________

Date: 23.06.2010 Place: The session took place at the beneficiary’s home, because of his limited

mobility, especially outside his house.

Counseling objectives/themes approached: 1. Explaining the role of the psychologist and the importance of counseling

sessions for improving the emotional state, for overcoming the crisis situation and for self-knowledge.

2. Making the client’s anamnesis.3. Client’s psychological assessment.

Methods and techniques used:Semi-structured interview, directive discussion, specific techniques used in

person focused technique, using specific instruments for evaluation (GDS-15).

At the client’s request for discussing with a psychologist about his problems, the counseling process started with Mr. Flavian Popovici. Previously, a discussion with the social worker took place for presenting the social and medical situation of the beneficiary and the observations regarding the general emotional state of the client expressing the presence of depressive symptoms.

1. In the beginning of the session, we focused on creating the therapeutic alliance based on the principles of person centered therapy (empathetic listening, unconditional positive feedback, congruence). The client, although expressed to the social worker the wish of talking about his problems and to participate in counseling sessions, showed reticence regarding the counseling process. His beliefs were motivated through the following words “I’m not mad yet, but I’m afraid of becoming mad.”

Starting with the client’s freely expressed reluctance, the counseling process was defined with all its stages based on directive discussion. So, this process was normalized by eliminating the madness stigma and client’s beliefs regarding the psychologist.

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Also, I’ve discussed with Flavian Popovici about the goal of the counseling sessions and their importance, by listing the positive results and the possibilities that the sessions can offer: the possibility to self-knowledge, improving the emotional state, overcoming the crisis situations etc. The client agreed to the terms of the counseling process and to making the anamnesis and the psychological assessment.

2. After this introductive stage, based on the semi-structured clinical interview, I started the client’s anamnesis which was focused on identifying the main life events with a significant psychological impact. The client approved sharing his life experiences, talking about the confronted lack of income, about his uncertainty and precarious medical situation, and also about being abandoned by his wife (when she left abroad and he remained in Romania). During the discussion, the client didn’t express his emotions regarding the events mentioned, verbally, non-verbally or para-verbally. However, he admitted having negative thoughts regarding life and being affected by his situation.

3. From the discussion with the social worker, but also from what the client told, I could identify many depression symptoms. This motivated starting the psychological evaluation with the depression test GDS-15. Mr. Popovici participated without restraint, expressing his trust in psychological testing and in what tests can tell about the individual’s psychological situation.

Observations:1. The client wishes to continue the sessions, expressing his will to improve

his emotional state.2. At the following session, we will continue the psychological assessment

through other specific instruments.

Recommendations:• A psycho-protective family climate;• Continuing the counseling sessions, if the medical condition of the

beneficiary permits;• The data obtained in the clinical interview confirms the necessity of a

specialized psychiatric consultation.

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II.6.4. INDIVIDUAL COUNSELING FILE

Case registration number: 73/19 June 2009 Client’s name: Flavian Popovici

Sessions. Main marksTechniques, methods and instruments used in counseling

Observations Date

Specific objective: Creating the therapeutic relationship.

Developed activities during the counseling session:1. Explaining the role of the psychologist and of the counseling sessions;2. Client’s anamnesis;3. Starting the psychological assessment.

Semi-structured clinical interview, directive discussion, techniques specific for the person focused therapy, assessment instruments.

Although he requested psychological counseling, at the beginning of the session, the client showed reticence towards the counseling process, but after receiving the clarifications requested, Flavian Popovici accepted to participate to the psychological assessment and to counseling, expressing his trust in psychological testing.

27.06.2009

Specific objective: Making the psychological assessment.

Developed activities during the session:1. Applying the psychological assessment instruments.

Assessment instruments

The client agreed to participate to the assessment.

03.07.2009

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Specific objective: Establishing with the client’s approval the objectives of the counseling sessions after psychological assessment and anamnesis.

Developed activities during the session:1. Presenting the evaluation’s results;2. Discussing the objectives of the counseling sessions.

Semi-structured interview, directive discussion, Socratic dialogue, expressing feelings.

The client agreed to participate in establishing the objectives of the sessions.

Initially, Flavian Popovici refused to express his feelings regarding his present situation and to talk about his negative emotional state. The emotional relief of the client was difficult because of his reticence in expressing feelings.

10.07.2009

Specific objective: Identifying the automatic negative thoughts.

Developed activities during the session:1. Making a list with the client’s automatic negative thoughts;2. Explaining the way in which those are associated to other symptoms of depression and represent a distortion of the reality.

Cognitive-behavioral techniques, explanation.

The client wanted to understand the mechanisms that are at the base of depression and, although at the beginning of the session he didn’t want to participate in identifying the negative thoughts, during session he collaborated to listing these thoughts.

17.07.2010

Specific objective: Discussing the automatic negative thoughts identified by the client.

Developed activities during the session:1. Discussing the automatic negative thoughts: when they appear, in what context, what they refer to; 2. Establishing ways of identifying them and understanding their effects.

Cognitive-behavioral techniques

Reticence from the client. The client didn’t feel well physically. 24.07.2010

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Specific objective: Discussing the automatic negative thoughts identified by the client.

Developed activities during the session:1. Discussing the automatic negative thoughts: when they appear, in what context, what they refer to; 2. Establishing ways of identifying them and understanding their effects.

Cognitive-behavioral techniques

The client wished to restart the discussion from the previous session and to tell about the way in which he managed to face the negative thoughts during the previous week.

31.07.2009

Specific objective: Identifying leisure time activities.

Developed activities during the session:1. Discussing the client’s options in spending leisure time.

Techniques specific to the person focused therapy, semi-structured interview, directive discussion.

The client was initially suspicious about the importance of leisure time activities that didn’t offer the possibility of having negative thoughts, but he was willing to find such activities.

07.08.2009

Specific objective: Understanding the importance of respecting the treatment prescribed by the specialist doctor.

Developed activities during the session:1. Discussions regarding the medical treatment that the client needs to follow;2. Identifying the advantages of respecting the treatment.

Supportive counseling, Socratic dialogue, semi-structured interview.

The counseling session was stopped at the middle because the client didn’t feel well physically.

14.08.2010

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Specific objective: Strengthening self-confidence.

Developed activities during the session:1. Highlighting the client’s qualities and abilities.

Elements of Ericksonian therapy (therapeutic metaphor “Mirror castle”) and therapeutic story “Ski accident” (Michel Dufour)

The client appreciated the therapeutic stories and wanted to discuss about them. Also, as a result of the previous session, the client started spending his time doing different pleasant activities (reading, writing, crosswords).

21.08.2010

Specific objective: Strengthening self-confidence.

Developed activities during the session:1. Highlighting the client’s qualities and abilities.2. Exercises for raising self-esteem.

Elements of Ericksonian therapy: Therapeutic story „Good luck, bad luck, who knows?”, for making the client more relative regarding his life experience and reconstructing life scenario, techniques for increasing self-esteem.

The client collaborated. He appreciated the therapeutic story and participated in the exercises for increasing self-esteem.

28.08.2010

Specific objective: Presenting coping strategies for preventing relapses.

Developed activities during session:1. Discussing the possible ways of preventing the relapse of depressive symptoms.

Cognitive-behavioral techniques, role play.

The client participated with reticence in the role play.

04.09.2010

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Specific objective: Preparing the end of the counseling.

Developed activities during session:1. Recapitulation of the main important elements during the counseling;2. Discussions for preparing the client regarding the end of the counseling process.

Specific techniques in the person focused therapy, Socratic dialogue and explanation.

The client expressed his fears regarding the end of the counseling process and the possibility of his situation getting worse.

11.09.2010

Psychologist, ______________________

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BIBLIOGRAPHY:

1. Antonucci, T. C., Vandewater, E. A. & Lansford, J. E., „Adulthood and ageing: social processes and development”, in Kazdin, A. E. (Ed), Encyclopedia of psychology, Vol. 1, American Psychological Association, Oxford University Press, Washington D.C., 2000;

2. Blaga, L., „Trei fețe”, in Opera poetică, Editura Humanitas, 2008;3. Bosworth, H., Park, K.-S., McQuoid, D. R., Hays, J. & Steffens, D., The impact

of religious practice and religious coping on geriatric depression, International Journal of Geriatric Psychiatry, 18, pp. 905-914, 2003;

4. Carstensen, L., „Social and Emotional Patterns in Adulthood: Support for Socioemotional Selectivity Theory”, in Psychology and Ageing, Vol.7, No.3, 1992;

5. Crose, R., „Teaching the psychology of later life”, in Bronstein, P. & Quina, K., Teaching Gender and Multicultural Awareness: Resources for the Psychology Classroom, America Psychological Association, 2003;

6. Flach, F.F., Resilience: How to bounce back when the going gets tough, Hatherleigh Press, New York, 1997;

7. Folkman, S. & Moskowitz, J., T., Coping: Pitfalls and Promise, Annual Review Psychology, 55, pp. 745-774, 2004;

8. Fontaine, R., „Bătrâneţe fericită, bătrâneţe optimă”, in Iacob, L., Vârsta a treia, cunoaştere şi intervenţie, Centrul de Formare în analiză şi intervenţie pentru grupurile sociale defavorizate, Project Tempus JB- JEP 142397/99, Iaşi, 2001;

9. Gal, D., Dezvoltarea umană şi îmbătrânirea, Presa Universitară Clujeană, Cluj-Napoca, 2001;

10. Garmezy, N., Masten, A.S. & Tellegen, A., The study of stress and competence in children: A building block for developmental psychopathology. Journal of Child Development, 55, pp. 79-111, 1984;

11. Hemfelt, R., Minirth, F. & Meier, P., Labirintul codependenţei, Editura LOGOS, Cluj Napoca, 2001;

12. Jones, J., Religion, Health, and the Psychology of Religion: How the Research on Religion and Health Helps Us Understand Religion, Journal of Religion and Helath, 43(4), pp. 317-327, 2004;

13. Kolchakian, M., R. & Sears, S. F., Religious Coping in College Students, Journal of Religion and Health, 38(2), pp. 115 – 125, 1999;

14. Kubler-Ross, E., On Death and Dying. What the Dying Have to Teach Doctors, Nurses, Clergy and Their Own Families, Routledge, Abingdon, 2009;

15. Ladea, M., „Importanța diagnosticării depresiei la vârstnici. Rolul scalelor de evaluare”, in Revista Română de Psihiatrie, Volume 2, No.2-3, 2000;

16. Lambert, M.J., & Barley, D.E., “Research summary on the therapeutic relationship and psychotherapy outcome”, in J. C. Norcross (Ed.),

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Psychotherapy relationships that work, pp. 17-32, Oxford University Press, Oxford, 2002;

17. Langer, N., Resiliency and spirituality: foundations of strengths perspective counseling with the elderly, Educational Gerontology, 30(7), pp. 611-617, 2004;

18. Larousse, Marele dicţionar al Psihologiei, Editura Trei, Bucharest, p. 322, 2006;

19. Linden, M., Borchelt, M., Barnow, S. & Geiselmann, B., „The impact of somatic morbidity on the Hamilton Depression Rating Scale in the very old”, in Acta Psychiatrica Scandinavica, Volume 92, Issue 2, 1995;

20. Luca, C. & Azoiţei, N., „Asistenţa psihologică a copiilor rămaşi singuri acasă”, in Luca, C. & Gulei, A. (coord.), Asistenţa socială, psihologică şi juridică a copiilor rămaşi singuri acasă ca urmare a plecării părinţilor la muncă în străinătate, Editura Terra Nostra, 2007;

21. Marnat, G.G, Handbook of Psychological Assessment, Fifth Edition, John Wiley and Sons, Inc., Hoboken, New Jersey, 2009;

22. McIntire, S.A. & Miller, L.A, Fundamentele testării psihologice. O abordare practică, Editura Polirom, Iaşi, 2010;

23. Miller, W. R. & Rollnick, S., Motivational Interviewing, Second Edition, Guilford Press, New York, 2002;

24. Montreuil, M., Blanchet, A., Doron, J. & Ionescu, Ş., Tratat de psihologie clinică şi psihopatologie, Editura Trei, 2009;

25. Munteanu, A. & Muntean, A., Violenţă, Traumă, Rezilienţă, Editura Polirom, 2011;

26. Neugarten, B.L, The meaning of age: selected papers of Bernice L. Neugarten/edited and with a forward by Dail A. Neugarten, The University of Chicago Press, Chicago, 1996;

27. Ong, A.D., Bergeman, C.S., Bisconti, T.L. & Wallace, K.A., Psychological Resilience, Positive Emotions, and Successful Adaptation to Stress in Later Life, Journal of Personality and Social Psychology, 91(4), pp. 730-749, 2006;

28. Richardson, G.E., The Metatheory of Resilience and Resiliency, Journal of Clinical Psychology, 58(3), pp. 307 – 321, 2002;

29. Ross, K., Handal, J., Clark, E. & Vander Wal, J., “The Relationship Between Religion and Religious Coping: Religious Coping as a ModeratorBetween Religion and Adjustment”, in Journal of Religion and Health, 48, pp. 454-467, 2009;

30. Răşcanu, R., Introducere în psihodiagnoza clinică, Editura Universităţii, Bucharest, 2003;

31. Selligman, M.E.P. & Csikszentmihalyi, M., “Positive Psychology”, in American Psychologist, 55, pp. 5-14, 2000;

32. Shavelson, R. J., & Bolus, R., “Self-concept: The interplay of theory and methods”, in Journal of Educational Psychology, 74(1), pp. 3-17, 1982;

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33. Şchiopu U. & Verza E., Psihologia vârstelor, Editura Didactică şi Pedagogică, Bucharest, 1997;

34. Tombaugh, T.N. & McIntyre, N.J., „The mini-mental state examination: a comprehensive review”, in Journal of the American Geriatrics Society, Volume 40, No.9, 1992;

35. Veerbraak, A., Gerotranscendence: An examination of a proposed extension to Erik Erickson’s theory of identity development, 2000, Thesis submitted in partial fulfillment of the requirements for the degree of Master of Science in Psychology in the University of Canterbury;

36. Wagnild, G. & Young, H.M., “Resilience among older women”, in Journal of Nursing Scholarship, 22(4), pp. 252-255, 1990;

37. Wahl, H.-W. & Lehr, U., „Applied fields in psychological assessment: Gerontology” in Fernandez - Ballesteros, R.(Ed.), Encyclopedia of Psychological Assessment, Volume 1, London, U.K., Sage, 2002;

38. Wells, M., “Resilience in older adults livind in rural, suburban, and urban areas”, in Online Journal of Rural Nursing and Health Care, 10(2), 2010;

39. Werner, E. & Smith, R., Overcoming the odds: High risk children from birth to adulthood, Cornell University Press, New York, 1992;

40. Westhoff, K. & Kluck, M.L., Raportul psihologic: Redactare şi evaluare, Editura Sinapsis, Cluj-Napoca, 2009.

Web1. http://www.e-psiho.ro2. http://issues.org3. http://www.testepsi.ro4. http://www.sistempsi.ro

(Footnotes)1 http://www.psiho.eu/?p=141, page accessed on 30th March 2010.

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CHAPTER III. DEPRESSION AND DEMENTIA – HIGH RISK DISORDERS DURING THE THIRD AGE

III.1. DEPRESSIVE DISORDER

The depressive disorder is the most frequent psychiatric affection met in elders and is not often diagnosed at the level of primary assistance which leads to raising the functional incapacity27 and dependence of other persons and/or services in this age category.

The clinical description is similar to that of depression in adulthood; according to ICD 10 the following symptoms are distinguished:

a. Main symptoms:• monotonous depressive disposition lasting for at least 2 weeks;• loss of interest or pleasure in doing usual activities;• lack of energy, increased fatigue;

b. Associated symptoms:• loosing self-confidence and self-esteem;• inadequate or excessive self-blaming;• repeated thoughts about death;• suicide ideation or behavior;• reduced capacity of thinking or concentrating, e.g. indecision/hesitation;• modifications in psychometric activity;• sleep disorders (frequently insomnia or hypersomnia);• modifications of appetite with correspondent weight modifications.

The depressive disorder is different from the comprehensive sadness28 in the following:

Duration: symptoms last at least 2 weeks;Absence of fluctuations: the symptoms are present most of the days, most

of the time;Intensity: an unusual intensity for that person.

The ICD 10 and DSM IV diagnostic manuals establish the depression diagnosis through the presence of a number of main or associated symptoms:

• mild depressive episode: 2 main symptoms and at least 4 associated symptoms;

• moderate depressive episode: 2 main symptoms and at least 6 associated

27 Appreciation of the functionality includes the person’s capacity to do usual daily activities necessary for personal care (washing, dressing, toileting, alimentation, sitting and standing on chair and bed, walking etc.) and for an independent living.28 Has a causal relation.

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symptoms;• severe depressive episode: the 3 main symptoms and at least 5 associated

symptoms.

In addition, there is classification depending on the presence of psychotic symptoms and stupor29.

For detecting the presence of depression it’s important to know the symptoms described in the classification systems, but the caregivers must take into account that the elders have series of symptoms that often indicate the presence of a subclinical depression characterized by:

• lack of reports of being sad even when the person seems depressive to the ones around;

• hypochondria and excessive somatic preoccupation instead of sadness reports;

• subjectively reduced memory or a pseudo-dementia clinical picture;• pronounced anxiety;• apathy and decrease of motivation.

In practice it’s important to have a multifactor approach of depression through investigating both individual susceptibility (predisposing factors) and adverse life events (precipitant factors).

Predisposing factors (Baldwin et al., 2002, p. 36):• feminine gender (a higher frequency of depression was met in women);• a previous history of depression;• widowhood/divorce;• co-morbid physical affections; physical and psychological disabilities;• medicine, alcohol abuse and the presence of systemic illnesses;• takes care of someone30;• material and social problems;• lack of social support from family and community members.

Precipitant factors:a. life events:

• a great loss;• family separation;• acute physical disturbance;• illness or imminence of death in someone dear;• losing the house or necessity of moving in an institution;• major financial crisis;

29 Symptom which appears in some psychosis, manifested through silence, imobility and complete insensitivity.30 Although the elder is at the age at which he needs support, s/he is in the situation where cares for and supports other family members.

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• negative interaction with family or friends;• loosing “something significant” (including a pet).

b. chronic stress:• health and mobility decline;• dependence;• diminishing senses (seeing, hearing etc.), cognitive decline;• problems with the house;• major problems of family members affected;• socioeconomic decline;• marriage difficulties;• job problems;• retiring;• taking care of a chronically ill person or of a dependent family member;• social isolation.

Assessing the suicidal risk is difficult because many elders might think that life isn’t worth living anymore, but few of them present autolytic attempts.

The factors that indicate a high risk of suicide are (Baldwin et.al., 2002, p. 54):• demographic: old age (especially over 80), isolation, and male gender;• history: previous autolytic attempts, proofs of planning suicide as

changing last will;• recent great loss;• physical factors: a chronic and painful medical affection; alcohol abuse;

sedative/hypnotic substance abuse;• mental state: suicidal thoughts; plans of suicide; high agitation (objective

psychometric anxiety associated with a permanent internal anxiety); profound lack of hope, feelings of being useless, guilt and self-blaming; pronounced insomnia, hypochondria; psychotic ideation.

The most used evaluation scale for depression screening in elders is the GDS – Geriatric Depression Scale.

It was conceived as a 30 items self-evaluation scale but it’s frequently applied with the support of the caregiver, which doesn’t influence the results.

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GERIATRIC DEPRESSION SCALE (Yesavage et al., 1983 apud Baldwin et.al., 2002, pp. 155-156)

Instructions: Choose the answer that corresponds best to how you felt during the last week.*1.Are you basically satisfied with your life? No*2. Have you dropped many of your activities and interests? Yes*3. Do you feel that your life is empty? Yes 4. Do you often get bored? Yes 5. Are you hopeful about the future? No 6. Are you bothered by thoughts you can’t get out of your head? Yes7. Are you in good spirits most of the time? No*8. Are you afraid that something bad is going to happen to you? Yes*9. Do you feel happy most of the time? No10. Do you often feel helpless? Yes11. Do you often get restless and fidgety? Yes12. Do you prefer to stay at home, rather than going out and doing things? Yes13. Do you frequently worry about the future? Yes14. Do you feel that you have more problems with memory then most? Yes15. Do you think it is wonderful to be alive now? No16. Do you feel downhearted and blue? Yes17. Do you feel worthless the way you are now? Yes18. Do you worry a lot about the past? Yes19. Do you find life very exciting? No20. It is hard for you to get started on new projects? Yes21. Do you feel full of energy? No22. Do you feel that your situation is hopeless? Yes23. Do you think that most people are better off than you are? Yes24. Do you frequently get upset over little things? Yes25. Do you frequently feel like crying? Yes26. Do you have trouble concentrating? Yes27. Do you enjoy getting up in the morning? No28. Do you prefer to avoid social occasions? Yes29. Is it easy for you to make decisions? No30. Is your mind as clear as it used to be? NoNotes: (1) the answers indicate the answer scored 1; (2) *GDS scale with 4 items; (3) the questions in bold are the 15 items version. The total score for a possible depression: ≥ 11 for GDS 30 ≥ 5 for GDS 15 ≥ 2 for GDS 4

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COGNITIVE IMPAIRMENT TEST(Katzman et al.,1983, apud Baldwin et.al., 2002, p. 145)

Item Max. error Score Weight1. What year is it? 1 ______ x 4 = _______2. What month is it? 1 _______ x 3 = ______Phrase to rememberRepeat this phrase after me: Ex. “John, Smith, 42, High st., Bedford”About what time is it? 1 _______ x 3 = _______(within one hour)4. Count backwards from 20 to 1 2 _______ x 2 = _______5. Say the months of the year in reverse 2 _______ x 2 = _______6. Repeat address phrase. 5 _______ x 2 = _______

Total = _______

Note with 1 each incorrect answer; the maximum score that can be obtained is 28.Score: 0 - 11 normal or slight damage; 11 – 28 moderate to severe damage.

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Strategies caregivers can use in order to identify depression in elders: (Baldwin et.al, 2002, p. 51):

• become familiar with the main symptoms of depression;• take into account the high frequency of depressive disorder;• know the particularities of depression manifestations in elders;• give the same importance to both physical and mental health;• develop aptitudes for conducting a clinical interview with an elder;• remember that a difficult life event can trigger depression;• avoid the therapeutic “nihilism” (“nothing works”);• take into account the fact that depression is not “normal” in the life of

elders.

III.2. DEMENTIA

Dementia is characterized by a progressive decline of intellectual and social abilities. It is represented by a number of affections that determine the progressive deterioration in any part of the nervous system (neurodegenerative disorders).

The signs and symptoms of dementia vary from an individual to another, depending on genetic inheritance, lifestyle, cultural level and personal life experience. Some of the general characteristics of dementia are: decrease or loss of memory, capacity to think, reasoning, and language. While dementia evolves personality changes and abnormal behaviors can occur. Sometimes, persons suffering from dementia can lose basic abilities such as language or eating.

These signs and symptoms can indicate Alzheimer disease, vascular dementia or other cerebral diseases known to determine dementia.

Alzheimer disease is the most frequent cause of dementia. The structural cerebral modifications of the persons suffering from Alzheimer consist in losing neurons in the areas responsible for memory and in other areas. Also, they present low concentrations of neuronal mediators responsible for bidirectional transmission of messages between nervous cells. A first sign of Alzheimer might be the loss of memory which is constantly increasing. While it evolves, the illness affects language, thinking, capacity of understanding, reading and writing. Sometimes, the affected persons can become anxious or aggressive.

