‘Replacement Care’ for Working Carers? A Longitudinal Study in England, 2013–15

In the context of rising need for long‐term care, reconciling unpaid care and carers’ employment is becoming an important social issue. In England, there is increasing policy emphasis on paid services for the person cared for, sometimes known as ‘replacement care’, to support working carers. Previous research has found an association between ‘replacement care’ and carers’ employment. However, more information is needed on potential causal connections between services and carers’ employment. This mixed methods study draws on new longitudinal data to examine service receipt and carers’ employment in England. Data were collected from carers who were employed in the public sector, using self‐completion questionnaires in 2013 and 2015, and qualitative interviews were conducted with a sub‐sample of respondents to the 2015 questionnaire. We find that, where the person cared for did not receive at least one ‘key service’ (home care, personal assistant, day care, meals, short‐term breaks), the carer was subsequently more likely to leave employment because of caring, suggesting that the absence of services contributed to the carer leaving work. In the interviews, carers identified specific ways in which services helped them to remain in employment. We conclude that, if a policy objective is to reduce the number of carers leaving employment because of caring, there needs to be greater access to publicly‐funded services for disabled and older people who are looked after by unpaid carers.     

FAMILY CARERS: SOME IMPEDIMENTS TO EFFECTIVE POLICY AND SERVICE DEVELOPMENT

The shift to community care for people with disabilities in Australia has given rise to some recognition and acknowledgment, in both academic research and policy development, of the importance of their carers. However, information about government policy and services for carers is fragmented and limited. Our knowledge about the prevalence of caregiving and the socio-demographic characteristics of carers and their service needs, is inadequate. Studies in relation to carer use of and satisfaction with services tend to be small scale and focussed on a specific service or carer group. Carer views on broader mainstream service provision have received little attention. This paper identifies gaps in our knowledge as well as the practical and conceptual difficulties in documenting the range of services available and the relevant social policy. These difficulties are likely to reflect barriers to broad and effective policy and service development.     

A Model for the Comprehensive Assessment of Older People and Their Carers

Correspondence to Beverley Hughes, Department of Social Policy and Social Work, University of Manchester, Oxford Road, Manchester M13 9PL. Summary Although local authorities and social service departments arein the process of developing systems of assessment in relationto care management, there has been little debate about the principleswhich ought to underpin assessment processes, nor about thepurpose, scope, and content of comprehensive assessment witholder people. This article discusses these issues and proposesa framework for comprehensive assessment with older people andtheir carers, derived from development work with social workersin a number of local authorities. Of particular importance isthe need for comprehensive assessment to embody meaningful mechanismsfor user and carer participation and empowerment; to acknowledgenot only need and risk but strengths and resources; to regardthe older person as the centre of a network of personal, familial,and social factors which together determine her or his qualityof life and level of risk. The implications for practitionersare examined.     

From Assistance to Prevention: Categorizing Young Carer Support Services in Australia,and International Implications

Young people who provide unpaid care for a relative with chronic illness or disability are a growing focus of public policy and research in Australia and internationally. Support services for these young carers have emerged, but not enough is known about their effectiveness. This article develops an analytical framework that categorizes young carer support services according to their goals and the types of intervention provided. The analytical framework is based on Australian data. It is applied to young carer support services available in Australia but may be applicable to other countries. The aim of the framework is to provide a structure for assessing the effectiveness of current services in supporting young carers by clarifying service goals and identifying gaps in existing service provision. The framework contributes to conceptual discussions about young carer supports, and it can