Parkinson illness. The medical statistics show that 30-40% of the persons suffering from Parkinson develop dementia in late illness phases. In reverse, many persons suffering from Alzheimer develop physical symptoms similar to those suffering from Parkinson such as rigidity of members, tremor at rest, speaking disorders and rigid walking.

Lewy body dementia. Lewy bodies are protein deposits in deteriorating neurons. They usually appear in the deteriorated areas situated profoundly in the brain of Parkinson suffering persons. When scattered throughout the

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whole brain, Lewy bodies determine symptoms similar to those of Alzheimer. Dementia with Lewy bodies can affect dreams, speed of thinking, memory, language, reasoning, and understanding. Also, it can cause hallucinations and space disorientation, leading to the tendency of getting lost.

Vascular dementia is caused by shrinking or obstruction of the arteries that irrigate the brain, or by vascular accidents caused by the disruption of blood circulation in certain brain areas. The onset of symptoms is often brutal but, sometimes, the illness progresses slowly, making it difficult to differentiate from Alzheimer. Vascular dementia is frequently characterized by problems of thinking, language, walking and seeing.

The most frequent problems in conducting the differential diagnosis of several types of dementia are related to depressive disorders. The following criteria are useful in making the differential diagnosis between the cognitive and affective disorders in types of dementia and depression (Tudose, 2001, p. 49):

DEPRESSION DEMENTIA

PRIMARY DISORDER Depression with secondary memory modifications.

Dementia (with depression added over).

INSTALLMENT Subacute (weeks or months). Gradual (years) in BA; abrupt in multi-infarct dementia.

INITIAL EVOLUTION The depressive symptoms usually appear first.

The cognitive difficulties appear first.

COGNITIVE STATUSMemory “decrease”, frequently total, subjective and unreported by tests.

The cognitive disorders are clearly seen at tests.

PROGNOSIS The treatment can solve all symptoms.

The treatment can solve depression but memory disorders remain unchanged.

Neuropsychological and clinical characteristics that differentiate dementia from major depression (Tudose, 2001, p. 50):

CHARACTERISTIC TIPICAL FOR DEMENTIA TIPICAL FOR MAJOR DEPRESSION

Pattern of disposition Long lasting Episodic

Easily change of disposition Yes No

Consciousness of forgetting No Yes

Recognizing memory Affected Intact

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Suggestions for the caregivers in stress management and preventing exhaustion

Care activities for the persons with dementia can lead the caregivers to physical and emotional exhaustion. Moreover, many of the difficulties faced by caregivers are caused by their own emotional problems or by the behavior and cognitive changes in a demented patient (Breakey, 2001, p. 485).

It’s important for the mental health professionals to educate the families and caregivers in management strategies and to meet their emotional needs.

We present some suggestions for these caregivers for diminishing their level of stress and emotional exhaustion (Breakey, 2001, p. 485):

• Furniture items in the rooms where persons with dementia live must be few, ordered and arranged for permitting free access;

• All sharp objects and dangerous substances (knives, cleaning solutions etc.) must be locked;

• Polished parquet or any type of slippery floors must be covered with carpets to prevent slipping;

• Bathroom, shower or bathtub must have handrails or devices for support;• Bathroom, bedrooms and corridors of the house must have night lights;• It’s important that persons with dementia have regular meals, including

supplements at 11:00 and 17:00;• If the person affected by dementia can’t use the spoon and fork, than the

food must be prepared so it could be eaten with the fingers;• Because choosing food or the order of eating the courses can cause

confusion, it’s indicated that meal courses are served in turn;• If the affected person loses weight, liquid food can be an alternative;• It’s advisable that the person with dementia is kept awake and active

during the day. Snoozing must be discouraged, excepting the case when this would cause more problems. In the evening, before going to sleep, it’s advisable to offer a glass of warm milk or a calming tea that doesn’t contain exciting substances;

• To efficiently manage the problems of sphincter control that might occur (urinary and fecal incontinence) it’s recommended to encourage the person to go to the toilet at regular hours;

• Mark clearly, with signs, the bathroom and toilet. Drawings can be used when the person doesn’t understand words anymore. Diapers or single use lingerie for adults can be used (for example pampers);

• In case the incontinence is a new problem, it’s good to consult a specialized doctor to find out if it’s not caused by another affection, like urinary tract infection;

• The caregivers must not forget to ask for support from other family members or friends. Counseling and temporary care centers can be a solution to overcome stressful periods or overburden.

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BIBLIOGRAPHY:

1. American Psychiatric Association, DSM IV - TR 2000 - Manual de diagnostic și statistică a tulburărilor mentale, Asociația Psihiatrilor Liberi din România, Bucharest, 2003;

2. Baldwin, R.C., Chiu, E., Katona, C. & Graham, N., Guidelines on Depression in Older People. Practising the Evidence,Martin Dunitz Ltd., London, 2002;

3. Breakey, R. W., Servicii integrate de sănătate mintală. Psihiatrie comunitară modernă, Editura Fundației Pro, Bucharest, 2001;

4. Van Der Brug, A.F., Manual de nursing psihiatric, MAD Foundation, Ermelo, 1996;

5. Jeican, R., Psihiatrie pentru medicii de familie, Editura Dacia, Cluj-Napoca, 2001;

6. Katzman R., Brown T. & Fuld P., American Journal of Psychiatry no.140, 1983;

7. Tudose, C., Demențele. O provocare pentru medicul de familie, Editura InfoMedica, Bucharest, 2001;

8. World Health Organization, ICD-10. Clasificarea tulburărilor mentale și de comportament. Simptomatologie și diagnostic clinic, Editura All, Bucharest, 1998;

9. Yesavage J.A., Brink T.L. & Rose T.L., „Development and validation of a geriatric depression screening scale: a preliminary report”, in Journal of Psychiatric Research no.17, 1983.

Web:1. http://ajp.psychiatryonline.org2. http://www.patient.co.uk

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CAP. IV. LEGISLATIVE FRAMEWORK IN ASSISTING THE ELDERS


IV.1. INTERNATIONAL RECOMMENDATIONS

Ageing of population is a characteristic phenomenon for most of European and Western states. EUROSTAT31 speaks of a continuous ageing of the population in the last decades (Eurostat, 2010, pp. 14-16) which leads to the necessity of developing sustainable resources and mechanisms for protecting the rights and freedom of the elderly.

The documents elaborated by international organizations like United Nations32, Council of Europe33 and other international institutions, demonstrate a special attention to the phenomenon of ageing and the need for social protection of the elderly.

The first International Plan of Action on Ageing was adopted in 1982, during the World Assembly on Ageing held in Vienna. In 1991 the Principles for Elderly Care were established, structuring aspects regarding the rights of elders through: independence, participation, care, self-fulfillment and dignity. In 2002, after 20 years since the first plan, was felt a need for updating the policy in this area.

International Plan of Action on Ageing34 is the first international instrument, found at the base of how the policy and programs regarding ageing are thought and formulated. Its goal is to strengthen the capacity of governments and civil society to face in an efficient way the process of ageing and to manage the potential of development and the dependencies of elders.

This plan also promotes cooperation at national and international level and includes 62 recommendations regarding actions of research, collecting and analyzing data, training and education and other recommendations in the following areas: health and nutrition, protection of elder consumers; housekeeping and environment; family; social welfare; income security and employment; education.

The plan is part of an international assembly of standards and strategies developed by the international community in the last decades. That’s why its provisions must be considered in relation with those from complementary domains such as: human rights, family, persons with disabilities, health etc.

31 Official website of EUROSTAT: http://epp.eurostat.ec.europa.eu/portal/page/portal/eurostat/home/, accessed in November 2010.32 Official website of United Nations: http://www.un.org/, accessed in November 2010.33 Official website of the Council of Europe: http://www.coe.int/, accessed in November 2010.34 It was adopted in April 2002 in Madrid, with the occasion of the second United Nations General Assembly dedicated to ageing. The official website of the International Plan of Action on Ageing is: http://www.un.org/ageing/madrid_intlplanaction.html, accessed in November 2010.

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In Romania, aspects of this Plan were taken into account for modifying and updating the legislation regarding elders, the standards regarding the quality of the services offered in institutions and at home, in creating the Memorandum of social inclusion (2005), the Strategic National Reports on Social Inclusion (2008) and the legislation of pensions.

The European Social Charter35 is the European instrument of reference for social cohesion. It provides a series of elementary rights that the signatory states undertake to assure to their citizens: right to health protection, right to social security, right to social and medical assistance, right to receive social services, right to information and consultation. Most of these rights refer to assuring the access to a minimum of basic services and the elimination of social marginalization of different categories of population. Article 23 of this document refers to the right of elders to receive social protection, which includes taking or promoting adequate measures for:

• permitting the elders to remain full members of the society as long as possible;

• permitting the elders to freely choose their lifestyle and to have an independent existence in their usual environment as long as they wish to and this is possible;

• guaranteeing the elders that live in institutions a corresponding assistance regarding their private life and participation in establishing the life conditions in the institution.

These two documents together with other subordinated international plans and programs are at the base of the strategies and programs dedicated to the protection of the elders and represent references for the legislation of many signatory states, including the Romanian legislation36.

IV.2. ROMANIAN LEGISLATION The main normative documents in the area of assisting the elders are:

• Law no.17 since 6th March 2000 regarding the social assistance of the elders;

• Government Decision no. 886 since 5th October 2000 for approving the National Assessment Grid of the Needs of Elders;

• Government Decision no. 499/2004 for establishing, organizing and

35 Adopted in 1961 and revised in 1996. The official website of the European Social Charter is: www.coe.int/socialcharter. Romania ratified this document through Law no. 74 since 3rd May 1999 for ratifying the revised European Social Charter, adopted at Strasbourg on 3rd May 1996, published in the Official Monitor of Romania no. 193 since 4th May 1999.36 Such an example is the 2005 – 2008 National Strategy for the development of the social assistance system for the elders, adopted through the Government Decision no. 541 since 9th June 2005.

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functioning of the consultative committees of civic dialogue for the problems of elders, within the prefectures;

• Order no. 491/180 since 23rd May 2006 for the approval of the medical-social evaluation grid of the persons hospitalized in medical-social assistance units;

• The Order given by the Ministry of Labor, Social Solidarity and Family no. 246 since 27th March 2006 regarding the approval of the minimum quality standards for the homecare services for the elders and for the residential centers for the elders;

• Government Decision no. 1317 since 27th October 2005 for supporting the voluntary activities in homecare services for the elders;

• Law no. 292 since 20th December 2011 of social assistance.

Depending on the personal situation of the beneficiaries and the problems they are facing, the elders can be at the same time disadvantaged persons, persons with disabilities, pensioners etc. So, in the area of social assistance for elders, other normative documents can be taken into account from areas such as:

• pensions and other forms of social benefits;• social health insurances;• services for persons with disabilities;• services for disadvantaged persons etc.

The new law of social assistance no.29/2011 includes, in chapter IV dedicated to the integrated measures of social assistance, a part of these perspectives, for an integrated approach of the problems faced by elders.

IV.3. INSTITUTIONAL COMPETENCES

The specific Romanian legislation in the assistance of elders mentions the institutions and their attributions in offering support to this social category. These institutions can be grouped depending on their hierarchy and geographical area in national, county and local institutions.

As a result of applying the principle of subsidiarity (principle that is at the base of the national social assistance system), some specific attributions in the area of assisting the elders are common for two or more institutions.

Below are the institutions mentioned by Law no. 17/2000, in descending hierarchical order, with the specific description of the corresponding attributions and tasks.

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Ministry of Labor, Family and Social Protection:• proposes legislative measures in this domain (including the form of the

National Assessment Grid of the Needs of Elders), individually or in collaboration with other ministers or institutions;

• ensures the methodological guidance, coordinates, controls and evaluates the application of Law no. 17/2000 dispositions;

• ensures funds for the following costs:- social assistance activities developed by Romanian associations and

foundations;- capital investments and repairs for social assistance units in

disadvantaged areas;- completion of extra-budgetary incomes of the elders centers, when the

local budgets become insufficient etc.

National Council of the Elders37 according to the law of establishment, organizing and functioning, has the following attributions:

• offers support to state institutions in applying the recommendations of the Elders World Assembly and supervises their implementation;

• proposes to the Government programs for the continuous amelioration of the elders life conditions;

• watches the application of legislation regarding the elders and notifies the competent institutions upon the deviations found;

• formulates research themes and contracts the elaboration of sociological studies regarding the life of elders together with specialized institutions and units, makes its own analyses and elaborates points of view regarding the improvement of living standards of the elders;

• approves projects of normative acts regarding the elders, their approval being consultative;

• offers support in the associative organization of the elders and their active participation in social life;

• represent the Romanian elders in relations with similar organizations in other countries or international elders’ organizations;

• participates, as a civil society representative of the elders, in workgroups, councils and committees organized at national, local and ministry levels (including the subordinated agencies and institutions), along with other social and governmental partners, for analyzing and proposing measures for the improvement of living standards of the elders;

• informs the President of Romania, the Prime Minister, the management of central governmental bodies with social protection attributions, the

37 Established by the Law no.16/2000 regarding the establishment, organization and functioning of the National Council of the Elders. More information regarding this institution can be found on its official website: www.cnpv.ro.

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prefects and mayor's offices upon aspects related to the risks and crisis situation in which some elders are found;

• has permanent relations of collaboration with the mass-media representatives, for informing the population regarding problems of elders.

Consultative committees of civic dialogue for the elder's problems38 have the following main attributions:

• analyzing the socioeconomic problems related to the elders;• elaborates proposals for solving these problems;• elaborates annual reports that will be forwarded by the prefect to the

Ministry of Labor, Social Solidarity and Family and to the Ministry of Administration and Internal Affairs.

County Agencies for Social Benefits:• accredits, monitors and evaluates the social and socio-medical activities

developed by the providers of assistance services for elders;• in case there isn’t a specialized social assistance department within the

local council, it has the responsibility of making the social assessment and the evaluation of the elder’s situation and to take the decisions regarding the approval, rejection, suspending, or ending the right to social assistance services.

Local councils:• are responsible for organizing the social and socio-medical services39 of

care for the elders at local level;• employs caregivers by hour, part-time or full time payment for assuring

the home care of dependent elders according to the national evaluation grid;

• monitors and evaluates the social and socio-medical services offered according to the law;

• ensures funding for the social assistance for elders through:- subventions offered for completing the extra-budgetary incomes of the

centers for elders;- offering funds to the nongovernmental organizations, foundations etc.

which are active in this domain and accredited according to the law;

38 Established by the Government Decision no. 499/2004 regarding the establishment, organization and functioning of the consultative committees for civic dialogue for the problems of elders, within the prefectures.39 The services can be offered directly (by the public social assistance services or the subordinated specialized departments), in partnership with other institutions, or by subcontracting other institutions.

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- covers the costs for organizing and functioning of the services for elders and the salaries of the homecare personnel (caregivers);

• annually decides the average monthly cost of maintenance paid by the elders accommodated in centers for elders or by their supporters;

• assures, from the local budget, for the elders without incomes and legal supporters, the monthly contribution for assuring the personal homecare services and the assistance and care in residential centers;

• takes decisions for approving, rejecting, suspending and ending the right to services for:

- social assistance services organized at local level;- receiving care in the administered centers for elders;- homecare.

Local Public Services for Social Assistance (PSSA):• evaluates the needs and/or the level of dependence based on the social

assessment and the evaluation grid, and proposes the measures for assistance according to the individual situation;

• takes the decision to offer services, if the elder doesn’t have the capacity to give his/her consent; in this case, the services offered will be established based on the results of the social assessment, the evaluation grid of necessities and the recommendations of the specialist doctor and the services will be offered with the acceptance of the first degree relatives or of another family member;

• offers counseling to the elders and their family members for preventing social marginalization and for offering support or the social reintegration of the elders;

• depending on the elder’s and his/her supporter's income level, PSSA can offer the needed services for free or with the payment of a contribution;

• at the request of the Guardianship Authority, makes within 10 days since receiving the request, a social assessment regarding the non-respecting of the care commitments undertaken through selling-buying contracts with care clauses, signed by elders which were assisted for this by the Guardianship Authority;

• ensures the funerals of the elders without legal supporters or when those do not have the necessary income for covering these costs.

Guardianship Authority• has the obligation to offer, at the elder’s request, free counseling for

signing juridical selling-buying contracts, donation or loan documents with real estate guarantees that concern the mobile or immobile goods of the respective elder;

• at the beneficiary’s request, by default, assists the elder at signing the

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juridical documents concerning the estrangement of his/her goods for their own care40; in these cases, the Guardianship Authority receives by default and keeps a copy of these documents;

• receives notifications/self-notify regarding the violation of the clauses stipulated in the documents mentioned above and has the obligation to request in 24 hours a social assessment from the social assistance services, concerning this aspect;

• proposes measures of legal execution of the dispositions included in the documents mentioned above and, depending on the case, can request to the Court the contract dissolution.

Nongovernmental associations and foundations:• can become providers of homecare services for the elders, through the

accreditation of these services by the county departments;• can request from the responsible institutions homecare services for

elders;• can complete, depending on the situation and on the request of services

providers, the group that makes the social assessment and the evaluation of the elders’ needs.

Elder's family members/legal representatives/supporters:• have the obligation to assure the care and support of the elders;• agree upon the offering of services at home/in centers for elders in the

situation when the elder can’t express his/her consent due to the medical situation;

• pay the contribution established by the social services providers or the monthly maintenance cost in elders centers, if the elder’s income is insufficient.

IV.4. SOCIO-DEMOGRAPHICAL CHALLENGES

The World Health Organization warned, in the last decade, upon the fact the needs of care on long term will continue to raise under the influence of several factors: the evolution of family structure; the geographical mobility of active population; the rapid process of demographic ageing. Romania has, according to the Census in 2002, 19.4% old population (Population and Housing Census, 18th March 2002), and these aspects become important in our country, where

40 For this type of contracts it’s recommended to insert the exact and detailed measures that will be taken for improving the elder’s situation.

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the care offered to elders is, traditionally, provided by families (Gîrleanu-Şoitu, 2006; Stan, 2001).

The social and health policies must face a new challenge, of assisting semi-dependent and dependent elders for long periods of time (Vlădescu, Astărăstoae, Scîntee, 2010, pp. 87-96).

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BIBLIOGRAPHY:

1. Alternative Sociale Association, Ghid de informare în domeniul traficului de persoane. Prevenire. Combatere. Asistenţa victimelor, Iaşi, 2006;

2. Balahur, D., „Drept şi legislaţie în asistenţa socială” in Bejan, P. (coord.), Asistenţă socială vol. II. Învăţământ la distanţă, Anul I, Semestrul 2, Editura Universităţii „Al. I. Cuza”, Iaşi, 2009;

3. Eurostat Statistical Books, The EU in the world. A statistical portrait, Publications Office of the European Union, Luxenbourg, 2010;

4. Gîrleanu-Şoitu, D. & Rădoi-Ciurlică, M., Sisteme de acţiune socială, Editura Fundaţiei Academice AXIS, Iaşi, 2008;

5. United Nations Economic Comission for Europe, „Advancing intergenerational solidarity” in UNECE Policy Brief on Ageing no. 8, August 2010.

Legislation:1. Government Decision no. 886 since 5th October 2000 for approving the

national Grid for evaluating the needs of the elders, published in the Official Monitor of Romania, Part I, no. 507 since 16th October 2000;

2. Government Decision no. 499 since 7th April 2004 regarding the establishment, organization and functioning of the consultative committees for civil dialogue regarding the problems of the elders, within the prefectures, published in the Official Monitor of Romania, Part I, no. 338 since 19th April 2004;

3. Government Decision no. 541 since 9th June 2005 for approving the national strategy for developing the social assistance system for the elders within the period 2005-2008, published in the Official Monitor of Romania, Part I, no. 541 since 27th June 2005;

4. Government Decision no. 1317 since 27th October 2005 for supporting the volunteering activities in the area of homecare services for the elders, published in the Official Monitor of Romania, Part I, no. 997 since 10th November 2005;

5. Law no. 74 since 3rd May 1999 for the ratification of the revised European Social Charter, adopted in Strasbourg on 3rd May 1996, published in the Official Monitor of Romania, Part I, no. 193 since 4th May 1999;

6. Law no.16 since 6th March 2000 regarding the establishment, organization and functioning of the National Council of the Elders, republished with its

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further modifications and completions in the Official Monitor of Romania, Part I, no. 304 since 8th May 2009;

7. Law no.17 since 6th March 2000, regarding the social assistance of the elders republished in the Official Monitor of Romania, Part I, no. 157 since 6th March 2007, with its further modifications and completions;

8. Law no.292 since 20th December 2011 of social assistance, published in the Official Monitor of Romania, Part I, no. 905 since 20th December 2011;

9. Order no. 491/180 since 23rd May 2003 for approving the Grid of medico-social evaluation of the persons that get into medico-social assistance units;

10. Order no. 246 since 27th March 2006 of the minister of labor, social solidarity and family for approving the minimum quality Standards specific for the homecare services and for the residential centers for the elders, published in the Official Monitor of Romania, Part I, no. 637 since 24th July 2006.

Web:1. http://www.un.org

2. http://www.coe.int

3. http://epp.eurostat.ec.europa.eu

4. http://www.cnpv.ro

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CAP.V. SOME JURIDICAL PROBLEMS OF THE ELDERS


INTRODUCTION

In the following section we will shortly present the institutions of law or regulations that elders most often face. The following considerations aim to make the interested person more aware of the rights, obligations and risks assumed when signing a legal document and the way in which he can valorize the rights offered by law or gained through legal contracts or documents.

The present chapter doesn’t wish to summarize law treaties, but to address in an accessible but rigorous language, to the target group of this publication so they can have a minimal juridical education, and when they will go to a specialist (lawyer, notary) they will have the necessary notions for asking for the proper serflaw.

Most of the times, the notary will reflect in the prepared documents the beneficiary’s expressed will. Making the elder aware of the rights and options he has, will permit the law specialist to have an efficient communication with the beneficiary and, by analyzing the concrete situation, to prepare the actually needed document.

So, the main role of this chapter is to present the options that can be formulated in hypothetic situations, with their advantages and disadvantages. It’s not possible to make this presentation an exhaustive one.

Where considered to be opportune, the presentation of the incident regulations is done by examples of court decisions (real and not modified) for showing the way in which a legal regulation is practically applied.

V.1. PRELIMINARY ASPECT. TERMINOLOGY. APPLYING THE LAW IN TIME.

V.1.1. Preliminary aspect

In 2011, more exactly on 1st October 2011, the Civil Code, Commercial Code, a series of laws, and other normative documents have been abrogated41 and

41 Article 230 of Law no. 71 since 3rd June 2011 for applying the Law no. 287/2009 regarding the Civil Code:“At the date when the Civil Code enters into force, the following are abrogated:a) the Civil Code (since 1864), published in the Official Monitor no. 271 since 16th January 1864, no. 7 since 12th January 1865, no. 8 since 13th January 1865, no. 8 since 14th January 1865, no.

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replaced with Law no. 287/2009 regarding the Civil Code, with its modifications

11 since 16th January 1865, no.13 since 19th 1865, with the later modifications and completions, excepting the dispositions of articles 1169-1174 and 1176-1206, which are abrogated when the Law no. 134/2010 regarding the Civil procedure Code comes into force;b) Law no. 313/1879 for cancelling the penal clause in any contract and for the adding of a line at article 1.089 in the Civil Code, published in the Official Monitor no. 40 since 20th February 1879;c) the Commerce Code since 1887, published in the Official Monitor no. 31 since 10th May 1887, excepting the dispositions of articles 46-55, 57, 58 and 907-935, still applicable in the relations between professionals, which are abrogated at the date when the Law no. 134/2010 comes into force, the second book «About the maritime commerce and about navigation» and the disposition of articles 948, 953, 954 line (1) and 955, which are abrogated when the Maritime Code comes into force;d) Decrete no. 2.142/1930 for the promulgation of the Law regarding the functioning of the central land register for railways and channels no. 148/1930, published in the Official Monitor no.127 since 12th June 1930;e) Law no. 178/1934 regarding the reglementation of the consignment contract, published in the Official Monitor no. 173 since 30th July 1934;f ) article 17 and articles 19-28 of Law no. 153/1937 regarding the general stores and warranties for merchendisers and cereals (docks and silos), published in the Official Monitor, Part I, no. 81 since 7th April 1937;g) Law-decrete no.115/1938 for the unification of dispositions regarding the land registres, published in the Offcial Monitor, Part I, no. 95 since 27th April 1938, with the following monidifications;h) Carol the 2nd Civil Code, republished in the Official Monitor no. 206 since 6th September 1940, with the following modifications;i) Carol the 2nd Commersial Code, republished in the Official Monitor no. 194 since 23rd August 1940, with the following modifications and completions;j) Law no. 319/1944 for the right of inheritance of the surviving spouse, published in the Official Monitor no. 133 since 10th June 1944;k) Law no. 163/1946 for the temporary replacement of land evidence documents of destroyed, circumvented or lost land registres, published in the Official Monitor no.62 since 14th March 1946, with the following modifications;l) Law no. 242/1947 for transforming the temporary land registres from the Old Kingdom in land publicity registries, publiced in the Official Monitor no. 157 since 12th Julay 1947, with the following modifications;m) Law no.4/1953 regarding the Family Code, republished in the Official Bulletin no.13 since 18th April 1956, with the following modifications and completions;n) Decrete no. 31/1954 regarding the natural and legal persons, published in the Official Bulletin no. 8 since 30th January 1954, with the following modificiations and completions;o) Decrete no. 32/1954 for applying the Family Code and the Decrete regarding the natural and legal persons, published in the Official Bulletin no. 9 since 31st January 1954, excepting the articles 30-43 which are abrogated when the Law no. 134/2010 comes into force;p) Decrete no.167/1958 regarding the extinctive prescription, republished in the Official Bulletin no. 11 since 15th July 1960;q) articles 1-33 and 36-147 of Law no. 105/1992 regarding the reglementation of private international law relations, published in the Official Monitor of Romania, Part I, no. 245 since 1st October 1992, with the following completions;r) Law of land tenancy no. 16/1994, published in the Official Monitor of Romania, Part I, no. 91 since 7th April 1994, with the following modifications and completions;s) articles 21-33 of Law of housing no. 114/1996, republished in the Official Monitor of Romania, Part I, no. 393 since 31st December 1997;

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and completions42.

V.1.2. TerminologyThe existence of two civil codes that succeed force us to establish, in order to

avoid any confusion, different names for the two documents. So, in the following, we will refer to the Civil Code from 1864 by the expression “Civil Code” and abbreviation “Civ. c.” and the Law no. 287/2009 regarding the Civil Code with its modifications and completions will be reffered to as the “New Civil Code” and abbreviation “N. Civ. C.”

ş) articles 7, 14 and 15 of Law no. 119/1996 regarding the civil status documents, republished in the Official Monitor of Romania, Part I, no. 743 since 2nd November 2009, with the following modifications;t) article 32 of the Law of land fund no. 18/1991, republished in the Official Monitor of Romania, Part I, no.1 since 5th January 1998, with the following modifications and completions;ţ) article 9, line 8 of Law no.112/1995 for the reglementation of the juridical situation of some estates used as houses, passed in the property of the state, published in the Official Monitor of Romania, Part I, no. 279 since 29th November 1995, with the following modifications;u) title VI “The juridical regime of the real movable guarantee” of Law no. 99/1999 regarding some measures for accelerating the economic reform, published in the Official Monitor of Romania, Part I, no. 236 since 27th May 1999, with the following modifications;v) articles 12, 14-25, article 32 line (2), articles 43 and 44 of the Government Emergency Ordinance no. 40/1999 regarding the protection of renters and the establishment of rent rates for spaces used as houses, published in the Official Monitor of Romania, Part I, no. 148 since 8th April 1999, approved with modifications and completions through the Law no. 241/2001, with the following modifications; from the same date, the dispositions of articles 12 and 14-25 are not applied neither to the contracts of renting the house in course of execution;w) Law no.509/2002 regarding the permanent commercial agents, published in the Official Monitor of Romania, Part I, no. 581 since 6th August 2002;x) article 40 line (1), articles 41 and 42 of Law no. 272/2004 regarding the protection of children’s rights, published in the Official Monitor of Romania, Part I, no. 557 since 23rd June 2004, with the following modifications;y) articles 1, 5-13, 16, article 18 line (2) thesis I, article 56 lines (1)-(4), articles 57, 59-63 and 65 of Law no.273/2004 regarding the juridical regime of adoption, republished in the Official Monitor of Romania, Part I, no. 788 since 19th November 2009;z) article 90 line (2) of Law of gases no. 351/2004, published in the Official Monitor of Romania, Part I, no. 679 of 28th July 2004, with the following modifications and completions;aa) title X “The juridical circulation of lands” of Law no.247/2005 regarding the reform in the domains of property and justice and adiacent measures, published in the Official Monitor of Romania, Part I, no. 653 since 22nd July 2005, with the following modifications and completions;bb) any other contrar dispositions, even if they are included in special laws.”42 Law no. 287/2009 was published in the Official Monitor of Romania, Part I, no. 511 since 24th July 2009, was modified through Law no. 71/2011 and rectified in the Official Monitor of Romania, Part I, no. 427 since 17th June 2011 and in the Official Monitor of Romania, Part I, no. 489 since 8th July 2011.

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V.1.3. Applying the law in timeA first problem is determining the law which is applyied to the documents

or acts finished, executed or done before or after the New Civil Code came into operation.

Solving this problem consists in applying two law principles:• The principle of un-retroactivity of the new civil law;• The principle of immediate application of the new civil law.

These principles are consecrated by the Romanian Costitution and the civil law is object of art. 6 N. Civ. C.:

(1) The civil law is applicable as long as it is in force. It can not be applied retroactively.

(2) The juridical documents and facts done or produced before the new law came into force cannot generate other juridical effects than those provided by the law that was in force when they were done or produced.

(3) The juridical acts that are nule, abolishable or affected by other causes of unefficiency at the date when the new law came into force, are subject to the provisions of the old law and cannot be considered valid or efficient according to the provisions of the new law.

(4) Prescriptions, decays and usurpations started and not ended at the date when the new law came into force are totally subject of the legal dispositions that set them.

(5) The dispositions of the new law are applied to all the documents and facts done or produced after it came into force, and to the juridical situations born after it came into force.

(6) The dispositions of the new law are also applicable to the future effects of the juridical situations born before it came into force, derived from the state and the capacity of the persons, from marriage, filiation, adoption and legal obligation to support, from property relations, including the general regime of goods, and from neighbourhood relations, if these juridical situations subsist after the new law came into force.”

The cited provisions are clear, and for the aim of this publication, no further comments are needed. However, it’s important to mention that the literature expresses the following opinion, with which we agree:

“… the exception of the ultraactivity of the old law is applicable not only in case the new law deliberately provides this but also in case of suppletive juridical norms43. This is because the parties that make a juridical act leave on the count of

43 The law norms are suppletive if they establish a certain conduct, which is compulsory for the parties only in case they haven’t established through their will, another conduct (in both civil codes, in the absence of a contrary provision, the costs related to signing the exchange contract are supported, equally, by the parties).Opposed to these are the imperative norms. The norms of civil right are imperative when they impose to the subjects of law an action or abstention and don’t permit a derogation (in both civil rights is imposed the authentic form of donation under the sanction of absolute nullity).

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suppletive juridical norms, that are in force at that moment, the establishment of some conditions and effects of the juridical act in cause, so the abrogation finds the old law incorporated, through the parties will, in juridical acts done under its influence; as a result, the new law, if applied to these juridical acts, would ignore the parties will and would cancel the effects prepared by the parties, although not realized yet. That’s why it’s natural that the law that governed the juridical act to be applied to all its effects even to those produced after the law is abrogated.” (Boroi, Anghelescu, 2011, p. 18)

V.2. THE CAPACITY TO CLOSE JURIDICAL ACTS AND THE CONSENT OF THE ELDER

For assuring the validity of juridical acts the law provides some general conditions that must be fulfilled by the person that diposes of his rights. These conditions are compulsory each time a contract, a will is closed, an inheritance is accepted etc.

In the case of elders, often their capacity to close juridical acts and give their consent is disputed.

V.2.1. Legal competenceLegal competence consists in the person’s aptitude to gain and exercise

subjective civil rights and to assume and execute civil obligations through the completion of civil legal acts.

Total legal competence is gained, usually, by reaching the age of 18 years old.Legal competence is lost as result of decease or of being put under interdiction. The banned person can’t assume on his own (without the approval of the

tutor/guardian or, in case, of the tutelary authority/instance44) contractual obligations or give disposals through unilateral acts.

44 In the reglementation of the New Civil Code Article 229 of Law no. 71/2011: „(1) The organization, functioning and attributions of the tutelary instance are established through the law regarding the judicial organization. (2) Until the reglementation through law of the organisation and functioning of the tutelary instance:a) its attributions, provided by the Civil Code, are fulfilled by the instances, sections or, depending on the case, specialized courts for minors and family;b) the psiho-social evaluation report, mentioned by the Civil Code, is done by the tutelary instance, excepting the evaluation provided at article 508, line (2), done by the general department of social assistance and child protection;c) the authorities and institutions with attributions in the field of child protection, more exactly natural persons, continue to exercit the attributions provided by the reglementations in force at the date when the Civil Code entered into force, excepting the ones given in the competence of the tutelary instance. (3) Until the reglementation mentioned in line (1) comes into force, for fulfilling the attributions

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A mental alienated person that hasn’t been put under interdiction has the capacity to sign a document but, the validity of his/her consent will be analized for each document separately.

Putting under interdiction is a mean of juridical protection of the persons without consent wich can’t defend their interests or exercise their civil rights.

The interdiction can be required by close persons, inhabitants or administrators of the house where the person lives, Civil Serflaw, public notary, courts, local public administration organs, care institutions or any other person.

A premiere on this matter is the possibility of choosing the tutor and the possibility of constituting the family council45.

So, any person that has full legal capacity can designate through a unilateral act or mandatory contract, in authenticated form, the person46 proposed as tutor47 for taking care of the person and his/her goods in case the person will be put under interdiction. The designation can be revoked anytime.

regarding the exertion of tutelage related to the belongings of the minor or, depending on the case, related to supervising the way in which the tutor administers the goods of the minor, the tutelary instance can delegate some of these obligations to the tutelary authority.”45 Family council is reglemented by articles 124-132 N. Civ. C.Family council can be established for supervising the way in which the tutor executes his/her rights and fulfilles his/her obligations regarding the person and belongings of the banned person. The tutelary instance can constitute a family council, including 3 persons, usually relatives or friends (the tutelary instance names also two replacements). The tutor can’t be a member of the family council.Naming the members of the family council is done with their approval.The meetings of family council members are held at the minor’s domicile. In case the convocation was done at the tutelary instance’s request, the meeting will be held at its headquarters.The family council gives consultative approvals, at the request of the tutor or the tutelary instance, and takes decisions, the cases provided by the law. The consultative approvals and decisions are taken through the majority’s vote, the council being chaired by the oldest member. The family council’s decisions will be motivated and recorded in a specially created registry, held by one of the council members, designated for this by the tutelary instance.The documents signed by the tutor in the absence of the consultative approval are annullable. Signing the document without respecting the approval of the council is in the responsibility of the tutor.The tutor can request the institution of a new council, if in the complaints formulated according to the present code the instance decided at least twice, definitively, against the decisions taken by the familt council. If establishing a new family council is not possible, as in the case of opposite interests between the minor and all family council members and suppleants, the tutor can ask the tutelary instance to exercise the guardianship alone.46 In case more persons were designated as tutors, without any preference, or there are more relatives or friends of the minor’s family which can fulfill the tutelary tasks and express the will of being tutor, the tutelary instance will decide taking into account their material possibilities and moral guarantees needed for the harmonious development of the minor.47 When naming the tutor or, depending on the case, during the guardianship, the tutelary instace can ask, by default or at the request of the family council, the tutor to give real or personal guarantees.

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In absence of a designated tutor, the tutelary authority/instance will appoint with priority as tutor, if there aren’t any opposite grounded reasons, a relative or affiniated person or a family friend of the person to be put under interdiction, which is capable of fulfilling this task, taking in consideration the personal relationship, the distance between residences, the material and moral guarantees presented by the proposed tutor48.

If needed, until the request of putting under interdiction is solved, the tutelary instance can name a special guardian for taking care and representing the person proposed for being put under interdiction and for administrating his/her goods.

The interdiction produces its effects since the date when the court’s decision remains definitive. Nevertheless, the loss of the legal competence can be opposed to a third party since fulfilling the formalities of publicity provided by the Civil Procedure code, excepting the situation the third party found out about the interdiction another way.

The juridical documents signed by the person put under interdiction are annulable even if at the date when the document has been signed the person had discernment.

The tutore is owed to take care of the person put under interdiction, for accelerating his/her healing and for improving his/her living conditions. For this the income and, if needed, goods of the person put under interdiction will be used. The tutelary instance will decide, taking into account the circumstances, if the person put under interdiction will be cared at his residence or in an institution.

The tutor can’t, in the name of the person put under interdiction, to make donations or to guarantee another person’s obligation49.

From the goods of the person put under interdiction, his/her descendants (son/daughter, grandchildren) can be gratified by the tutor, with the approval of the family council and with the authorization of the tutelary instance, but without exemption from report. This means that other relatives (brothers, cousins etc.) and aquintances of the person put under interdiction cannot benefit from donations.

48 Establishing the tutor is done with his/her approval. When the tutor was established through a mandatory contract, the person designated as tutor can refuse his/her naming from the motives mentioned by the law:

a) having 60 years old;b) preganant woman or the mother of a child younger than 8 years old;c) the person that raises and educates 2 or more children;d) the person that, due to the illness, the type of activities done, distancing the domicile

from the place where the minor’s belongings are or from any other based motives, couldn’t fulfill this task.

49 Exceptions are the ordinary gifts, according to the material situation of the banned person.

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Also, the tutor can’t, without the family council’s approval and tutelary authority’s authorization, alienate, share, put mortgage or take any actions on the minor’s goods, renounce at the patrimonial rights of the person or sign any other valid documents that exceed the right of administration.

In administering the patrimony of the person put under interdiction, the tutor will have to respect also the articles 802 to 845 of the Civil Code.

If the factors that caused the interdiction have ended, the court will cancel it. This can be claimed by the person put under interdiction, by the tutor and by the persons or institutions that can request the interdiction. The decision of canceling the interdiction produces its effects since the court decision remains definitive. Nevertheless, the tutor’s right of representation can be opposed only after the formalities of publicity, provided by the Code of Civil Procedure, excepting only the situation when the third person found out another way.

According to article 16 of Law no. 71/2001 the persons that were under tutelage, guardianship or any other protection measure when the new Civil Code came into force are subject to the New Civil Code dispositions concerning their capacity.

V.2.2. ConsentBy the term consent we understand the exteriorization of the decision to

conclude a juridic civil act.In order to be valid, the expressed consent, according to the 1864 Civil Code,

should cumulatively meet the following requirements:• To come form a person with discernment;• To be expressed with the intent of producing juridical effects;• To be exteriorized;• Not to be altered by a flaw of consent.

Between the old reglementation and article 1024 of the New Civil Code there is only one difference of expression. According to the latter “the consent of the parties should be serious, free and expressed knowingly.”

As a consequence, in order to be valid, the consent must cumulatively meet the following requirements (Boroi, Anghelescu, 2011, p. 131):

• To be knowingly expressed, which means to come from a person with discernment;

• To be serious, or widely to be expressed with the intention of producing juridical effects;

• To be free, this means that it must not be altered by a flaw of consent.Regarding the condition “to be externalized” we mention that article 13 N.

Civ. C. states that “giving up a right is not presumed”. So, taking in consideration that for verifying the other conditions of the

consent we need a form of expression that can be known, we consider that the

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condition of exteriorizing the consent is still actual. But the doctrine of the jurisprudence should define its content in the new reglementation.

Most often, the documents signed by elders are “accused” of being annulable due to the lack of discernment and/or due to the intervention of a flaw of consent.

Discernment is a state of fact and supposes that the person giving his/her consent has the capacity of appreciating the juridical effects produced by the manifestation of his/her will. The lack of discernment is sanctioned through the relative nullity of the juridical act.

Article 1205 of N. Civ. C. keeps the sanction of relative nullity of the juridical act concluded with a person without discernment. As a new element, through line (2) of article 1205 N. Civ. C., the legislater establishes that “the document signed by a person that ulterior is put under interdiction is affected by nullity if, at the moment when signed, the causes of being put under interdiction were present and known”.

The doctrine analyses differently (Boroi, Anghelescu, 2011, p. 133) the provisions of this article, but the conclusion reached is that “article 1205, line (2) the N. Civ. C. has a restrictive interpretation in the way that the legislator, through an unhappy formulation, wished to underline that, in the respective hypothesis, the anullation can’t intervene for the lack of capacity but for the lack of discernment.”

For avoiding the anullation of juridical acts consented by an elder is recommended that previously he/she should be subject to a psychiatric evaluation and its results to be kept and, if needed, to be presented to the notary.

Flaws of consent are: error, dolus, violence and damage.In the ligh of the new reglementations, the flaws of consent remain the same.

But there are some modifications regarding the conditions of the flaws and their effects.

Damage is a flaw of consent that consists in the material prejudice suffered by one of the parties due to the obvious value disproportion between prestations, existent in the moment of signing the convention (Boroi, 2001, p. 171).

This flaw can appear, according to the legal dispositions, only in the case of documents signed by persons between 14 and 18 years old.

In the reglementation before the New Civil Code there was only one exceptional situation when the elder (or his succesors) could invoke the flaw of damage: after accepting the succestion expressely or impliedly, “the succession should have been absorbed or reduced with more than a half through finding a testament, not known at the moment of acceptance”, according to art. 694 of the Civil Code.

According to art. 1.221 N. Civ. C. “there is a damage when one of the parties, taking advantage of the need, lack of experience or lack of knowledge of the other party, stipulates in his/her favor or in the favor of another person, a prestation obviously bigger, at the date of concluding the act, than his/her own prestation.

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The existence of damage is appreciated also through the nature and goal of the contract.

The damage can exist also when the minor assumes an obligation which is excessive by reporting to his patrimonial situation, to the advantages obtained through the contract or to all circumstances.”

It can be observed that comparing to the old reglementation, where the damage was considered only for minors with limited legal capacity, the New Civil Code distinguishes between the damage of the adult and the damage of the minor. For the purpose of our chapter, we are focusing on the damage of the adult. In this case, the legislator established that cancellation is admissible only if the damage is over half of the value of the prestation promised or executed by the damaged party, in the moment when the contract was signed. The disproportion has to subsist until the date of the cancellation request.

The sanction in the case of damage is the relative nullity of the juridic act finished after the New Civil Code came into force, or the reduction, or increase of one of the prestations.

The right to cancellation or reduction of obligations can be prescribed in one year since the contract was signed. The anullability of the contract can’t be opposed as exception when the right of action is prescribed.

Violence is the consent flaw that consists in threatening a person with something bad enough to produce fear, so the threatened person is determined to close a juridic act which he/she wouldn’t do in normal conditions.

Being an actual situation, it can be demonstrated in an eventual litigation through any evidence, so the elder forced to sign a juridic act should be encouraged to tell to as many people as possible, to the authorities, social workers etc. about the tensioned relations before consenting such acts, for using their testimony and the correspondence with the authorities in the eventuality of a civil lawsuit.

In the new reglementation, regarding violence, the legislator makes some specifications for clarifying some situations discussed previously in the doctrine.

Such a situation is signing a contract by a person due to a need. The controversy in this situation is the existence or inexistence of violence as consent flaw and the sanction applied. The solution, after analizing article 1218 N. Civ. C., is “if one of the parties of the juridical act takes advantage of the necessity in which the other party is found, the juridical act might be cancelled according to the rules applied for violence.” (Boroi & Anghelescu, 2011, p. 148).

Another new element is in article 1220 N. Civ. C. which states that “violence leads to cancelling the contract even when it’s applied by a third party, but only if the party whose consent was not flawed knew or, depending on the case, should have known the violence applied by the third party.” So according to the new reglementation, if the contractant didn’t knew and shouldn’t knew about the violence produced by a third party, the party with the flawed consent can’t

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request the cancellation of the act, but can request compensations according to line (2), article 1220 of N. Civ. C.

The dolus consists in misleading a person through deceitful means for determining the person to sign a juridical act.

Analysing the conditions of the dolus, the following aspects were retained: “from the article 960 of the Civil Code it results that the dolus, not excluding the consent, doesn’t impede forming the contract, but it makes it annulable because it affects the freedom of the will. This means that it has to be proven that when the document was signed deceitful means existed, coming from one of the parties and that they were the determinant cause of the contract and without them, the other party wouldn’t have signed it. In a case where the court cancelled an authentic selling-buying contract, the dolus was deduced from the actual relationships between the parties, which is illegal because a presumption, no matter its gravity, is not sufficient. The one which invokes the dolus must prove clearly that deceitful means existed and that they produced the aimed result consisting in obtaining the consent at the moment of contracting. In the appeal, this was the justification for cancelling the action.” (Perju, 1992, p. 59)

According to the new reglementation there isn’t anymore the condition that, for being a consent flaw, the dolus has to be determinant for signing the contract because “the party with the flawed consent through dolus can request the annulations of the contract, even if the error was not essential.” (article 1214, line (2), N. Civ. C.)

As result, according to the New Civil Code, the only condition that has to be respected for having a dolus is that deceitful means have to come from the other party, from the representative, supposed or gerent of the other party’s businesses or from a third person, if the other party knew or should have known the dolus when signing the contract.

By error it’s understood the false representation of circumstances when signing a juridical document (Boroi, 2001, p. 161).

Depending on the consequences, the error is of three kinds:• Obstacle error (destructive of will) sanctioned with absolute nullity;• Serious error (error – consent flaw) can lead to the annulations of the

document (relative nullity);• Indifferent error (false representation of circumstances that are less

important for the juridical document, without affecting its validity) can determine, at most, a decrease in value of the prestation.

The New Civil Code differentiates the error, by the criterion of the involved consequences, in essential and nonessential.

According to the New Civil Code the error is essential when:1. is related to the nature or object of the contract (error in negotium);

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2. is related to the identity of the prestation object (error in corpore) or a quality of it or any other circumstance considered to be essential by the parties and without it the contract wouldn’t have been signed (error in substantiam);

3. is related to the identity of the person or a quality of the person and without it the contract wouldn’t have been signed (error in personam);

4. is related to the expression of the will or when the declaration was transmitted inexactly through another person or through long-distance communication means (error of communication or of transmission).

Law error is essential when is related to a juridical regulation which is determinant, according to the will of the parties, for signing the contract.

The nonessential error represents, according to the doctrine (Boroi, Anghelescu, 2011, p. 136) “the false representation of less important circumstances for signing the juridical document, that the party in error would have signed the document even if he/she has had a correct representation of those circumstances.”

The situations of nonessential error are provided in the New Civil Code at article 1209 and 1210. These are completed with examples from the jurisprudence and doctrine.

Another classification of the error is related to the nature of the reality which was falsely represented. So, the error can also be of law. The New Civil Code establishes for the law error the rule according to which this error can be invoked if there are inaccesible and unpredictable legal dispositions. Through this reglementation the legislator ended the divergences that existed in the professional literature and in the jurisprudence regarding the admittance of law error as consent flaw (see Boroi, Anghelescu, 2011, p. 218).

The sanction that is applied in the case of essential error is the relative nullity of the contract.

Most often, the nonessential error doesn’t flaw the consent of the parties, so, the only sanction that can be applied in this case is the increase or decrease of the prestation value.

Also, the New Civil Code offers the parties the possibility of adapting the contract. According to article 1213 N. Civ. C. if one party is entitled to invoke the invalidation of the contract due to error but the other party declares that he/she wishes to execute or executes the contract as it has been understood by the party entitled to invoke the invalidation, the contract is considered to be signed as this latter party understood it.

Therefore, after being informed on the way the entitled person to invoke the annulation understood the contract and before this person obtains the annulations, the other party must declare, in 3 months since the notification or since the date of receiving the summon, that agrees to the execution or is going

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to execute without delay the contract, as it has been understood by the party in error.

If the declaration was done and communicated to the party in error in the term previously mentioned or the contract has been executed, the right to obtain the annulation is cancelled and the notification is considered to be without effects.

Case presentation. Decision no. 207/2007 – Craiova Appeal Court (portal.just.ro accessed on 10.08.2010)

“The error – consent flaw reglemented by article 953 and 954 Civil Code as false representation of the substantial qualities of the object of the document (error in substantiam), or of the contracting person (error in personam) leads to the sanction of relative nullity of the document. In the case of error distructive of will, as false representation of the nature of the document that is signed (error in negotio), or of the object’s identity (error in corpore) the sanction applied is the absolute nullity.

The error invoked in the case is not error in corpore, when one of the parties believes that it negotiates a good while the other has in mind another, because this error is not related to the identity of the good; both the seller and the buyer are negotiating the same good, land.

It is not the case of the two error situations that involve the sanction of absolute nullity, because the applicant, as third party related to the selling-buying contract, can’t invoke the sanction of relative nullity.

Selling the good of another is punished with absolute nullity of the contract only under the existence of bad intentions of both parties. The fact that the defendant saw the land before signing the document and the fact that it was fenced, can’t be a proof of the bad intention of the buyer because it’s obvious that seing the land doesn’t involve measuring it.

The applicant S.C. Company brought proceedings against G.S. for the absolute partial nullity of the selling-buying contract signed on the 30th January 2006, by RUSĂNEŞTI Co. – company in insolvency, represented by liquidator B.V., as seller and by the defendant as buyier, for the area of 90.65 square meters of land.

It has been shown that on the 22nd March 2005, in the insolvency file of the debtor RUSĂNEŞTI Co., the area of 2081.06 square meters was bought, situated inside the headquarters of the insolvent, identified in the location sketch as plot no.2, and in this surface was included the access alley marked in the annexed sketch through points 4, 89, 90, 27 with exit to county road no.643. It was also shown that the defendant bought on the 30th January 2006 plot no.1 for which the documentation was wrongly done, because in this plot it has been included the access alley and in the same day the sketch was redone, but when the documents

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were given, the wrong sketch was attached. RUSĂNEŞTI Co., as defendant was introduced in the cause, through liquidator.

The defendant G.S. invoked the exception of lack of procesual quality of the accuser, based on the fact that the error on which the accusation was build is reason to relative nullity that can be requested only by the contracting parties. Due to the cause, he requested the rejection of the action as being groundless because the selling-buying contract was signed according to the cadastral documents and for the bought estates, the land register no.201 was created.

The liquidator brought evidence to proof that by mistake, in the selling-buying contract of the defendant, the noted area is 1210.21 square meters, while the correct area is of 1119,65 square meters.

Olt Court – Commercial Department, through sentence no. 207, given on the 15th May, in file no. 6919/104/2006, rejected the exception of lack of procesual quality as being groundless and rejected as being groundless the applicant’s action.

Against this sentence the applicant appealed.The appeal is not founded.Regarding the first appeal motive regarding the wrongful appreciation of the

sanction caused by error in corpore the Court retains that it is not founded.The error consent flaw reglemented by article 953 and 954 of the Civil Code

as false representation of the substantial qualities of the object of the document (error in substantiam), or of the contracting person (error in personam) causes the sanction of relative nullity of the document.

In the case of the error distructive of will, as false representation of the nature of the document to be signed (error in negotio), or of the object’s identity (error in corpore) the sanction applied is absolute nullity.

The nullity invoked by the applicant is not error in corpora, because the error is not related to the identity of the object, both seller and buyer negotiating upon the same good, land.

So, the appreciation of the instance that in this case is not one of the two situations of error that are sanctioned through absolute nullity and that the applier, as third party of the selling-buing contract, can’t invoke the sanction of relative nullity that can be requested only by the contracting parties is correct.

Regarding the second appeal motive regarding the selling of another one’s good while both parties knew that the land was owned by another person, this is not grounded too.

The aspect invoked by the applier that the defendant saw the land before signing the contract and that it was fenced, can not be retained as proof of bad intentions of the seller because it’s obvious that seing the land doesn’t involve measuring it, so he couldn’t know that the area seen is of 1210,21 square meters.

Besides, from the expertise done results that without the area pretended by the applicant, the surface of the bought land would be smaller than the one

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indicated in the selling-buying contract, and with this area, the surface of the applicant would be bigger than the one mentioned in the document.

In consequence, in this case we are not in the situation of selling the good of another person in the conditions of bad intentions of the parties, which would lead to the absolute nullity of the contract, so the conclusion of the first court is also correct.

For the mentioned reasons the appeal will be rejected.”

V.3. PATRIMONIAL RIGHTS AND OBLIGATIONS OF THE SPOUSES. MATRIMONIAL REGIMS

Until the New Civil Code came into force, the only matrimonial regime was the community of goods regulated by the Family Code. The analysis of the matrimonial regimes is important, for the elders, especially from the perspective of disposal (through onerous contracts or donations) of the goods aquired during life and of the right of inharitance of the living spouse. So, our presentation will circumscribe these endings.

The New Civil Code kept this regime and renamed it the matrimonial regime of the legal community of goods, but introduced the regime of separation of goods and the regime of conventional community50.

Regarding the elders it’s important to mention the fact that they can change their matrimonial regime.

Choosing a different matrimonial regime than the legal community is done through signing a matrimonial convention, written and authenticated by the public notary, with the consent of all parties, expressed personally or through a representative with authentic and special mandate with a predetermined content51.

The convention signed during marriage produces effects starting with the date established by the parties or the date when it was signed.

For being opposable to the third parties, the matrimonial conventions are subscribed in the National Registry of Matrimonial Regimes52, organized according to the law.

Taking into consideration the nature of the goods, the matrimonial conventions will be noted in the land register, in the commerce registry and in other publicity registers mentioned by the law. In all of these cases, not fulfilling the special publicity formalities cannot be covered by the subscription in the National Registry of the Matrimonial Regimes.

50 Article 312 N. Civ. C.51 The format conditions are provided under the sanction of absolute nullity by article 320 N. Civ. C.52 Any person, without having to justify any interest, can explore the National notary registry of matrimonial regimes and can request, respecting the law’s conditions, releases of certified extracts.

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V.3.1. The matrimonial regime of community of goods in the Family Code

The matrimonial regime in the Romanian law was the community of goods. So, the goods acquired by the spouses during marriage were compulsory common goods53, according to article 30 of the Family Code and the exceptions were restrictively provided by the law.

So, according to article 31 of the Family Code, the goods that are the property of each spouse are:

• the goods acquired before marriage;• the goods acquired during marriage through inheritance or donation

with the exception when the disposer stated that the goods will be common;

• the goods of personal use and the ones that one of the spouses use for excerting his profesion;

• the goods acquired as prizes or rewards, scientific or literary manuscripts, artistic drafts and projects, inventions and inovation projects and other similar goods;

• insurance indemnity and compensations for damages to the person;• the value that represents and replaces a personal good or the good that

represents this value.Regarding the common goods, when the marriage ends, the common

property will be split in shares and after the official sharing the goods will be individualized and will become the exclusive property of each spouse.

The law presumes that during marriage, both spouses contributed equally to acquiring the common goods, so the quota of each is ½ (50%). This presumption can be cancelled if it ca be proven that one of the spouses had a larger contribution to forming the community of goods. The spouses’ contribution is appreciated on the whole and not for each good. Also, the work in the household or for educating the children is taken into consideration and not only the incomes gained through work, commercial activities, investments etc.

During marriage, the spouses use the common goods without having a mandate from the other spouse, which is presumed. The exception in this case is the right of disposal on real estates, for which the law states that the consent of the other spouse is necessary.

V.3.2. Matrimonial regimes according to the New Civil CodeThe married elders can choose as matrimonial regime: legal community,

goods separation and conventional community.

53 „The goods gained during marriage, by any of the spouses are, from the date they were gained, common belongings of the spouses. Any contrary convention is nule. The quality of common belonging must not be proven”.

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Legal community of goods (article 339-359 of N. Civ. C.) is the continuation of the matrimonial regime regulated by the Family Code (abrogated in present).

The persons that haven’t signed after 1st October 2011 a matrimonial convention are subject of this regime. The whole reglementation from the Family Code was taken over in its content, the modifications being mainly formal.

In the new reglementation, the alienation documents with real rights having as objects common goods can be finished only with the approval of both spouses. Nevertheless, any of the spouses can decide alone, by onerous title, regarding mobile goods for which the alienation is not subject to specific publicity regulations, according to the law. If the interests of the spouse that hasn’t participated in the alienation of the goods have been damaged, he/she can pretend only damage-interests from the other spouse, without affecting the rights gained by the third weel-intended party.

Each spouse can benefit from the rightful share, at the end of the marriage, of the community of goods.

The document signed without the express consent of the other spouse, when it is necessary acoording to the law, can be subject to annulation.

The regime of goods separation is reglementated by articles 360-365 of N. Civ. C.

In case this regime was choosed, than each of the spouses is the exclusive owner of the goods acquired before marriage and of the goods acquired in his/her own name after this date.

When adopting this regime, the public notary makes an inventory of the personal mobile goods, no matter the way they were acquired. The inventory is annexed to the matrimonial convention and is subject to the same publicity formalities as the matrimonial convention.

The goods acquired by the spouses together are common property and are owned in shares.

If one of the spouses aquires a personal good and is using totally or partially the goods of the other spouse, the latter can choose, respecting the proportion of the goods used without his/her consent, from requesting the total property of the acquired good and pretending loss-interests. However, the property can be claimed only before the spouse that aquires disposes of the good excepting the case when the third party knew that the good was acquired through the valorification of the other spouses’ goods.

When this regime ends, each spouse has a right of retention over the other one’s goods, until the total debts between the spouses are payed.

The regime of conventional community is applied when, in the conditions and limits described in this section, through matrimonial convention, is derogated from the dispositions for the legal community regime. If the

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matrimonial convention doesn’t state differently, the juridical regime of conventional community is completed with the legal dispositions regarding the regime of legal community.

In case the conventional community is adopted, the matrimonial convention can refer to one or more of the following aspects:

• including, totally or partially, the personal goods or debts acquired before or during marriage, excepting the personal goods or the goods used by one of the spouses in his/her proffesion;

• restricting the community to the goods or debts specially provided in the matrimonial convention, no matter if they are acquired before or during marriage, excepting the obligations assumed by any of the spouses for covering the usual costs of marriage;

• the obligation of having the consent of both spouses for signing administrative documents; in this case, if one of the spouses can’t express his/her consent or abusively opposes, the other spouse can sign the document, but only with the approval of the tutelary court;

• including the clause of taking a share of a good before sharing; the execution of this clause is in-kind or, if this is not possible, through the equivalent from the total net value of the community;

• modalities of liquidation of the conventional community.Through matrimonial convention it can be set that the surviving spouse to

take over, without any costs, before sharing the inheritance, one or more of the common goods, owned in common by the spouses. This is the clause of taking a share of a good before sharing, which can be in the benefit of both spouses or only for one of them.

Regarding the application in time of the disposition related to matrimonial regimes, article 27 of Law 71/2011 states: “No matter the date of marriage, regarding the personal and patrimonial relations, the spouses are subject to the Civil code dispositions since it came into force.”

V.4. THE INHERITANCE OF THE SURVIVING SPOUSE

One of the problems faced by the elders is the sucesorial rights that they have from the deceased spouse.

The difficulty of clarifying the juridical situation resulted from the decease of one of the spouses, when the surviving spouse is not the only heir, especially in case of long matrimonies, consists in the fact that for determining the sucesoral table54 is necessary to effectuate the sharing of the goods acquired during

54 „Succesoral table sintagm designates the patrimony transmitted for death cause. The succesoral table is formed by the assembly of the goods and values (positive and negative) which, in their entirety, represent the succesoral property remained after the deceased person and represent the

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marriage. Only by determining the patrimony of the deceased person (named in the professional literature de cuius), the sucesoral table and the extent of the rights gained by the surviving spouse can be determined.

So, because the succesoral procedure, when there is the agreement of all persons, is done in front of the public notary, who does the docuements based on the parties declarations, without making complex investigations, its necessary for the surviving spouse to know which are his/her goods and which are the goods of his/her spouse, so the determination of the succesoral table to be done correctly. Once the succesoral table was established, the surviving spouse must also know his/her succesoral rights, so through the sharing convention he/she won’t consent injuring clauses.

According to article 91 of Law no. 71/2011 the inheritances opened before the New Civil Code came into force, are subject to the laws which are applicable when the inheritance is opened.

V.4.1. Determination of the succesoral tableThe patrimony of the deceased person (de cuius) at the date of death

constitutes the succesoral table subject to sharing between heirs.There are some exceptions from this rule, applicable both before the New

Civil Code came into force (Deak (b), 1999, pp. 559 – 560) and in the present.The goods brought to the succesoral table as result of reducing the excessive

liberalities55 and/or as effect of report of donations56 are the following:• estates over which the right of property is reconstructed;• natural, civil, industrial fruits produced by succesoral goods;• life insurance compensation, in case there isn’t any determined

beneficiary.Although these goods don’t exist in the de cuius patrimony at the moment

of death, they will be subject to the succesoral sharing. Determining the de cuius patrimony supposes establishing the personal goods of each spouse and each ones quota from the common goods.

Depending on the choosed matrimony regime the personal goods of de cuius and of the surviving spouse will be determined, because only in this way the succesoral table could be correctly determined.

V.4.2. The succesoral rights of the surviving spouse

object of inheritance share.” (Costin et al., 2007, p. 615)55 „Excessive liberalities, sintagm which designates generically the donations done by the deceased person over the available quotas, so by violating the legal succesoral rights of the heirs.” (Costin et al., 2007, p. 588)56 Report of donations – obligation which falls upon the descendants and surviving spouse (which come to the inheritance together and actually) to rebring (fictively, just for calculation) at the succesoral table, with some exceptions, the belongings received as donations from the one leaving the inheritance.

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In the absence of a legal testament made by de cuius, Law no.319/1944 admits to the surviving spouse the following rights:

• a right of inheritance in competition with any of the relatives from the legal classes of heirs or in the absence of other heirs;

• a special right of inheritance over the mobile goods and objects good to the household, and also over the wedding gifts;

• a temporary right of habitation over the house.Excepting the rights over the wedding gifts, the New Civil Code keeps these

rights.

1. Right of inheritance of the surviving spouse in competition with any of the relatives from the legal classes of heirs or in the absence of relatives from the four classes.

First of all, we have to mention that in the reglementation of both the 1864 Civil Code and the New Civil Code determining the persons that will inherit de cuius is done taking into account, mainly two elements: the order or class of the succesors and their degree of kinship with the deceased (Eliescu, 1997, p. 63).

Using these criteria and by applying the principles of priority depending on the class of succesors, the persons that will actually inherit can be determined.

Relatives of de cuius are shared in four classes of heirs which are called to the inheritance one after another. The existence of succesors in a class, remove from the inheritance the relatives from the following classes. This is the principle of priority of the class of succesors.

If a class includes more succesors, the preference in the same class will be given according to the proximity of the kinship degree. The closeness of the relative is established through the number of generations, each generation being considered a degree, according to article 680 Civ. C./article 963-964 N. Civ. C. (Ibidem, p. 64). In a straight line (parents, grandparents, children, and grandchildren), ascending and descending are counted as many degrees as the number of generations between two relatives. In collateral line, the degree of kinship is determined by counting the number of generations until reaching the common ascendant (parent, grandparent, great-grandparent etc.), and from this one to the deceased person.

The classes of succesors are the following:Class I: descendants. Children, grandchildren and great-grand children

from children are included in this class (the children of the deceased and their descendants in unending straight line).

Class II: ascendants and priviledged collaterals. From this category are the parents, sisters and brothers and their descendants until and including the 4th degree of kinship (with the deceased). This class is mixed, being an exception from the principle of proximity of the kinship degree, meaning that although the

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priviledged ascendants (parents) are closer in degree to the deceased than the priviledged collaterals, all relatives included in this class will come together to the inheritance.

Class III: ordinary ascendants. This class includes all ascendents (grandparents, great-grandparents) excluding the ones from class II.

Class IV: ordinary collaterals. It includes the relatives in collateral line (uncles, aunts, cousins, brothers or sisters of grandparents) excluding the ones from class II. The relatives in this class are called to inheritance until and including the 4th degree of kinship.

Part of these succesors can’t be removed from inheritance even through the deceased person’s act of will expressed through testaments, disinheritannces or donations, being the beneficiaries of a succesoral reserve established by the law. The succesoral reserve will be detailed in the section dedicated to the testament.

The surviving spouse is not included in any class of heirs. He/she can’t remove and can’t be removed through the existence of succesors from the four classes of heirs. But his/her share of the inheritance varies, depending on the class of heirs with which he/she comes in contest.

The surviving spouse heirs the following quotas of the inheritance of the other spouse as it follows (aticles 971-972 N. Civ. C. keep the previous reglementation from article 1 of Law no. 319/1944):

• when he/she comes to succession with the legitimate children of the deceased or only with some of them or with their descendants, he/she inherits a quarter;

• when he/she comes in contest with the father and mother of the deceased, or only with one of them, in both cases together with the brothers and sisters of the deceased and their descendants, or only with one of them, he/she inherits a third;

• when he/she comes to the succession with the father and mother of the deceased, or only with one of them, or only with the brothers and sisters of the deceased and their descendants, or only some of them, he/she inherits a half;

• when he/she comes to the succession with the other ascendants or collaterals until the fourth degree of kinship, he/she inherits three quarters;

• in the absence of the relatives mentioned above, the surviving spouse inherits the total inheritance.

The surviving spouse is a heir with an inheritance reservation for half of his/her legal inheritance quota, which means that the deceased, through documents for death causes (testaments, disinheritances) or through liberalities (for example donations) done during life, can’t diminish the segment of succesoral patrimony57 with more than half of the quota inherited by him/her.

57 Segment of the succesoral active which actually belongs to an heir, universal heir or with a

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As a result, the surviving spouse can’t be removed from the inheritance. He/she can be removed from succession only through his/her act of will.

2. Special inheritance right of the surviving spouse over the furniture and objects from the household and over the wedding gifts

This right is recognized to the surviving spouse when he/she comes to the inheritance in contest with the heirs from classes II-IV. In this way, article 5 of Law no. 319/1944 states that the surviving spouse “will inherit beside his/her succesoral quota, the furniture and objects of the household and the wedding gifts.”

Furniture and objects of the householdThis supplementary right over the furniture and objects of the household

was provided by the legislatior for assuring to the surviving spouse the same living conditions, by not depriving him/her from the goods that he/she used to use with the deceased spouse.

Of course, the surviving spouse won’t inherit, over his succesoral quota, all the goods of the household, but only the deceased spouse’s share from such common goods and personal goods from this category of the deceased.

For the surviving spouse to inherit alone this category of goods it’s necessary to comply with two special conditions simultaneously:

• the suriving spouse must not come at the inheritance with the deceased’s descendants;

• the deceased person must not have diposed of these goods through libe-ralities between the living (donations) or with death causes (testament).

From the second condition results that these goods are not reserved for the surviving spouse (Deak (b), 1999, p. 138).

The New Civil Code doesn’t mention expressly the second condition but, when mentioning the succesoral reserve, through article 1088 N. Civ. C. it’s mentioned:

“The succesoral reserve of each heir is half of the succesoral quota which would have been inherited as legal heir, in the absence of the liberalities and disinheritances.”

So, neither the new reglementation makes the surviving spouse entitled to inherit the furniture and goods of the household.

In the special literature it has ben shown that: “knowing if the furniture belongs to the household will be done, in concrete, taking into account the destination that the spouses actually gave to these things, even if their use in the household is not according to the usual purpose. Will be part of the household,

universal title, from a succesoral property as result of its share between all heirs which are entitled to participate at its sharing.

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taking into account this subjective destination, all the goods which serve to a modern establishment of a household, and those things which serve only to the commodity or common pleasure of the spouses; for example, the furniture of the house, the ornaments as paintings, statues, recreation libraries, eventually horses, cars, with the condition that, in all cases, these should have been destined to the common use of the spouses.

The works of art of great value or rare objects won’t be considered as household goods, because the legislator stated that the surviving spouse will keep the household only by supposing that the objects within it have a usual value.

Also, the objects used within an industry, proffesion or artistic, scientific, or sports occupation won’t belong to the household because they weren’t destined to a common use.

It doesn’t matter if the furniture and objects of the household were brought by one of the spouse at marriage or during it. If at the death of the deceased the spouses lived separately, the right will be only over the things of the household when the common living ended” (Eliescu, 1997, pp. 110 - 111).

Also, within the doctrine it has been mentioned that the goods of the farm-type household (labor and production animals, tools used within a farm) are not included in the category of the furniture and objects of the household (Deak (b), 1999, p. 141).

Wedding giftsThe wedding gifts were, until the 1st October 2011, subject of the same

juridical regime as the household furniture and objects.Through wedding gifts we understand, in principle, the manual gifts given to

the spouses when celebrating their marriage, no matter if the gifts were for both spouses or only for the deceased spouse, including the gift from one spouse to another and no matter if they were commonly used or not.

In the reglementation of the New Civil Code, the surviving spouse doesn’t benefit from such a supplementary right over his/her succesoral quota.

3. The right of habitation of the surviving spouse

The right of habitation of the surviving spouse is provided by article 4 of Law no. 319/1994. The reglementation is also found in article 973 N. Civ. C. 58.

58 Article 973 N. Civ. C. The right of habitation of the surviving spouse (1) The surviving spouse which is not the titular holder of any real right of using another house corresponding to his/her needs benefits from the right of habitation over the house in which he/she lived until the inheritance was opened, if this house is part of the inheritance belongings. (2) The right of habitation is free, inailenable and insesizable. (3) Any heir can request the restrain of the habitation right, if the house is not totally needed by

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According to these law texts the surviving spouse has, beside the other succesoral rights and no matter the heirs with whom he/she comes in contest, a right of habitation over the house in which he/she lived, if the house is included in the inheritance and if the surviving spouse doesn’t have another personal house.

The right of habitation consists in the right of a person, in this case the surviving spouse, to use a house for his/her personal needs and of his/her family.

The right of habitation over the house which belonged to the deceased person supposes the fulfillment of the following conditions:

• the house (totally or partially) should be part of the inheritance, meaning that it should have been a personal good (total) of the deceased spouse or a common good (partial);

• at the date of opening the inheritance (the decease of the spouse) the surviving spouse was settled in the house which represent the object of the right of habitation;

• the surviving spouse doesn’t have a personal house;• the deceased hasn’t stated differently. Because for the surviving spouse

the only reservation is for the rightful quota of the inheritance, it results that this right can be removed through the act of will of de cuius.

The right is temporary. It can be maintained until the succession ends and, in any situation, at least one year after the spouse’s death.

The right of habitation ends if the surviving spouse marries before the succession ends59 (Albert et al., 2003, p. 347).

The other heirs can request the limitation of the right of habitation if the house is not totally needed by the surviving spouse or they can buy for the

the surviving spouse, or the change of the habitation object, if he/she puts at the surviving spouse’s disposal another corresponding house. (4) The right of habitation ends after sharing, but not earlier than one year since the inheritance was opened. This right ends, even before one year, in case the surviving spouse re-marries. (5) All litigations regarding the right of habitation reglemented through the present article are solved by the instance competent to judge the inheritance sharing, which will emergently decide, in counseling room.59 Extract from Decision no. 40/2002 of Oradea Court of Appeal: according to the regulations of succesoral matters, the date of opening the succession is 17th February 1951, date from which the succesoral vocation of the possible heirs is analysed along with the way in which they strengthen their quality by accepting the inheritance. By not approaching the problem that the recurrent wouldn’t have accepted the succession of her husband, and respecting the quality as surviving spouse at that date, which also wasn’t contested by anyone, it’s obvious that she is the heir of the deceased MC, and this quality, once gained, can’t be lost.The idea according to which the recurrent would have lost the quality of heir of her first husband, by marrying on the 3rd July 1952 with K.T.S., is false because there is no other person with the quality of surviving spouse of MC than the recurrent. The referrals to the end of the habitation right in case of re-marriage of the spouse are not relevant at all, because the situations can’t be analysed through analogy, the institutions being completely different. The right of habitation given to the surviving spouse represents a protection measure which ends when the person gets over the need situation which generated this protection, but without loosing the quality of heir.

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surviving spouse a proper house for his/her needs. If the parties don’t agree, the court will urgently solve the litigation, in counseling room.

Case presentation. Surviving spouse. Right of habitation. Conditions for recognision

Bucharest Court of Appeal, civil section IV, decision no. 181 since 24th January 2001.

Through the action registered on 27.10.1998 at sector 1 Bucharest Courthouse, the applicants S.S., S.F. and S.V. requested the eviction of the defendant M.P.E.H. from the estate in Bucharest, G.N. Blvd., bl. 2, fl. 7, ap. 65, sector 1.

In the motivation of the request it was shown that the defendant is the surviving husband of F.M., their daughter being deceased in present. After her death, the defendant remarried, living together with his actual wife in the estate gained by their daughter before marriage.

The dispositions of article 4 of Law no. 318/1944 were invoked.After a complete procesual cycle, the sector 1 Courthouse pronounced the

civil sentence no. 9618/23.05.2000 through which the action was rejected as being groundless.

The instance affirmed that the parties are co-owners of the apartment and until the opening and end of the succesoral debate, even if the surviving spouse lost the right of habitation through marriage, he has the right of using the apartment.

The claimants attacked this decision through an appeal because they considered it unfonded and illegal because the evidence in the file wasn’t taken into consideration and the invoked legal dispositions – Law no. 319/1994 – was misinterpreted.

Bucharest Court – Civil Section III pronounced the civil decision no. 2926/A/28.09.2000 through which the appeal was admitted; it changed the sentence totally by admitting the action as it was formulated. For sustaining this solution the dispositions of last line of article 4, Law no. 319/1944, were invoked.

Against this decision the claimers declared appeal, based on the dispositions of article 304, point 9 Civil Procedure Code.

A first reason for appeal was that none of the parties could be part of this trial as procesal party, because the succession of deceased M.F. was not debated, and by default, an inheritance certificate was not issued, each party having only a succesoral vocation.

Also dispositions of substantial right were violated by the appeal court, by ingnoring the rule of unanimity in the relations between co-owners, because a co-owner can’t request the eviction of another co-owner, confusing the right of habitation with the right of property in shares.

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Analysing the invoked appeal motives, the considerations of the decision under appeal and the documents in the file, the Court found that the appeal is not grounded and rejected it.

Both claimants and defendants have active and passive procesual quality in this situation, because they have succesoral vocation, situation which was not contested by any of them and it doesn’t involve the existence of an inheritance certificate. This succesoral vocation permitted the eviction action by persons and regarding persons that are succesors of deceased M.F.

Neither the second aspect invoked by the claimants can be taken into consideration by the instance.

According to article 4, line 1 of Law no. 319/1944, the surviving spouse, which hasn’t another personal house, will have, until the inheritance debate ends and, in any case, at least one year since the death of the deceased spouse, beside the right of inheritance, a right of habitation over the house in which he/she lived if the house is part of the succession.

In the last line of the same article it’s shown that the habitation right ends if the surviving spouse remarries if he/she marries before the inheritance is debated.

From the interpretation of these texts it results clearly that, if the surviving spouse remarries before one year since the death of the deceased spouse, his/her right of habitation ends before the inheritance is debated.

These dispositions have an imperative character and don’t condidtion the existence of the inheritance debate and the issuing of the heir certificate.

Also, based on these legal provisions, the right of habitation is a temporary right, compared to the situation when the surviving spouse married within one year since the death of is/her spouse when this right is lost. This right is not confused to the right of inheritance, the Civil Code providing expressly the situations when a person can be removed from inheritance.

The appeal instance made a correct interpretation of the legal dispositions mentioned above, noticing that the claimants lost the right of habitation by living in the estate abusively, not having the right of inheritance.

This idea is maintained also by the provisions of article 653 Civil Code which states that only the ascendants and descendants have the right of posesion since the death of the deceased, the other heirs entering in the possession of the inheritance only with the approval of the justice. The claimers aren’t in any of the two categories mentioned above.

Noticing that the appeal instance pronounced a grounded and legal decision, the Court rejected the appeal as being groundless (http://www.juris.ro/reviste-numere/Pandectele-Romane, accesed on 10.08.2010).

V.4.3. Determining the heirs with whom the surviving spouse comes to

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the inheritanceFor having a concrete succesoral vocation, or for being called to the

inheritance, the potential successor must fulfill three conditions:• to have succesoral capacity;• not to be unworthy;• not to be removed from inheritance by a preferable class or relative in

kinship, or through the act of will of de cuius (in the case of heirs without reservation rights).

The succesoral capacityAccording to article 654 Civil Code “to succeed it’s necessary that the person

which succeds to exist at the moment of opening the inheritance.”Article 957 N. Civ. C, states:A person can inherit if he/she exists at the moment of opening the inheritance.

The dispositions of articles 36, 53 and 208 are applicable.If, in the situation when more persons die, it can’t be established if one

survived after the other, they don’t have the capacity of inheriting one another.The moment of opening the inheritance is the one when de cuius died.

Persosn that “exist” according to the Civil Code and the New Civil Code are:• persons which are alive at the moment of opening the inheritance;• persons which are conceived but unborn at the date the inheritance

was opened, with the condition that they are born alive (article 7, line 2 of Decree no. 31/1954 – old reglementation /article 36 N. C. civ. – in present) 60;

• missing persons, if the date of decease established through a court decision won’t have a previous date than the date of opening the inheritance. (Article 53 N. Civ. C.)

Succesoral unworthinessSuccesoral unworthiness is the decay by right of the legal heir from inheriting

a determined inheritance, including the reserve to which he/she would have had the right from this inheritance, because he/she made (him)herself guilty of a serious offense towards the person leaving the inheritance or towards his/her memory (Deak (b), 1999, p. 65).

From the three cases of succesoral unworthiness reglemented by article 655 of the Civil Code, only one was applicable when it was abrogated: the attempt on the life of the person leaving the inheritance. For this unworthiness case to be incident it was necessary that the murder or murder attempt to be made

60 For establishing if a person was conceived at a certain date the presumption (reglemented by article 61 of Family Code – old reglementation and article 412 N. Civ. C. – in present) is applied, according to which the conception period is between the three hunderedth and one hundered and eightieth day before the child was born.

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with intention (not by fault) and that a conviction sentence (penal) should have existed (Ibidem, p. 69).

For the actions commited after 1st October 2011 it’s unworthy to inherit:• the person penally convicted for a crime with the intention of killing the

person leaving the inheritance;• the person penally convicted for the crime committed before opening

the inheritance, with the intention of killing another possible successor which, in the situation that the inheritance would have been open at the date of the crime, he/she would have removed or limit the succesoral vocation of the person who commited the crime.

Also, according to article 959 N. Civ. C. (applicable only to the actions committed after the New Civil Code came into force) it can be declared as unworthy for inheriting:

• the person penally convicted for comiting, with intention, against the one who leaves the inheritance, serious crimes of physical or moral violence, or actions from which resulted the death of the victim;

• the person that, with bad intentions, hid, altered, destroyed or forged the testament of the deceased;

• the person which, through dolus or violence, impeded the person leaving the inheritance to make, modify, or revoke the testament.

The preferable class of heirs or relative depending on the degreeThe componence of the claas of heirs and the way of determining the degree

of kinship were presented in the section dedicated to the inheritance quota of the surviving spouse. In the new reglementation, the general principles of legal devolution of the inheritance remain the same, but the legislator provided them in article 964 N. Civ. C.

The legal inheritance is assigned to the succesors through the following three principles:

• the principle of calling to inheritance the relatives in the order of legal heirs classes;

• the principle of proximity of the kinship degree between the heirs of the same class61;

• the principle of equality between the relatives of the same class and degree.

The decease of a person before the one of de cuius doesn’t necessarily involve that his/her place will be taken by relatives from the following class or that relatives of a distant degree which were excluded from inheritance due to his/her existence will take his/her place.

61 Inside the same class, the relatives closer in grade remove from inheritance the relatives more distant in grade.

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In these cases the legal dispositions regarding the retransmission of the inheritance or the succesoral representation can be incident.

In case of retransmitting the inheritance, the legal heir surviving the deceased no matter how long in time – gains the succession and – confounded with its own – leaves it to his/her own heirs.

So, the decease of the only representant of a class of heirs, even if at a very short time, doesn’t remove the class, the rigths of the surviving spouse being determined in consequence. Not even if he/she doesn’t leave at his/her turn heirs that succeed him/her, the surviving spouse won’t be in contest with the subsequent class, but the inheritance of the deceased successor (if he/she expressed the acceptance of the inheritance) will be considered vacant.

Only if in term of succesoral option62 the acceptance of the inheritance by the deceased successor or of his/her sucesors hasn’t occurred or they renounced at the inheritance, the surviving spouse comes in contest with the subsequent class of heirs.

The succesoral representation is a benefit of the law through which a legal heir (not applicable in case of inheritance through testament) of a distant degree – named representant – asscends in the degree, place and rights of his/her ascendant – named represented – which is deceased at the date of opening the inheritance, for taking the share that would have been entitled to receive from the inheritance, if he/she would have been alive63.

In the reglementation of the 1864 Civil Code the unworthy couldn’t be represented. The New Civil Code through the definition given to the succesoral representation eliminates the condition that the representetd not to be unworthy of receiving the inheritance, and, more than that, it mentiones that the succesoral representation intervenes also in case the representant is unworthy ot inherit the represented, renounced at the inheritance or was disinherited.

The new reglementation expressly establishes that for coming through succesoral representation to the inheritance of the deceased, the representant must fulfill all general conditions for inheriting.

The succesoral inheritance has a limited area of application, being admitted only in relation with the descendants of the deceased’s children and the descendants from sisters and brothers.

The beneficiaries of inheritance retransmission and succesoral representation don’t gain supplementary rights than the persons that, in normal conditions, should have inherited the deceased, but these law institutions must be taken into consideration by the surviving spouse for determining in concrete the persosn with whom he/she comes to the inheritance.

62 The general term of succesoral option is of 6 months (one year according to article 1103, line (1) N. Civ. C.) since the date of decease.63 Please consult articles 664 - 668 Civil Code.

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V.5. THE ALIENATION OF RIGHTS FROM THE PERSONAL HERITAGE

The elders, from various reasons, alienate their goods for assuring decent means of life or for expressing their attachment and gratitude to persons that are next to them in difficult situations or that help them feel less lonely.

The main ways of alienation used by the elders are the selling-buying contract with or without the obligation of fostering, the contract of lifelong rent, of donation and of heritage (usually named - but falsely from the juridical point of view - “legacy”).

The goods are alienated either actually or by stipulating a longer term in the contract for alienation, or the nude property is actually alienated but with keeping the right of usufruct of use or habitation, depending on the situation.

V.5.1. The alienated rightOften the elders alienate a good, usually estates, but they wish to use it

undisturbed until the end of life.Most times, when such alienation is wished, the first question is the content

of the obligation that the receiving person has to assume towards the giving person.

Such an approach, without being forbidden by the law, we think is wrong because it wouldn’t actually reflect the will of the parties. Actually the wish is to transmit a good at the death of the present owner, but also the guarantee that until that date the good won’t be given to someone else.

The right of ownership is the most complete real right because it offers to the owner three attributes: possession, use and disposition.

By detaching or limiting some attributes from the juridical content of the ownership right new real rights are born, named derivates of the ownership right.

Some of these derivates of the ownership right are the right of usufruct, the right of use and the right of habitation.

The right of usufruct is that main real derived right, essentially temporary, of the goods that are in the property of another person, which confers to its titular the attributes of posesion and use, with the obligation of conserving their substance and of giving them back to the owner when the usufruct ends.

From the juridical characteristics of this real right, the ones which are more important for the approached theme are the temporary nature – if the titular is a person it can be lifelong at the most and it ends when the person dies – and the untransmissible nature.

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According to article 69 of the Law no.71/2001 and after the Civil Code came into force, the usufruct rights are exercited according to its dispositions, if the present law doesn’t state otherwise.

By not being an essentially personal right, the benefit of the usufruct can be alienated (for free or onerously) and the good can be exploited by rent, commodate etc.

The right of use and habitation are varieties of the usufruct right that are particularized through the fact that the titular has the attributes of posesion and use of another person’s goods recognized, but only in the limits of satisfying his needs or his family members’ needs.

The right of habitation is different than the right of use64 only by the fact that the object is an estate.

So, both use and habitation rights are essentially temporary, being at most lifelong. Therefore, alienating only the nude property and keeping the right of usufruct or its variaty (use, habitation) offers the giving person the certitude of using the good in the period established through a contract or, depending on the case, until his death.

Also, the full owner can alienate the nude property and the right of usufruct to different persons.

The transmission, between the living, of the right of property and its derivates of a land, with or without constructions, could have been done before the New Civil Code came into force, only through authentic juridical documents (Law no.247/2005, title X, article 2).

Article 230, letter aa) of Law no.71/2011 repealed title X “The juridical circulation of lands” of the Law no. 247/2005.

According to the new reglementation regarding real estates, which include lands, article 557, line (4) of the N. Civ. C., the right of property on lands is acquired through notes in the land Register, if the law doesn’t state otherwise.

The registration in the land Register is done based on the authentic notary document, on the court decision that remained definitive, on the inheritance certificate or another document released by the administrative authorities, if the law states this.

But, according to article 56 of Law no.71/2011, until all the formalities necessary to put into practice the provisions of article 557 N. Civ. C. are established, the incident reglementations remain in force and the registration in the land Register of the ownership right and other real rights, based on the documents created for transmitting, constituting or modifying these rights, is done only with the purpose of opposability towards third parties.

64 The right of use is that right, essentially temporary, derived from the property right, which confers to its titular the attributes of use and posesion over a good in the property of another person, but only in the limits of satisfying the personal and family needs.

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Case presentationThe obligation of taking care of the person resulted from the contract of

fostering is not divisible (active and passive) and, as a result of non-divisibility, the obligation is not considered fulfilled if it wasn’t executed, totally, towards all the creditors.

As a consequence, even if one of the persons having the right of usufruct has passed away, the nude owner can’t consider that the right of usufruct is only on ½ quota of the estate.

Timişoara Appeal Court, Civil Section, Decision no. 1672/R since 21st September 2006.

Through the civil sentence no. 5866 since 21st November 2005, Arad Courthouse admitted partially the action formulated by the applier I.V. and ordered the evacuation of the defendants P.G. and P.D. from the estate registered in the land Register 15208 A., rejecting the final request of evacuating the defendant P.M. from the estate.

For pronouncing this decision, the first instance noted that through the contract of forstering authenticated with no. 16866/1989, the defendant P.M. and her ex-husband P.G. (deceased) transmitted to the applicant I.V. the right of nude property of the estate, in exchange of being taken care of, keeping the lifelong usufruct right.

The Courhouse appreciated that the applier benefits of all the attributes offered by the real right of property over ½ quota of the estate and that can exercit all the actions necessary for defending his right of property, situation in which the evacuation of P.G. and P.D. is justified by the fact that they occupy the estate without having the right to live in it.

Through the civil decision no. 147 since 11th April 2007, Arad Court admitted the appeal intended by the defenders and changed partially the appealed sentence, by rejecting the request of the complainant I.V. of evacuating the defendants P.G. and P.D. from the estate and maintaining the rest of the sentence’s provisions.

This decision was maintained by the Timişoara Appeal Court which, through the civil decision no. 1672 since 21st September 2006, rejected the appeal of the complainant I.V. against the decision taken in the previous appeal.

For pronouncing this solution, the Court of Appeal noted that, in case one of the persons taken care of deceased, the complainant can’t consider that the right of usufruct is on only ½ quota of the estate, because the obligation assumed through the contract is not divisible (active and passive), so, the obligation is not fulfilled if it wasn’t executed, totally, towards all the creditors.

Also, the defendant P.M. kept the lifelong right of usufruct over the estate and the statement of the complainant according to which the defendant should have obtained his approval, as nude owner of the property, for tolerating in the estate the defendants P.G. and P.D., is wrong because, according to to article 534 of the Civil Code, the usufructuary can rent or give the exercise of his/her right,

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can dispose as he/she considers the use of the estate and the nude owner doesn’t have the right to restrict the exercise of using the estate.

In this way, article 539 of the Civil Code establishes the express obligation of the nude owner to refrain from any action that could harm the rights of the usufructuary.

V.5.2. General notions about civil contractsIn this section we will present only the more sensitive aspects that could

be of interest for the elder persons regarding the selling-buying contract with or without fostering clauses, the contract of lifelong rent and the contract of donation.

The law regulates widely most of these contracts and the professional literature is rich in analysing them. The contract of fostering, which often appeared in the selling-buying contracts as one of the clauses, was - until the New Civil Code came into force - a product of practice although a special attention was given to it by the authors of juridical articles and books. After, the legislator included it in articles 2254-2263 of N. Civ. C. as a different contract than the selling-buying one.

Regarding contractual aspects, the article 102 of Law no. 71/2011 is very important: “The contract is subject to the law in force at the date when it was signed, regarding its signing, interpretation, effects, execution and ending. The modification of the contract is done respecting all the conditions provided by the law that is in force at the date of the modification. Regarding the elements that are not subject of the modifications, the provisions of article (1) are applicable.”

So we have to know two regulations:• the one before the New Civil Code for verifying the validity and for

understanding and executing the contracts signed until the 1st October 2011;

• the one included in the New Civil Code for understanding the effects of the documents that are going to be signed.

1. Selling-buying contract• In the reglementation of the 1864 Civil Code

The Civil Code includes an entire title dedicated to selling (articles 1294-1404), but although generous, a definition of this contract was given by the doctrine and not by the legislator65.

The selling-buying contract is the contract through which a person, called seller, transmits to another person, called buyer, in exchange of the latter’s obligation to pay a price in money (Safta-Romano, 1999, p. 18).

65 Article 1294 of Civil Code defines the sell as being “a convention through which two parties are obliged between themselves, one to transmit to the other the property of a belonging/good and the other one to pay to the first one its price.”

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Although the selling-buying contract is a consensual contract, meaning that the simple manifestation of will is not only necessary but also sufficient for assuring its validity, in case of alienating estates, it is necessary to have the contract authenticated (in matter of constructions – in the professional literature – there isn’t a unitary point of view).

As soon as the parties identifyied the alientated good and agreed upon its price, by respecting the prescribed form of the document when the law prescribes such a condition as being compulsory, the contract is completed. Giving the good and paying its price are matters that are related to its execution and not to its validity.

Generaly it is accepted the fact that anyone can sell and buy goods that aren’t restricted in the civil circuit. There are also exceptions from this rule expressly provided by the law. From these exceptions, the one of interest for us is the one provided by article 1307 of the Civil Code which stipulates that selling between spouses is forbidden.

A very important aspect of the contract is the price. For the validity of the contract it’s necessary that it should be expressed in money, to be determined or determinable, and to be real and serious.

If the price is not established in money, than the contract is not a selling-buying one, but an exchange one. So, establishing the price in money is the essence of the selling-buying contract.

The price is determined when it is expressed as an amount of money, in the national currency or other currency. The price is determinable only when are established the aspects based on which the price will be calculated at the date of the payment (for example, selling stocks at the value since 1st September 2010 established by the Bucharest Stock Market).

Also, the price has to be real. Opposed to the real price is the fictive price, which is established by the parties since the contract is signed, but that is never paid. For example, through a secret understanding, the seller gives a price reduction to the buyer (Malaurie et. al, 2009, p. 142).

A price is serious when is not derisory. It is derisory when is inexistent (zero euros) or when is ridiculously little (a gold bar for one euro). The appreciation of the price seriosity is done according to an objective criterium (Ibidem, p. 143). Still, the price doesn’t depend strictly on the real value of the sold good, but also on the subjectivity of the parties which have a certain freedom in establishing it (Safta - Romano, 1999, p. 44).

Based on the authonomy of will and contractual freedom, from various reasons, the parties can convene on establishing an apparent, simulated sell, with the agreement of transferring the property without the payment of the price by the aquirer.

Mainly, the simulation of the price is not illicit; the law sanctions it only exceptionally. So, such an agreement is valid, but if proved that the price was

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fictive (inexistent), the operation is null as selling-buying but valid as disguised donation, if proven that the seller had the intention of gratifying and if the conditions for the validity of donation are fulfilled (Chirică, 2005, p. 96).

Taking into consideration the special importance of the price, it’s necessary to preserve the proof of the payment. That’s why it’s recommended to ask the public notary to personally check the payment and to attest it in the contract (as a fact personally perceived based on the parties declaration) or to make the payment through bank transfer and keep the proof next to the selling-buying contract.

• In the reglementation of the New Civil CodeSelling is the contract through which the seller transmits or takes the

obligation to transmit to the buyer the property of a good in exchange of a price which the buyer takes the obligation to pay.

Also, the transfer can refer to a derivate of the right of property or any other right.

Any good can be freely sold if the selling is not forbidden or limited by the law, convention or testament.

It must be mentioned that according to the New Civil Code, the selling between spouses is not forbidden.

If at the moment of selling an individual determined good perished in totality, the contract doesn’t produce any effects. If the good had perished only partially, the seller that didn’t know this at the moment of selling can request the annulation of the sell or the corresponding reduction of the price.

The price consists in an amount of money. It has to be serious and determined or at least determinable.

The sell can be annulled when the price is established without the intention of being paied. Also, if the law doesn’t state otherwise, the sell can be annulled when the price is so diproportionate from the value of the good, that it’s obvious the parties didn’t consent a selling.

If not stated differently, the costs for signing the selling-buiyng contract are supported by the buyer.

The measurement, weighing and costs for delivering the good are the seler’s tasks while the taking over and transportation from the place of execution are in charge of the buyer, if not stated differently.

In the absence of a contrary clause, the costs for the payment operations of the price (bank commissions) are the buyer’s obligation.

The doubtful clauses of the selling contract are interpreted, usually, in favour of the buyer.

Excepting the cases provided by the law or if the will of the parties don’t state otherwise, the property is transferred to the buyer since the contract is signed, even if the good was not delivered or the price hasn’t been paid yet.

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The clause through which the seller reserves the right of property over the good until the total payment of the price remains valid even if the good was delivered. But this stipulation can not be opposed to third parties until the publicity formalities are fulfilled, according to the law and depending on the nature of the good.

The good must be delivered in the state in which it was found at the moment of signing the contract. In absence of a deadline, the buyer can ask the delivery of the good as soon as the price is paid.

The buyer can request the resolution of the sell if he/she lost the total or partial property, significantly large that, if he/she knew the eviction he/she wouldn’t have signed the contract. The seller is obliged to return the total price even if, at the eviction’s date, the value of the sold good decreased or if the good suffered significant harm, from the buyer’s fault or by force majeure. But if the buyer obtained a benefit from the harm of the good, the seller has the right to reduce the price with an amount equal to this benefit.

If the sold good has, at the eviction’s date, a higher value from any cause, the seller is obliged to pay to the buyer, besides the price of selling, the increase of the value, cumulated until the date of the eviction. Also, the seller can be obliged to pay damage interests66.

The seller has to guarantee the buyer against any hidden flaws that make the sold good improper for use or that decreases the good’s value or use so much that the buyer wouldn’t have bought or would have paid a smaller price.

It’s considered to be hidden the flaw that, at the moment of delivery, it couldn’t have been discovered without special assistance by a prudent and diligent buyer.

The buyer has the following main obligations: to take the sold good and to pay the selling price.

If not stated otherwise, the buyer is obliged to pay interests to the price from the day of gaining the property, if the good produces civil or natural fruits, or from the day of delivery, if the good doesn’t produce fruits but gives him/her other benefits.

When the buyer hasn’t paid, the seller is entitled to obtain the enforcement of the payment obligation or the resolution of the selling and, in both situations, damage interests, if this is the case.

2. Fostering contractIn the reglementation of the New Civil Code many solutions were taken over

from the practice and literature existent before it came into force. In articles

66 The purchaser called in front of the court by a third party which pretends that he/she has rights over the sold belonging must call the seller. In case he/she didn’t do this, being condemned through a decision of a judged situation, he/she looses the right of guarantee if the seller proves that there were enough reasons for rejecting the request.

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2254-2263 N. Civ. C. are the detailed rules that govern this contract. Regarding the aim of our presentation, in the following section we will detail only the essential regulations regarding the fostering contract, with referral, at the same time, to the modifications of the actual legislation.

The fostering contract is an onerous contract, based on which one of the parties transmits to the other one the property of one or more goods, in exchange of the assumed obligation of providing, in-kind, the necessary things for living until the end of life, being at the same time an aleatory contract, because the duration of the obligation assumed by the debtor depends on the duration of creditor’s life, which represents an uncertain event.

The fostering contract, according to the actual legislation is signed in authentic form under the sanction of absolute nullity. Before the N. Civ. C. came into force, the simple manifestation of will of the parties was both necessary and sufficient for the document to be valid.

Providing care, by the debtor, is a strictly personal obligation which, if unfulfilled, determines the cancellation of the contract (article 1020 of Civil Code/article 2263, line (3) N. Civ. C.).

The obligation of care can also be for free, situation in which there isn’t an alienation of goods from the beneficiary of care or from a third party.

In connection with the contract’s content, the obligation of care assumed by the debtor has the character of being indivisible when is assumed to more creditors.

In case of an indivisible care obligation, with more creditors, the debtor hasn’t fulfilled his/her obligation when he/she satisfied only one of the creditors, because the indivisible obligation can’t be fulfilled partially, the civil sanction of the contract’s resolution leading to the restitution of all goods – object of the contract, no matter to which and in which proportion they belonged to each creditor.

The cancellation of the contract is disposed only if, from the debtors’ guilt, the creditor hasn’t received the care described in the contract which, usually, consists in assuring food, clothing, medicine, satisfying any other needs and the care is provided in-kind. If there isn’t any legal impediment, the parties can agree, at the date of signing the contract or after, that the care to be converted, permanently or temporary, in an amount of money that the debtor-caregiver has to pay to the creditor-cared of, for covering totally or partially the obligation of fostering.

The refuse to receive the care, without a solid reason, constitutes an abuse of the creditor, which can’t obtain the cancellation of the contract by making use of his/her own guilt.

If the creditor taken care of reserved the right of longlife usufruct over the estate with the nude property transferred to the debtor at the date of signing the

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contract, the latter can live in the estate only if tolerated and can be evicted at the request of the creditor as beneficiary of longlife usufruct.

If the court will decide the resolution of the fostering contract from the debtor’s guilt, the previous situation of the parties is re-established (the property of the good returns to the patrimony of the creditor), and the counter value of the executed prestations are not paid back.

3. Contract of lifelong rentThe contract of lifelong rent is an aleatory contract, usually with onerous

title, through which a person alienates a good or pays an amount of money (capital) in exchange of a periodic prestation in money, which is going to be paid until his/her death (lifelong rent).

The amount of the rent rate is established, freely, through the will of the parties. Most of the considerations presented for the fostering contract are also applicable to the lifelong rent contract. This resemblance comes from the aleatory character of both contracts. Still, some things are important to be mentioned.

If the person in favor to which the rent was established (including the third party beneficiary) doesn’t exist at the date of constituting the rent (deceased) the contract is struck of absolute nullity, according to article 1644 of the Civil Code. The contract is struck by absolute nullity also in the case of constituting the rent in favor of a person having a desease from which he/she died within 20 days (maximum 30 days according to article 2247 N. Civ. C.) since the date the contract was signed, according to article 1645 of the Civil Code. If the rent is established in favor of a person suffering from a terrible disease, but within 20 days (respectively 30 days) dies due to some other cause (for example: car accident, victim of a crime etc.) the contract is valid because the alea aspect (the chance of winning and loosing) existed.

If the lifelong rent was constituted for free, it can be declared by the parties as not trackable, according to article 1650 of the Civil Code. Also in this case the creditors can follow the amounts paid as rent for debts of food, of rent (Deak (a), 1999, p. 579).

In case of cancellation due to not paying the lifelong rent, the due and paid rates are not returnable.

A new element provided in the New Civil Code consists in the fact that the lifelong rent is constituted during the life duration of the creditor if the parties haven’t stipulated constituting it during the life or the debtor or of a third established person.

If before the New Civil Code entered into force, the term and way of payment the rent rates were established by the parties, and the amount of the rent rates weren’t indexed, the risk of the national currency depreciation being supported by the creditor, now the legislator, through article 2248 N. Civ. C. states that the

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rent rates are paid quarterly in advance and indexed depending on the inflation rate, if the parties haven’t established differently.

According to article 2.249 N. Civ. C. for guaranteeing the payment obligation of the rent constituted in onerous title, the creditor benefits of a privilege or, depending on the case, of a legal mortage over the good. For registering the legal mortage is not necessary to declare the value of the guaranteed claim.

4. Donation contract The old and the new reglementation in matter of donations are similar. So,

in the following section, if there isn’t signalized a difference between the 1864 Civil Code and the new one, it means that the affirmations are valid no matter the legal dispositions that succeded.

The donation contract is the unilateral, free and solemn contract, through which a person (donor) irrevocable transmits a personal patrimonial right to another person (receiver), which accepts it.

The solemn character of the contract supposes its creation as written document, usually authenticated. In the case of corporal mobile belongings (with a value under 25000 lei67 - article 1011, line (4), N. Civ. C. – the solemnity of signing the donation document is replaced by the remittance of the good. In this case, delivering the good is not a way of executing the contract, but the form requested by the law for the validation of the donation.

Therefore, the simple manifestation of will for transmitting a right for free is not sufficient, a written and authenticated agreement being necessary or, where the law permits, the delivery of the good.

In the professional literature it is shown that the irrevocable character of the donation contract is its essence (Ibidem, p. 124). The special characteristic of irrevocability of donations compared to the other juridical documents is established by the Civil Code through article 801 and articles 822-824 and by the New Civil Code through article 1015. The irrevocability, in this case, is a condition of validity for the donation document. So, is totally struck by absolute nullity the contract that includes clauses that are incompatible with the donation principle of irrevocability.

Such clauses are, for example: the obligation of paying the future undetermined debts of the donor and/or of a third person, the right of having the donated good, the right of unilateral termination of the contract etc.

The legislator chose, in case of such clauses, to declare the nullity of the contract and not of the clause because such a stipulation provided within the contract makes the whole contract lacking the free will of the donor.

67 Article 95 of Law no. 71/2011The value limit of the corporal mobile belongings provided at article 1.011, line (4) N. Civ. C. will be periodically updated, through Governmental Decision.

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However the donation can include charges, in the way that the receiver, by accepting the donation, takes the obligation of having a certain demeanor (to give, to do or not to do a certain thing), but its fulfillment or unfulfillement must not be exclusively in the power of the donor. This rule must be respected also in the case of donations with conditions.

4.1 Legal clauses of revocation or reduction of donationsAlthough the donator is forbidden to make any stipulations that are contrary

to the principle of irrevocability, the law provides special cases when the donations can be revoked.

Revoking the donations is done by right, through a court decision or through the simple manifestation of the donor’s will.

An institution similar to countermanding is the report of donations which supposes the return (fictive, for calculating the due quota of the deceased person’s patrimony) of the donated good in the inheritance patrimony of the donor.

Also, reduction of donations takes place in case the donor exceeds the available quota.

Revoking due to supervenience of childrenThe donation is revoked, for the actions done before 1st October 2011,

by right, in case the donor had no children or descendant in the moment the donation contract was signed and after that his/her child is born from or outside marriage.

If the child was born after the New Civil Code came into force, the revoke for supervenience of childen is not operable68.

Revoking due to ingratitudeThe court’s decision of revoking due to ingratitude intervened in the

following cases, limitatively provided by article 831 Civil Code: attempt at the donor’s life (Deak (a), 1999, p. 176)69; severe crimes, cruelties or injuries (it was required that the action to be done with intention); unjustified refuse of food. The unjustified refuse of food supposes that the donor needed and asked for food in the situation of not having any obliged relatives (according to the law) to take care of him/her and the receiver refused him/her without any justification (having the possibility).

68 Article 96 of Law no. 71/2011The provisions of article 829 of 1864 Civil Code are not applied in case the child was born after the civil code came into force.69 A penal conviction is not requested; it’s sufficient to establish the intention of killing, the manifest intention of the author to end the donor’s life. Killing without intention is not reason for cancellation.

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In the reglementation of the New Civil Code70 these cases were maintained, and the revocation due to ingratitude operates also in case the donor knows about the intention of persons to attept to murder the donor and he/she doesn’t inform the latter. So, if this situation started or continued after the New Civil Code entered into force, the donation is revocable.

The action of revocation due to ingratitude is ended if it wasn’t executed within one year since the described facts happened and the receiver can renounce before the end of this term to the right of revoking. The action can be started only against the author of the ingratitude (not against his/her heirs) but if the donor dies after starting this action, it can be continued against the heirs. Admitting the action doesn’t have effects against the third parties that gained the donated goods unless they knew about the existence of the action and the formalities of publicity regarding its promotion were fulfilled (for example registration of the litigation in the land Registry), according to article 831, line 1 C. Civ. and 1024 N. Civ. C.

Case presentation. Revocation due to ingratitude. ConditionsAccording to article 831, point 2 Civil Code, the donation between the living

is revoked due to ingratitude if the donor is culpable of crimes, cruelties, or severe injuries.

From text interpretation it results that not any moral violation or any unappropriate attitude lead to revoking the donation due to ingratitude, but only the facts of an important severity.

Timişoara Court of Appeal, Civil section, decision no. 2347 since 15th November 2006

Through the civil decision no. 578 since 28th June 2006, Timiş Court admitted the appeal declared by the defendant C.V. against civil Sentence no. 762 pronounced by Timişoara Courthouse in the file no. 2867/C/2006, which changed it totally, by rejecting the civil action formulated by the claimant M.V., having as object revoking donation.

For deciding like this, the court of appeal noted that, on the 26.01.2000, through the donation contract authenticated at public notary office G.C.M., the claiming donor M.V. donated in favor of the defendant C.V. the indivisible quota of X% of the estate registered in the 101062 land Registry Timişoara, Y% of the same estate to her daughter married at that time to the defendant C.V., while the Z% of the estate remained in her property.

The court also noted that through the civil sentence no. 7240/2002 of Timişoara Courthouse the marriage between the defendant C.V. and named C.D., daughter of the claimant, ended, situation that lead to several disagreements between the ex-spouses, revealed in the content of the penal sentence no. 1291/2005 of Timişoara Courthouse, through which it was ascertained that on 27.08.2005,

70 Article 1023 N. Civ. C.

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around 23.00, the defendant C.V. addressed injuries and threatenings to the claimant, but without having the nature of alarming the injured party, for which the defendant C.V. was acquitted and punished with an administrative fine.

So, the court appreciated that the first instance was wrong considering that the mentioned penal sentence is not relevant for the present trial. The sentence, corroborated with the testimonial evidence show another state of the situation that the one deduced by the first instance.

In consequence, the court appreciated that, although there were disagreements between the spouses, including insults and threatenings, they are not that severe for leading to applying the provisions of article 831, line 1, point 2 Civil Code.

Against this decision the claimant M.V. acted, by invoking the dispositions of article 304 point 7 and 9 Code of civil procedures, showing that the penal sentence mentioned above has the character of and extrajudicial evidence in the present litigation, and the appeal instance changed it by eliminating the testimonial evidence directly administred by the first instance.

Timişoara Court of Appeal, through the civil sentence no. 2347 since 15th November 2006, rejected the appeal against the decision of the appeal instance. For pronouncing this decision, the instance noted that the claimant built her action on the dispositions of article 831 line 1 point 2 Civil Code, and from the evidence administred – documents attached to the file and witnesses testimonies – it resulted that based on missunderstandings between the defendant C.V. and his ex-wife, daughter of the claimant, the defendant addressed injuries to the claimant.

This fact was noted in the penal sentence no. 334/2005 of Timişoara Courthouse, through which the defendant was aquited for the crime provided by article 205 Penal Code, and punished, according to article 181, line 3 Penal Code, reported to article 91, letter „c” Penal Code, through an administrative fine of 200 lei.

The court also took into consideration the fact that this penal decision was relevant in the present trial for appreciating the severity of the defendant’s actions, resulting from its content that the injuries and threatenings didn’t have the nature of alarming the claimant, and from the witnesses’ testimonies heard, the defendant addressed to the claimant insults based on the conflicts between him and his ex-wife.

Also, the court established that the contravention protocols through which the defendant was sanctioned according to Law no. 61/1991 for the disturbance of public order (attacked through complaint) and the complaint addressed to the Timişoara Police by his ex-wife for the acts of violence and disturbing the public order are after the action was started.

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So, the court decided that, although between the parties took place incidents, including addressing insults or threatening, they weren’t so severe to fulfill the conditions of article 831, line 1, point 2 Civil Code.

Revoking donations between spousesRevoking the donations between spouses71 is the essence of this contract,

being provided by article 937, line 1 Civil Code/article 1031 N. Civ. C.

Revoking donations for the non-execution of tasksThe donation, the previous and present legislation can be purely free or with

tasks.When the donor included a task, the receiver has the obligation of executing

it. The task, for being valid, mustn’t be impossible, illicit or immoral.The task can be established in favor of the donor, in favor of a third person

or in favor of the receiver.The task can’t have a higher value than the object of donation; on the contrary,

the receiver will have to fulfill the task in the limit of the donated good’s value, updated to date when the task has to be fulfilled. If the receiver doesn’t fulfill the task assumed, the donor or his/her descendants can request the execution of the task or the revocation of the donation.

In case the task was stipulated in favor of a third party, he/she can request only the execution of the task.

The right to the action through which the task execution or revocation of donation is requested can be prescribed within 3 years since the task had to be executed.

When the donation is revoked for the unfulfillement of tasks, the good returns to the donor’s patrimony, free of any rights instituted in time over it, excepting the case when the good was alienated, when the provisions of article 1848 N. Civ. C. are applied.

Report of donationsDonations are reported if they are done in favor of a legal heir (surviving

spouse or descendant), being considered an advance of the inheritance.So, any heir belonging to the class of descendants and the surviving spouse,

if he/she accepted the succession, must report, meaning to return all he/she received from the deceased as donation, excepting the situation when the donor stated differently (Eliescu, 1997, p. 481).

If he/she comes to the inheritance, the receiver will have to report the received donation. He/she could keep the donation by renouncing to the inheritance.

71 The donation between spouses can have as object only the personal belongings of the spouse which donates.

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According to the previous legislation the report of the mobile goods was done through “taking less” and in case of estates “in-kind”. According to the New Civil Code the report of donations is done through the equivalent. Is considered to be unwritten the disposition which imposes the receiver the in-kind report. Nevertheless, the receiver can make the report in-kind if at the date of request he/she is still the owner of the good and he/she didn’t put any real tasks or rented it for a period of more than 3 years.

Reduction of donationsThe possibility of a person to make donation must not affect the succesoral

rights of some certain classes of heirs. In their favor there is a succesoral reserve that they will inherit (if they accept the inheritance) even against the will of the deceased expressed through donations, testament clauses or other liberalities.

In case of affecting, through donations, the succesoral reserve, these will be reduced, in reverse chronological order for filling the legal succesoral rights of the heirs. So, without annulling or revoking the donations they will become, since the decease of the donor, ineffective.

The heirs and their succesoral reserve are analysed in the section dedicated to legacies.

V.5.3. Testamentary dispositions. Legacy. Active trust substitutionsThe testament is a juridic template, a form taken by the last will of a person. Next to legacies – which are dispositions reffering to succesoral patrimony

or the goods that are part of this patrimony – the testament can include disinheritances, tasks imposed to the legal or testamentary heirs, cancellation of previous testamentary provisions etc.

The testament can be holograph (handwritten by the testator, dated and signed by him/her), authenticated or mistic (secret – signed within a procedure done in front of the judge).

Once the New Civil Code entered into force the mistic testament can’t be used anymore, but the ones done before 1st October 2011 keep their validiy.

The legacy is a testamentary disposition through which the testator designates one or more persons who, at his/her death, will receive a free tilte, his/her whole patrimony or a fraction of it, or some determined rights.

The right to revoke a legacy is not subject to any legal restriction, being considered a right insusceptible of abuse. Also, any engagement of maintaining a legacy will be absolutely nulle, being considered a pact regarding a future inheritance.

Legacies can’t affect the succesoral reserve. The succesoral reserve is that specific part of the patrimony owned by the person leaving the inheritance, to which the heirs have the right according to the law, against the will of the deceased manifested through liberalities done during life (donations) and/

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or through terstamentary dispositions (legacies or disinheritances) (Deak (b), 1999, p. 335).

So, the testator is forbidden that through the mentioned documents to give any dispositions, tasks, clauses that might affect the rights of his/her succesors who accepted the inheritance.

The heirs and the amount of the succesoral reserve are established imperatively by the law, and they can’t be changed through the will of the person leaving the inheritance, not even with the agreement of the presumed heirs. The agreements regarding the future inheritance are expressly forbidden by the law and sanctioned with absolute nullity.

The heirs are: surviving spouse, parents and descendants no matter the remove.

The reserve for the surviving spouse is of ½ from his/her legal heir quota, which will be determined by the class of legal succesors with which he/she comes to the inheritance.

The reserve of the parents is of ½ of the deceased’s goods if he/she “leaves mother and father” and of ¼ if he/she “leaves only one parent”.

The descendants have, depending on the “children left” a reserve of ½ of the inherited goods for one child, 2/3 for two children and ¾ for three or more.

The professional literature appeciates that the reserve of the decendants is calculated depending on the “children left as heirs” (meaning the ones that accepted inheritance). In case the descendants taking the inheritance are not first degree relatives, the reserve is established depending on the number of branches (number of deceased’s children). The table of goods depending on which the sucesoral reserve is calculated, is determined by the fictive (“on paper”) adding of the goods that were object of the liberalities, during his/her life de cuius, to the good existing in the deceased’s patrimony at his/her death.

According to the new reglementation, the succesoral reserve of each heir is half of the succesoral quota which, in absence of the liberalities of disinherintances, would be deserved as legal heir (article 1.088 N. Civ. C.).

Substitution of the person in charge with testamentary dispositions is the disposition through which a person, named instituted, is commissioned to administrate the goods that are the object of the liberality and to transmit them to a thid person, named substituted.

The previous legislation sanctioned with absolute nullity any disposition which contained a substitution of the person in charge with testamentary dispositions.

According to the New Civil Code, substitution of the person in charge with testamentary dispositions becomes legal, so a liberality can be discharged of a task which constitutes in the obligation of the instituted to administrate the goods that are the object of the liberality and to transmit them, at his death, to the designated substituted person. The task of administration and of transmitting

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the goods produces effects only regarding the mobile/immobile goods that represented the object of the liberalities and that at the date of instituted death can be identified and are in his/her patrimony.

When the liberality includes real estates, the task produces effects also on the mobile goods which replace them. If the liberality includes rights that are subject to publicity formalities, the task must respect the same formalities. In the case of estates, the task must be noted in the land Registry.

The rights of the substituted person are born at the death of the instituded person. The substituted person gains the goods which represent the object of the liberalities due to the will of the person which disposes it. The substituted person can’t be, on his turn, subject to the obligation of administring and transmitting the goods.

For executing the task, the person which disposes the substitution can impose guarantees and signing of insurance contracts.

When the substituted person preceeds the instituted person or gives up the benefit of the liberality, the good returns to the instituted person, excepting the case when stated that the good will be inherited by the substituted person’s heirs or a second substituted person is established.

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BIBLIOGRAPHY:

1. Albert, Ş., Uta, L. & Jora, C., Culegere de practică judiciară pe anul 2002, Editura Lumina Lex, Bucharest, 2003;

2. Boroi, G., Drept civil. Partea Generală. Persoanele, Editura ALL Beck, Bucharest, 2001;

3. Boroi, G. & Anghelescu, C. A., Curs de drept civil. Partea generală, Editura Hamangiu, Bucharest, 2011;

4. Chirică, D., Contracte speciale civile şi comerciale, Vol. I, Editura Rosetti, Bucharest, 2005;

5. Costin, M.N. & Costin, C.M., Dicţionar de drept civil de la A la Z, Ediţia a II-a, Editura Hamangiu, Bucharest, 2007;

6. Deak, F., Tratat de drept civil. Contracte speciale, Ediţia a II-a , Editura Actami, Bucharest, 1999, (a);

7. Deak, F., Tratat de drept succesoral, Editura Actami, Bucharest, 1999, (b);

8. Eliescu, M., Curs de succesiuni, Editura Humanitas, Bucharest, 1997;

9. Malaurie, P., Aynes, L. & Yves-Gautier, P., Drept civil. Contracte speciale, Editura Wolters Kluwer, Bucharest, 2009;

10. Perju, P., „Decizia nr. 1144/1991. Note şi comentarii”, în Revista Dreptul nr. 10/1992;

11. Safta-Romano, E., Contracte civile. Încheiere. Executare. Încetare., Ediţia a III-a, Editura Polirom, Iaşi, 1999.

Legislation:1. Civil Code;

2. Family Code;

3. Civil Procedure Code;

4. Law no. 272 from 19 July 2005 regarding the areas of property and justice as well as adjoining measures, published in the Romanian Official Journal, Part I no. 653 from 22 July 2005;

5. Law no. 319 from 10 June 1944 for the right to inheritance of the survining spouse, published in the Romanian Official Journal, Part I no. 133 from 10 June 1944;

6. Decree no. 31 from 30 January 1954 regarding persons and juridical persons, published in the Official Bulletin no. 8 from 30 January 1954.

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Web:1. http://portal.just.ro;2. http://www.juris.ro/reviste-numere/Pandectele-Romane.

ANNEXES

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Annex 1”ST. JOSEPH HOUSE” ELDERS CENTER IAȘI

– Presentation of services –

1. Human dignity„St. Joseph House” elders center through the social services offered, promotes

the dignity of the elder. Any social activity must be based on respect, which means considering the

poor person an individual with human dignity and own personality. The respect is translated through a profound esteem for the other person: for his interior world, for the history of his life and for his way thinking, acting, for his goal and his needs.

The old population represents a vulnerable category of persons due to the multiple difficulties confronted, especially due to age, incapacity and precarious material and financial situation. For facing the needs of the category of persons, the public and private institutions developed a series of social services and gave houses for the use of elders in difficult situations, like residential centers for elders, hospital-centers, day care centers etc.

2. Presentation of the institutionThe Congregation of the Daughters of Our Lady of Divine Providence which

is present in Romania since 1995, developed several services destined to the elders, from which the most important objective is the elders center „ St. Joseph House” in Iaşi.

The social center develops its activity since 2002 and the socio-medical care service is accredited since 2006. The maximum capacity or the Center is of 40 places.

In the elders center „ St. Joseph House” benefit from socio-medical care persons that have the legal age of pensioning and are in one of the following situation:

- don’t have a family and live in loneliness and uncertainty;- don’t have a house, are abandoned and live in the street or in other

precarious places;- don’t have any income or the incomes are very low so they can’t face the

actual economic situation;- are ill and need permanent assistance and the family can’t assure the

necessary care;- the person needs special services such as: physiotherapy, permanent

medical assistance, special diet etc.In many situations, being taken to a center is the only solution for solving

the problems faced by the elders and their family members. The elder’s accommodation to the institutional environment depends on the welcoming

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ANNEXES

atmosphere of the center, the quality of the relations and assistance received, these institutions being laudable if they are “inspired from principles not only of an organizational efficiency, but also of a loving care” (Pope John Paul II, 1998).

A particular note of „ St. Joseph House” elders center is the family climate created for helping the beneficiaries to feel comfortable, in an atmosphere of warm and Christian serenity.

3. The identification and selection of the assisted personsThe residential center uses and distributes informative materials regarding

the services offered to the elders. The sources of information which can be accessed by the interested persons are multiple: informative materials, the congregation’s website, the information received from the existing beneficiaries and from other persons who know the services offered in the center.

The identification and admittance of the beneficiaries is made by self-referral or referrals from the legal representatives of the elders, relatives or friends. The referral can also come from other institutions such as: churches, hospitals, police, non-governmental organizations and other institutions with which the elder came in contact.

The evaluation of the solicitant is made after a written request, submitted to the social assistance office of the center. Each request is analyzed within the meetings of the center’s commission, specially held for this goal. After evaluating the case and the person’s file, the request is sent for approbation. The definitive approbation is given in a session following the social evaluation and the presentation by the client of a set of medical analysis based on which the doctor of the center confirms that the person can be taken in the center. If the doctor’s answer is favorable, and the center can satisfy the specific needs of the solicitant, the next step is the actual institutionalization of the person in the „St. Joseph House” center where he/she benefits from the socio-medical services offered without any discrimination.

The steps for being accepted in the center are:1. submitting a request to the social assistance office;2. visit to the beneficiary’s home;3. making the social evaluation;4. making a set of medical analysis consisting in:

- hematologic examination;- biochemical examination;- electrophoresis – protein;- A, B and C hepatic samples;- pulmonary X-ray;- E.K.G.;- urinalysis;- coproparasitologic exam;

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- psychiatric exam;- V.D.R.L.;- medical letter from the family doctor stating the fact that the solicitant

can live in the center.The evaluation of the solicitant’s situation is made in the order of registering

the requests, but according to its mission, the center offers priority to the cases confronting severe socio-economical situations.

4. Evaluation of the beneficiaries needsAccording to the law72, the beneficiaries admitted in the residential center

“receive services based only on the initial evaluation and the complex evaluation of the individual needs”.

The needs for care of the elder are established through the National Grid for Evaluating the Needs of the Elders73 which includes the criteria for establishing the degree of dependence. For establishing the correct degree, the socio-medical evaluation file is created.

From the evaluations made until the present we observed that the needs of the elders are covered only partially, especially in the rural area. Here, but also in the urban area, poverty is often met in cases of lonely elders, without children and with very low incomes. The insufficiency of the material and human resources, the heath programs insufficiently developed or even their absence contribute to the degradation of the elders’ health situation and these are only some of the reasons for which the elders request their acceptance in the center. “The needs of the elders tend to be seen by some specialists involved in their assistance as deficiencies, although the origins of these needs are in the conditions that the elder doesn’t have a significant control” (Miftode, 2003).

The needs change in time, along with ageing and involves in most cases physical and psychological degradation. From this reason a periodical evaluation of the person’s needs is done for adapting and offering the best services on medium and long term.

Developing efficient services, of a good quality, is closely related to prospecting the needs of the third age persons, with a continuous informing activity regarding these needs and applying the most efficient ways of intervention.

72 The order of the Ministry of Labor, Social Solidarity and Family no. 246 since 27th March 2006 regarding the approval of the minimum quality standards for the services of homecare for the elders and the residential centers for elders, standard 14.73 Government decision no. 886 since 5th October 2000 for approving the national grid for evaluating the elders needs.

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5. Services offered in the „ St. Joseph House” centerService of accommodation and mealThe residential center offers the beneficiaries food according to their needs

and preferences, respecting the active legal dispositions. The accommodation is assured in rooms with two places, with its own bathroom and necessary utilities, adapted to the age particularities.

The alimentation consists in serving 3 main meals per day, to which the nutritional supplements are added according to the medical recommendations for each assisted person. The food is prepared in the center’s kitchen by specialized personnel and is served in the center’s dining room in bed, according to the assisted person’s possibility.

Socio-medical care serviceThe residential center offers conditions for maintaining the personal hygiene

of the beneficiaries and the collectivity in which they live. This service consists in effectuating the personal hygiene, permanent supervision and support in all daily activities, support for maintaining or readapting the physical or intellectual capacities, specialized medical consultations, monitoring the blood pressure, assuring and administering the medicine, assuring the necessary medical devices etc.

Physiotherapy and kinetotherapy service consists in respecting a schedule of medical gymnastics for maintenance and recovery done with specialists in collaboration with the doctor and nurse from the center. In the kinetotherapy exercises are done for maintaining the muscle tone and the articulation mobility, favoring the sanguine circulation, maintaining a good state of the body, raising the resistance to effort etc. The exercises are done in groups, in the gym or individually, according to the doctor’s recommendations.

Ergotherapy service consists in involving all the elders in different activities of housekeeping, manual activities, respecting the capacities and the availability of each beneficiary.

Animation service consists in organizing the leisure time of the elders through the initiation and involvement of all persons in different fun games and contests, organizing excursions, walks or picnics outside, anniversaries etc. The socialization of the beneficiaries is established according to their needs and their availability, preferences and resources are taken in account. The goal of these activities is preventing the degradation, facilitating the pro-social conditions, consolidating the relationships between the beneficiaries but also between the beneficiaries and employees, volunteers and collaborators.

Social assistance service consists in the coordination of the social relations, especially of external relations for favoring the reports between the personnel of the center and the elder, family of origin, the reports of the elder with the state authorities or other institutions. The beneficiaries are helped in making requests for obtaining their legal rights or for solving some situations.

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Religious service helps the elder to live in serenity and dignity during the last part of life according to the ritual of each beneficiary, with respect for the houses’ tradition. So, “the spirituality doesn’t eliminate the suffering, but develops a way of coping with it and gaining a new development of the personality” (Mitrofan, 2002).

Through the services offered, we are preoccupied for assuring a healthy diet to the elders, for assuring the daily personal hygiene, to combine the moments of relaxation and rest, to offer periodical medical consultations and the necessary therapy for each case.

6. The qualities of the worker within the centerThe persons employed in the center are specialized in different domains. The

center’s team is formed by: psychologist, social worker, kinetotherapist, medical assistants, associated doctors, nurses, chefs. The activity of the employed personnel is coordinated by the manager of the institution.

The worker is requested every day to renew a fundamental option: the decision to work for and with the elders in difficult situations that need support during life. This worker needs to “see” beyond the exterior aspect and to respect the human dignity. So, the person employed avoids to be influenced by prejudgments in his/her activity, avoids using offensive language and behaviors. More than that, he/she will to get closer to the beneficiary with respect, understanding each ones personal history.

Also, the worker must see and valorize the existing resources and the values present in each person: love, capacity to relate with others, joy, optimism.

The proficiency, giving, constancy, emotional involvement and interest for the others make the ambiance of the center a welcoming and familial house.

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BIBLIOGRAPHY:

1. Miftode, V., Tratat de asistență socială, vol. I, Editura Fundației Axis, Iași, 2003, p. 21;

2. Mitrofan, I., Psihologia pierderii și terapia durerii, Editura Sper, Bucharest, 20052, p. 185;

3. Pope John Paul II, 1998, Scrisoare către bătrâni, Colecția Documente, Editura Presa Bună, Iași.

Legislation:1. Government Decision no. 886 since 5th October 2000 for approving the

national Grid of assessing the needs of the elders, published in the Official Monitor of Romania, Part I, no. 507 since 16th October 2000;

2. Order no. 246 since 27th March 2006 of the minister of labor, social solidarity and family regarding the approval of the minimum quality Standards specific for the homecare services for the elders and for the residential centers for elders, published in the Official Monitor of Romania, Part I, no. 637 since 24th July 2006.

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Annex 274

REQUEST FOR SERVICES

Dear Sir,I, the undersigned, ___________________________________________________,resident in _________, street_____________________________, no.______, with the identity document ______________, serial _________, no._________, released by ____________________________, on __________________, I kindly request to approve my application for receiving support through the following psycho-social services offered by _________________________:

social assistance psychological counseling legal support socializing activities accompanying / visits of volunteers mediation between myself and other institutions material support

Date: Signature:

In attn. to the CEO of __________________________________________

74 Model for filling in – section I.4.2.

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Annex 375

INITIAL FILE OF THE CASE

TYPE OF REQUEST: verbal ____/ telephonic______/ written _____________DATE: _____________SOLICITANT: ______________________________________________________INFORMATION ABOUT THE BENEFICIARY:First and last name: ___________________________________ Age: _______Personal ID No. _____________, Identity document ______ Serial ___ No. ___Actual domicile: ____________________________________________________Legal domicile: ______________________________________________________ACTUAL SITUATION: ____________________________________________________________________________________________________________________________________________________________________________________________________________RESOURCE PERSONS:First and last name: ________________, age: _______, relation: ___________First and last name: ________________, age: _______, relation: ___________First and last name: ________________, age: _______, relation: ___________RELEVANT INFORMATION ABOUT THE ELDER AND OBSERVATIONS: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Responsible social worker ________________________________Signature of the social worker: ________________________________


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Annex 476

No………… / Date..……...

SOCIAL ASSISTANCE CONTRACT

CONTRACTING PARTIES1. ________________________________________Named SOCIAL SERVICES PROVIDER, With the office in: ___________fiscal identity code ___________bank account nr.: ____________________opened at bank: ______________accreditation certificate, serial:______ no.: ___________represented by: ______________________as: _______________________and2. _______(first and last name of the beneficiary) named BENEFICIARY,With the legal domicile in:___________________ street ___________________no:________ county:______________ Personal ID no.:____________________,identity document serial: _______ no. ___________, released on:___________ by:___________________ represented by ___________________ with the legal domicile in:_________________ street ____________________ no.________ county: _______________, identity document serial: ______no. ____________released on:_________________ by :____________________________________according (the document mentioning the quality of representative will be mentioned) ______________________________ no. ______date:____________1. TAKING INTO ACCOUNT:the plan of intervention no________/date____________the complex evaluation made on ______________the individualized plan of assistance and care no._________/date____________

2. AGREED UPON THE FOLLOWING:1. DEFINITIONS1.1 The social assistance contract: is the juridical document signed between a person or a public or private institution, accredited according to the law to offer


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social services – named social services provider – and a person found in risk or difficult social situation – named social services beneficiary – that express their agreement regarding the offering of social services.1.2. Social services supplier: person or public or private institution, accredited according to the law to offer social services (article 11 of the Government Order no. 68/2003, with the later modifications and adding).1.3. Social services beneficiary is the person at risk and in social difficulty together with his/her family needing social services, according to the intervention plan established and revised after the complex assessment. 1.4. Social services represent an aggregate of measures and actions taken to fulfill the individual, familial and group social needs, in order to prevent and overcome difficult situations, vulnerability or dependence and to maintain the person’s autonomy and protection, to prevent marginalization and to improve the quality of life, according to the Government Order no. 68/2003, with the later modifications and adding.1.5. Reassessment of the beneficiary’s situation represents the compulsory activity of the provider to assess the situation of the beneficiary after a period of time when he/she has received social services.1.6. Revising or creating the individualized plan of assistance and care represents the modification or completion brought to the individualized plan, based on the results of the reassessment of the beneficiary’s situation.1.7. Beneficiary’s contribution represents a share part of the total cost of the service / services offered by the provider, depending on the type of service and the material situation of the beneficiary, and can consist in money, services or in kind.1.8. Beneficiary’s obligations represent the total duties assumed by the beneficiary through the contract and fulfilled by the beneficiary improving at maximum the psycho-physical potential.1.9. Minimal quality standards: is a total of requests regarding the organizational and material framework, human and financial resources for reaching the compulsory level of performance for every specialized social services provider, approved according to the legislation. 1.10. Modifications of the social assistance contract are the modifications caused by a normative document that have been added to the social assistance contracts, independently from will of the parties’.1.11. Force majeure - an event beyond the parties’ control, that is not caused by their mistake or guilt, that couldn’t be foreseen when the contract was signed, and makes the contract execution and fulfilling impossible. 1.12. Initial evaluation represents the activity of identifying/determining the causes, the actual social development and integrity state of the beneficiary and their prognostic through specific methods and techniques used in social professions, by the social services provider. The goal of the evaluation is to know

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and to understand the problems faced by the beneficiary and to identify the first steps needed to establish the initial plan of the intervention. 1.13. Individualized plan of assistance and care includes adequate and individualized measures and services according to the social needs identified after the compex evaluation: a program of the social services, the responsible personnel and the procedures that need to be followed.1.14. Complex evaluation represents the activity of investigation and analysis of the actual state of social development and integration of the beneficiary, of the causes that generated and maintained the difficult situation in which the beneficiary is found and their prognostic, by using standardized instruments and techniques specific to the social, psychological, educational, medical, and juridical assistance domains.

2. THE SUBJECT OF THE CONTRACT2.1.77The subject of the contract is offering the following social services:__________________________________.2.2. 78The description of the social services offered by the social services provider: ____________________________________.

3. THE COSTS OF THE OFFERED SOCIAL SERVICES AND THE CONTRIBUTION OF THE BENEFICIARY3.1. The total cost per month of the services described at point 2 is: ________lei/month.3.2 79The monthly cost for each service provided is, as described below:for the social assistance and home care services for the elders the monthly cost is of ________ lei3.3 80 The beneficiary’s contribution for the received social services is, as described below:for the social assistance and home care services for the elders the contribution is of __________(cash/in kind)3.4. The contribution of the beneficiary will not influence offering the social services and will not hinder the possibility of the beneficiary to overcome the difficult situation.

4. DURATION OF THE CONTRACT4.1. The duration of the contract starts from _________ until ______________

77 The list of the social services that will be accredited can be annexed to the contract, with the agreement of both parties.78 The description of the offered social services can be annexed to the contract, with the agreement of both parties.79 The costs of the services can be annexed to the contract, with the agreement of the parties.80 The value of the beneficiary’s contribution is established after the complex evaluation process.

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4.2. The duration of the contract can be extended with the partie's agreement and only after evaluating the results of the services offered to the beneficiary, and, if applicable, after revising the individualized plan of assistance and care, through additional act to the contract.

5. STEPS IN OFFERING THE SOCIAL SERVICES5.1. Implementing the measures included in the intervention plan and in the individualized plan.5.2. Reevaluating the beneficiary’s situation.5.3. Revising the individualized plan of assistance and care for adapting the social services to the needs of the beneficiary.

6. THE RIGHTS OF THE SOCIAL SERVICES PROVIDER6.1. To check the truthfulness of the information received from the beneficiary.6.2. To stop offering the social services to the beneficiary if it’s proved that the beneficiary offered wrong information; 6.3. To use, according to the law, denominated data for statistics and for developing social services.

7. THE OBLIGATIONS OF THE SOCIAL SERVICES PROVIDER7.1. To respect the fundamental rights and freedoms of the beneficiary while offering the social services and also the rights of the beneficiary presented in this contract;7.2. To offer social services included in the individualized plan of assistance and care, following it and the minimal quality standards for social services;7.3. To make the necessary procedures in order to ensure the beneficiary of the continuity of social services in case of contract termination as described at point 12.1 and 13.1 letters a) and d). The continuity of the services will be assured by subcontracting and transferring of the social services.7.4. To be receptive and to take into account all the efforts of the beneficiary in fulfilling the contractual obligations and to consider that the beneficiary fulfilled his/her obligations only after full engagement has been shown; 7.5. To inform the beneficiary about:

• the social services content and the conditions for offering the services; • opportunity of receiving other social services;• lists at local level with accredited social services providers;• internal procedures; • any modification of the contract.

7.6. To reevaluate the beneficiary’s situation periodically and, according to the case, to complete and/or revise the individualized plan of assistance and care, exclusively in the beneficiary’s interest;

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7.7. To respect, according to the law, the confidentiality of the data and information related to the beneficiary; 7.8. To take into consideration the objective wishes and recommendations of the beneficiary, regarding the social services;7.9. To use the beneficiary’s contribution exclusively for covering the costs related to offering the social services;7.10. To inform the responsible public service of social assistance in the area where the beneficiary lives, about the identified needs and services proposed to be offered.

8. THE RIGHTS OF THE BENEFICIARIES8.1. In the process of offering the social services described at point 2, the social services provider will respect the fundamental rights and freedoms of the beneficiary.8.2. The beneficiary has the following contractual rights:a) to receive the social services described in the individualized plan of assistance

and care;b) to be assured with the continuity of the social services, while the conditions

that generated the difficult situation are maintained;c) to objectively refuse receiving the social services;d) to be informed in due time and using accessible terms, about:

• social rights, legal protection measures and risk situations; • modifications intervened while receiving the social services;• opportunities of receiving other social services;• local list of accredited social services providers;• internal procedures.

e) to participate in the evaluation of the received social services and to participate in taking decisions regarding the appropriate social intervention, having the right to choose from different types of intervention, if they exist;

f) the right to have access to the personal file;g) to express the dissatisfaction related to the offered social services.

9. 81 THE OBLIGATIONS OF THE BENFICIARY9.1. To participate actively in the process of receiving social services and in the reevaluation and revision of the individualized plan of assistance and care;

81 The beneficiary’s obligations will be filled in, depending on the case, with other obligations specific to the types of services included in this contract.

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9.2. To offer correct information regarding the identity and familial, medical, economical and social situation and to grant the social services provider the possibility of checking the truthfulness of information provided; 9.3. To respect deadlines and clauses established in the individualized plan of assistance and care;9.4. To contribute to the payment of the received social services costs with a share part from the total cost of the service/services offered by the provider, according to points 3.3 and 3.4.9.5. To announce any modification to his/her personal situation that occurred while receiving the social services; 9.6. To respect the behavior regulations, working schedule, contact persons etc.

10. 82COMPLAINTS10.1. The beneficiary has the right to complain verbal and/or in writing about the process of offering social services.10.2. The complaints can be addressed directly to the social services provider or through any other person from the team that is implementing the individualized plan.10.3. The social services provider has the obligation of analyzing the contents of the complaints, consulting both the beneficiary and the professional involved in the implementation of the individualized plan of assistance and care and to give an answer in maximum 10 (ten) days since the complaint was received.10.4. If the beneficiary is not satisfied with the way the complaint has been answered, he/she can address it further, in writing, to the Social Mediation Commission of the Iași county that will clarify the divergences between the parties or, if the case requires, to the competent Court of Justice.

11. LITIGATIONS11.1. The litigations related to ending, executing, modifying and stopping or other claims coming from this contract will be subject of a prior procedure of amiable solving.11.2. If, after 15 days from starting these unofficial procedures, the Social Services Provider and the beneficiary don’t manage to amiable solution a contractual divergence, each of the parties can ask for support from the Mediation Commission or can address to the competent courts.

12. 83 CONTRACT TERMINATION12.1. The following represent reasons for ending the contract:

82 The provider will have internal procedures where it will be stipulated the procedure regarding the complaints addressed by the beneficiaries, respecting points 10.1-10.3.83 Depending on the nature of the social services offered, the contract parties can renegotiate the damages to be paid by the responsible parties.

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a) objective refusal of the beneficiary to receive social services, expressed directly or through a representative, in writing and signed;

b) breaching by the social service provider of legal provisions regarding the social services if the action is invoked by the beneficiary;

c) the withdrawal of the functioning authorization or the accreditation of the social services provider;

d) the limitation of the activity for which the social services provider was accredited, if this affects the social services offered to the beneficiary;

e) changing the activity field of the provider, if this affects the social services offered to the beneficiary.

13. ENDING THE CONTRACTEach of the following represents a reason for ending the contract:

a) the period for which the contract was signed ended;b) the mutual agreement of the parties involved to ending the contract;c) the goal of the contract was reached;d) lack of necessary funds for supporting the contracted social services at

an optimum level;e) force majeure, if invoked.

14. FINAL CLAUSES14.1. The contracting parties have the right, in the contracting period, to agree upon contract’s clauses through additional documents, only in circumstances that harm the legitimate interests of the parties that could have not been foreseen when the contract was signed.14.2. The provisions of the contract will be completed with the ones of the national legislation which applies to this field.14.3. The governing language of the contract is Romanian.14.4. The contract will be interpreted according to the Romanian legislation.14.5. The social services supplier is responsible for monitoring and evaluating the offered social services.14.6. The measures taken for implementing the individualized plan for assistance and care will be communicated to the Social Assistance Department, according to the legislation.14.7. Based on the report regarding the results of the implemented individualized plan of assistance and care, the Social Assistance Department will monitor the activity of the social services provider.

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14.8. The beneficiary expresses its approval for giving one copy of this contract to the Social Assistance Department, without any violation of the right to confidentiality.

84ANNEXES TO THE CONTRACTa) individualized plan of assistance and care;b) the form of evaluation and re-evaluation of the social services provided

to the beneficiary, depending on the case;c) the assistance and care plan or the revised plan.

This contract for social services was signed at the provider’s office/beneficiary’s domicile in 2 (two) copies, one for each contracting party.

A copy of this contract will be sent to the Social Assistance Department by the social services provider.

Place: ___________Date: ________________

SOCIAL SERVICES PROVIDER, BENEFICIARY,_____________________________ ________________(name of the person/persons authorized to sign) (first and last name of the person)

Signature: _______ Signature: ________

84 The contracting parties can agree also upon other types of annexes.

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Annex 585

SOCIAL EVALUATION

Made by social worker(s): ____________________________________________Place and date: _______________________________________________________Persons that were present:_____________________________________________

I. Beneficiary’s identification data First and last name: ______________________________________________Place and date of birth:_______________________________________________Personal ID no.:______________ Serial and no. of ID document ___________Legal residence:______________________________________________________Actual residence:_____________________________________________________Civil status:__________________________________________________________Studies: _______________________Occupation:___________________________Ethnicity:_______________________ Religion:_____________________________

II. Data about the family:Data about the husband/wife:First and last name: ________________________________________________Place and date of birth:_________________________________________________Personal ID no.:________________ Serial and no. of ID document ____________Legal residence:_______________________________________________________Actual residence:____________________________________________________Civil status:__________________________________________________________Studies: ______________________Occupation:____________________________Ethnicity:________________________ Religion:____________________________

Data about children:Crt. No. First and last name Age Occupation Residence Observations

1

2

3

85 Model filled in - section I.4.5.

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Data about other persons living at the same address: Crt. No.

First and last name Age Civil status Occupation

III. Social history of the beneficiary____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

IV. Medical situation____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

V. Material/financial situationHomePersonal property: yes no No. of rooms: __________ Electricity Current water Heating TelephoneHygienic condition: Satisfying Unsatisfying

Cultivated land (type of culture): ________________________________________Animals: ____________________________________________________________Other properties: ____________________________________________________IncomesStabile: _____________________________________________________________Occasional: _________________________________________________________

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VI. Relations with the family and communityFamily relations: _____________________________________________________________________________________________________________________________________________________________________________________________Community relations:_____________________________________________________________________________________________________________________________________________________________________________

VII. Observations________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

VIII. Conclusions and recommendations________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Social workers: ___________________________________________ ___________________________________________

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Annex 686

NATIONAL GRID FOR ASSESING THE NEEDS OF ELDER PERSONS

File no: ____________ Date when taken in evidence: ____________ Date of evaluation: _____________________ Date of exiting from evidence: ___________

I. ASSESSED PERSONFamily name87:________________________ First name: _______________________Date and place of birth: ________________________ Age: _______________Address: ___________________________________________________________Locality: _________________ County _____________ Postal code _____________Telephone: ________________ Fax: ______________ E-mail: ___________________Profession: _________________ Occupation: _______________________________Studies: No studies Primary school Gymnasium High school University

Identity document: ____________ Serial _______ No.______________________Personal identification code: ___________________________________________Pension coupon (pension folder) no. ____________________________________Folder (coupon) for disability pension no. ______________________________Health insurance card no. __________________ Serial ____________________Gender: Masculine Feminine

Religion: ______________________________________

86 Model filled in - section I.4.6.87 To be filled out with the father’s initial

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Civil status: Not married Married on ______________________ Widow(er) since __________________ Divorced since ___________________ Separated since ___________________

Children: Yes No

If yes, write the first and last name, address and telephone of the children____________________________________________________________________________________________________________________________________________________________________________________________________________ II. LEGAL REPRESENTANTIVEFamily name : _______________________________________________________First name: _________________________________________________________Relation with the beneficiary: husband/wife son/daughter relative other persons

Date and place of birth: _________________________ Age: ______________Address: ___________________________________________________________Locality: _________________ County _____________ Postal code _____________Telephone: ________________ Fax: ____________ E-mail: _____________________

III. CONTACT PERSON IN EMERGENCY SITUATIONSFamily name : _______________________________________________________First name: __________________________________________________________Date and place of birth: ____________________________ Age: ______________Address: ___________________________________________________________Locality: _________________ County _____________ Postal code _____________Telephone: ________________ Fax: ______________ E-mail: __________________

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IV. SOCIAL EVALUATIONA. Living place House Apartment Other situations

Situated: First floor Superior floor Elevator

Composed of:• No. of rooms: ___________• Kitchen [ ] Bathroom [ ] Shower [ ] • Toilet

situated in the interior situated in the exterior

• Heating: without own system with wood/coal gas liquid fuel

• Current water yes no cold hot other situations

Living conditions: Luminosity adequate inadequate

Humidity adequate dampness

Hygiene adequate inadequate

The home has: stove, coking machine

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refrigerator washing machine radio/tv vacuum cleaner

Conclusions regarding the environmental risk:________________________________________________________________________________________________________________________________________

B. Family network The person lives: alone since: __________________________ with wife/husband since: ______________ with children since: ___________________ with other relatives since: ______________ with other persons since: ______________

List of persons the elder lives with (fisrt and last name, relation, age): ________________________________ Compatible yes [ ] no [ ]________________________________ Compatible yes [ ] no [ ]________________________________ Compatible yes [ ] no [ ]________________________________ Compatible yes [ ] no [ ]

• one of the persons the elder lives with is: ill with disabilities/ handicaped alcoholic

• receives family support: yes [ ] no [ ] money food house keeping

• the relations with the family members are: good with problems no relations

• neglect risk: yes [ ] no [ ]• abuse: yes [ ] no [ ]

If yes, describe:________________________________________________________________________________________________________________________________________

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C. Friends, neighbors network• had relations with friends:

yes no visits support relations

• the relations are: permanent rare

• frequents: a social group the church other

Specify: ____________________________________________________________Write the names of the friends and/or neighbors that have good and supportive relations with the elder, groups of support:____________________________________________________________________________________________________________________________________________________________________________________________________________

• is helped by friends, neighbors for: shopping housekeeping walks outside the home

• participation to: community activities recreational activities

• the community offers support: yes no

If yes, specify: ___________________________________________________________________________________________________________________________

V. EVALUATION OF THE ECONOMIC SITUATION• Personal monthly income, represented by:

social public insurance pension ________________________________ agricultural pension _________________________________________ I.O.V.R. pension _____________________________________________ pension for disability _________________________________________

• other incomes: ________________________________________________• total income: _________________________________________________• other owned goods: ____________________________________________

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VI. EVALUATION OF THE HEATH SITUATIONA. Present diagnoses1. ________________________________________2. ________________________________________3. ________________________________________4. ________________________________________5. ________________________________________

B. Present health situation• relevant family antecedents:

____________________________________________________________________• personal antecedents:

____________________________________________________________________• teguments and mucous (ulcerations, plagues etc.):

____________________________________________________________________• locomotory organs (including the mobility and walking disorders):

____________________________________________________________________• breathing organs (breathing frequency, cough, expectoration, dyspnea):

____________________________________________________________________• cardiovascular organs (blood pressure, stroke, pulse, pains,

dyspnea,breath rhythm disorders, edema, peripheral bloodstream disorders etc.):

____________________________________________________________________• digestive organs (dentition, nausea, pains, intestinal transit disorders

etc. - also includes the nutrition state):____________________________________________________________________

• urogenital organs (pain, urination disorders – urinary incontinence, genital problems etc.):

____________________________________________________________________• sense organs (hearing, seeing, taste, smell, tactile):

____________________________________________________________________• neuropsychiatric examination (information about reflexes, equilibrium

disorders, motor and sensorial deficits, jacksonian crisis etc.):____________________________________________________________________

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C. Relevant para-clinical investigations (data from the medical documents of the elder):________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

D. Recommendations from specialists regarding the hygienic, therapeutic and recovery treatment (data from the medical documents of the person – medical letters, family doctor, treatments etc.):________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

VII. EVALUATING THE DEPENDANCE LEVEL

Inclusion criteria for dependence levels Doesn’t need

care, support .

Needs temporary / partial care and support.

Needs permanent care.

Evaluation of the autonomy 0 1 2A. Evaluation of the functional status

A.I. Daily basic activities

1Corporal hygiene (general, intimate, special washing)

Independent Partial support. Only with support.

2

Getting the clothes on/off (the possibility of getting dressed/undressed, of cleaning oneself )

Independent

Independent and/or partially independent for dressing; needs support for taking the shoes on.

Only with support.

3Nourishment (possibility of self serving and feeding)

Eats independently

Needs support for cutting the food.

Only with support.

4 Elimination hygiene (continence) Independent Occasional

incontinence. Incontinent

5

Mobilization (moving from a position to another – standing-sitting, sitting-lying etc.)

Independent Needs support. Unable to leave the bed

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6

Walking inside the house (inside the room, with or without a stick, wheel chair etc.)

IndependentWalks with partial support.


7Walking outside the house (walking without means of transportation).

Independent Walks with partial support.


8

Communication (using long distance means of communication in order to alert: telephone, alarm, bell etc.)

Normal use of communication means.

Doesn’t use spontaneously the communication means.

Unable to use means of communica-tion.

A.II. Instrumental activities

1Preparing food (capacity of preparing the food independently).

Prepares and eats normally.

Needs partial support for preparing and eating.

The meals are prepared and served by another person.

2

Housekeeping activities (maintaining, cleaning, washing clothes, washing dishes etc.)

Does all the housekeeping alone.

Does simple activities partially.

Unable to do housekeeping activities, no matter the type of activity.

3

Budget and goods administration (able to administrate the own goods, budget, knows how to use the money etc.)

Administrates independently the personal funds.

Needs support for more complex financial operations.

Unable to administer the goods and to use money.

4Shopping (the capacity of buying the necessary things for a decent life).

Independent shopping.

Limited shopping and/or needs assistance.

Incapable of shooping.

5

Respecting the medical treatments (possibility to conform to the medical prescriptions).

Takes the medicine correctly (doses and rhythm).

Takes the medicine if the pills are prepared separately.

Incapable of administering the treat-ments.

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6

Using means of transportation (capacity to use the means of transportation).

Uses the public transportation or drives his/her own car.

Uses the public transportation only if accompanied.

Limited transpor-tation, only accompanied, by taxi or by car.

7

Leisure time activities (cultural, intellectual, physical activities etc. – alone or in group).

Done frequently.

Rarely, without spontaneous participation.

Doesn’t take part in such activities.

B. Evaluation of the sensorial and psycho-emotional status

1 Visual acuity

Good enough for reading, writing, manually working etc.

Distinguishes faces, sees good enough for orientation and avoids obstacles.

Sees only shadows and lights: blindness.

2 Hearing acuity Hears well.

Hears only strong voices or only with the help of a prosthesis.

Deafness or hears sounds but doesn’t understand the words.

3 Speaking deficiency Without Dysphasia, substitution voice etc.

Aphasia

4 Orientation Time and space oriented. Disoriented in time.

Disoriented in space and/or related to other persons.

5 Memory No memory disorders

Presents medium disorders, benign.

Presents severe disorders, malign.

6 Judgment Intact Reduced Severe alteration

7 Coherence Total kept Partially kept Incoherence

230


8 Behaviour Normal

Presents medium disorders (hypoactive, hyperactive etc.)

Presents severe disorders.

9 Affective disorders (depression)

Without Medium depression Major depression

NOTE: For each evaluated activity there are three possibilities: 0 - activity done without any help, regularly and correctly; - doesn’t need supervision or support. 1 - activity done with partial help and/or less correctly; - needs temporary supervision and/or partial help. 2 - activity done only with help; - needs permanent supervision and/or integral support. The evaluation of the functional and psycho-affective status is done taking into consideration the compulsory condition of assuring the physical and mental integrity for making it able to do basic daily activities.

VIII. RESULTS OF THE EVALUATIONIdentified needs____________________________________________________________________________________________________________________________________________________________________________________________________________B. Level of dependence:

• level IA – the persons that lost the mental, corporal, locomotors and social autonomy and for which the continuous presence of care personnel is needed;

• level IB – the persons which are still lucid or with mental functions that are not totally altered and need medical supervision and care for most of the activities in the current life, day and night. These persons can’t do the daily basic activities on their own;

• level IC – persons with severe mental disabilities (dementia), which conserved, totally or significantly the locomotor faculties and some daily gestures which are done only with stimulation. Needs a permanent supervision, behavior disorder care and regulated care for some of the corporal hygiene activities;

• level IIA – persons which conserved the mental autonomy and part of

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ANNEXES

the locomotor autonomy, but need daily support for some of the basic daily life activities;

• level IIB – persons that can’t change their position from laid to standing alone, but once standing, they can move around the living space and need partial help for some of the basic daily life activities;

• level IIC – persons that don’t have locomotor problems but need support for personal hygiene activities and for instrumental activities;

• level IIIA – persons that walk without support inside the house, eats and dresses alone, but needs support regularly for the daily activities; if these persons are sheltered in a special center for elders, they are considered independent;

• level IIIB – persons that haven’t lost the autonomy and can do on their own the daily activities.

IX. SOCIAL AND SOCIO-MEDICAL SERVICES (OF CARE) THAT ARE APT TO RESPOND TO THE IDENTIFIED NEEDS ________________________________________________________________________________________________________________________________________ X. THE WISHES OF THE ELDER ________________________________________________________________________________________________________________________________________XI. THE WISHES OF THE CAREGIVERS FROM THE INFORMAL NETWORK (RELATIVES, FRIENDS, NEIGHBOURS) ________________________________________________________________________________________________________________________________________XII. THE LOCAL SERVICES OFFER CAN COVER THE FOLLOWING IDENTIFIED NEEDS:____________________________________________________________________________________________________________________________________________________________________________________________________________XIII. CONCLUSIONS(Referrals to the level of dependence, to the place where to receive support and care – at home or in an institution, real possibilities for support, persons involved in the support services etc.)________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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Evaluated person: ____________________________Signature: ____________________________________Family: Wife/husband: __________________________ Signature:________________Son/daughter: __________________________ Signature:________________Legal representative: ______________________ Signature:________________XIV. EVALUATION TEAM

• MedicFirst and last name: ________________________________________________Specialist in: _________________________________________________________Unit he/she works in: _________________________________________________Address: ____________________________________________________________Telephone: ________________ Signature: ________________________________

• Social worker First and last name: ________________________________________________Specialist in: _________________________________________________________Unit he/she works in: _________________________________________________Address: ____________________________________________________________Telephone: ________________ Signature: _________________________________

• Social workerFirst and last name: ________________________________________________Specialist in: _________________________________________________________Unit he/she works in: _________________________________________________Address: ____________________________________________________________Telephone: ________________ Signature: ________________________________

• Other persons in the evaluation team________________________________________________________________________________________________________________________________________

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Annex 788

FORCEFIELD ANALYSIS

(+)Positive forces (-)Negative forces

88 Model filled in - section I.4.9.

234


Annex 889

LIFE CYCLE MATRIX

Family mem-bers

Family members age

0 - 1 2 - 4 5 - 7 8 - 12 13 -17 18 -22 23 -34 35 -60 61 -75 76-85

Legend: X – developmental stage n – needs r – resources

89 Model for filling in - section I.4.10.

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ANNEXES

Annex 990

INDIVIDUALIZED PLAN FOR CARE AND ASSISTANCE

Date created / revised: _____________________Case registration no.: ______________________A. INFORMATION ABOUT THE CASE1. First and last name of the beneficiary: ______________________________2. Date of birth: ____________; Age: ______; Personal ID no.: _______________3. Legal representative and relation with the beneficiary: _______________________4. Address: __________________________________________________________5. Reason for making/revising the plan of services:________________________________________________________________________________________________________________________________________ 6. Case manager that assures the methodological coordination of the person responsible for the case: ______________________________________________7. Person responsible for the case: ______________________________________

B. TEAM MEMBERS AND THE INSTITUTION THEY COME FROM: ____________________________________________________________________________________________________________________________________________________________________________________________________________

C. PRESTAŢII

Type Value / quantity

Local authority/ Institution/ NGO Starting date Period

D. SERVICES PROVIDED

TypeResponsible institution

Specific objectives

Starting date

Period of implementation

Responsible person


236


OBSERVATIONS REGARDING THE PROGRESS ACHIEVED: ____________________________________________________________________________________________________________________________________________________________________________________________________________

Person responsible for the case (name and signature): _____________________

Team members (name and signature): _________________________________ _________________________________

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ANNEXES

Annex 1091

PROGRAM AND SCHEDULE OF THE ACTIVITIES DONE AT THE BENEFICIARY’S HOME

Activity Time periodResponsible

person

Period of implementation

(weekly)

M T W T F S S

Date: _______________Case manager (name and signature): ____________________________________Person responsible for the case (name and signature): _______________________Beneficiary (name and signature): ______________________________________


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Annex 1192

MEDICINE ADMINISTRATION TABLE*

Month Day Yes/ No*(2) Medicine

Responsible for administering the

medicine

Signature of the

responsible person

Week 1*(1)

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

* The medicine administration table is done for both beneficiaries that are able to self administer the medicine and beneficiaries that need assistance for this.*(1) The table is the same for every week of the month.*(2) If the medicine is administered in that day, the corresponding checkbox will be marked.


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ANNEXES

Annex 1293

INDIVIDUALIZED PLAN OF RECOVERY

Objectives Activities Period of implementation

Responsible person

Date: ______________Case manager (name and signature): ____________________________________Person responsible for the case (name and signature): ______________________


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Annex 1394

SOCIAL INTEGRATION PROGRAM

Case registration no.: ______________First and last name of the beneficiary: _________________________________Person responsible for the case: _________________________________________

Activity (es) Responsible institution

Specific objectives

Starting date


Responsi-ble person

This annex was drawn up in two hardcopies, one for each side, with the beneficiary’s agreement.

Date: Person responsible for the case: Beneficiary:

_________ ___________________________ ______________


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ANNEXES

Annex 14

REPORT OF MEETING/TELEPHONIC CONVERSATION

MEETING TELEPHONIC CONVERSATION

Date: ______________ Hour: ______________ Scheduled – yes / noPlace ___________________________________

Present/contacted persons: __________________________________________Goal: ______________________________________________________________

Content of the meeting/conversation: _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Observations: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Made by:_______________________

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Annex 15No. _____ /_________

DONATION DOCUMENT

Signed today, _______________ , by (institution) __________________________ with the office in _________________, street _______________________no. ____ telephone ________________, fax:_________________, as donor, represented by _______________________, as (function) __________________, and___________________________________, personal ID no. ___________________, with the domicile in _________________________________________________, as beneficiary, which proceeded, first to donating and the later to receiving the following products with a total value of ____________ according to receipt/invoice no. ______ released on __________, by supplier ______________________

Crt. no. Product description Number of units Value

1

2

3

4

5

6

Clauses:• These products are destined to elders for ____________________________• The beneficiary,____________________________________, is not

allowed to estrange the products received by selling them to third parties and takes the obligation to use them only in the goal described above.

This protocol was made in 2 copies, one for each party.

Beneficiary/representative of beneficiary:

Institution representative:

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ANNEXES

Annex 1695

DECISION FOR ENDING THE SERVICES

Through the present document, institution ___________________________________ with the office in _____________________________, through _______________________, as __________________________, informs you about the fact that the psycho-social services will end for the beneficiary __________________________, case registration no.: ______________________, according to the following details:

Date of ending the services: ____________________________Reason for ending the services: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ This decision was printed in two copies, one for each party.

Date: Person responsible for the case: Beneficiary:

________ _________________________ _________


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Annex 1796

FINAL REPORT

I, the undersigned, _____________________, as ___________________________ propose ceasing the assistance for ______________________________________, beneficiary of psycho-social services offered by _____________________________The client received the following services:

Support for a period of _______ months, while he/she received material support consisting in __________________________________________

Psychological counseling for: _____________________________________ Accompanying for: _____________________________________________ Mediation: ____________________________________________________ Other services: _________________________________________________

The assistance is ceased due to: Reaching objectives Client refused further assistance Referred to similar services Client’s lack of cooperation Changing the legal domicile of the client Other situations: ________________________________________________

Contact person for following the case evolution: __________________________Contact address: _____________________________________________________Telephone:_____________; Fax:________________; Mobile: __________________E-mail: _________________________________________________Date of final report: ______________________________________Social worker, responsible for the case: ______________________Signature: _______________________________________________

Supervisor: ___________________Signature: ____________________


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ANNEXES

Annex 1897

MONITORING REPORT

Case registration no.: _________________________ Name: ___________________ First name: ___________________ Date when the assistance started: ____________Date when the assistance ended: _____________

Observations regarding the evolution of the case: _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Proposals: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Date: ____________________

Person responsible for the case:_______________________Signature: ___________________________


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Annex 1998

CONTRACT FOR PSYCHOLOGICAL ASSISTANCE

Contract signed by _________________________, as psychologist working at _____________________________ and __________________________________, as beneficiary of the counseling/therapy sessions offered as part of the psycho-social services addressed to elders. This annex includes:

Considerations regarding the psychological services:1. The frequency of the sessions:_______________________ 2. A session lasts: ___________________________ 3. The objectives established with the client and approved as such are the

following: a. ___________________________________________________________ b. ___________________________________________________________ c. ___________________________________________________________

Psychologist’s responsibilities regarding confidentialityAs psychologist for client _______________________ , I will respect the confidentiality of all information accessed during the counseling sessions, with the following exceptions provided by the law:1. The client’s statements show that his life was/is/can be in danger;2. When the client endangers another person’s life;

Also,3. Some information received during the counseling sessions can represent

the subject of scientific works or communication sessions between professionals, but without the disclosure of the client's identity, which will remain anonymous;

4. Some information received in the counseling sessions can be transmitted to the members of the multidisciplinary team for the client’s wellbeing.

98 Model for filling in – section II.6.1.

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ANNEXES

Client’s responsibilitiesAs beneficiary of the psychological services, I will respect the following:

• The program of the counseling sessions established in this annex;• I will announce if, from various reasons, I can’t come to one or more

sessions;• I will collaborate with the psychologist for reaching the objectives

established for the counseling sessions.

This annex was printed in two copies, one for each party and was created with the approval of the beneficiary.

Date: _________________

Signature of beneficiary:_______________________

Signature of psychologist: _____________________

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Annex 2099

REPORT OF PSYCHOLOGICAL EVALUATION

Case registration number: _________ / _________________Name of the beneficiary: _____________________________ Age: ____________ Education: __________________________________________________________Psychological evaluation made by: ____________________________________Number of sessions conducted: _______________________________________Evaluation methods used: ____________________________________________________________________________________________________________________________________________________________________________________________________________Psycho-medical characteristics of the elderFamily:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Material situation:____________________________________________________________________________________________________________________________________________________________________________________________________________Health situation:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Social relations:____________________________________________________________________________________________________________________________________________________________________________________________________________


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ANNEXES

Behavior characteristics:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Evaluation of cognitive-intellectual functions: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Evaluation of the emotional dimension: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Aspects related to the psychological profile: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Ways of reporting to third age problems: ______________________________________________________________________________________________________________________________________________________________________Recommendations: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Date of completing the report: ________________________

Psychologist: ________________________

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Annex 21100

PSYCHOLOGICAL COUNSELING SESSION REPORT

Case registration number: _________/ _______________Name of the client: ________________________________

Present persons: ____________________________________________________

Date: ________________Place where the session: ____________________________

Counseling objectives/themes approached: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Methods and techniques used: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Observations and recommendations: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Psychologist, ____________


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Annex 22101

INDIVIDUAL COUNSELING FILE

Case registration number: _______/___________ Client’s name: _______________________________

Sessions. Main marks

Techniques, methods and instruments used in counseling Observations Date

101 Model for filling in - section II.6.4.

Documents

Alternative Sociale_Elders Methodology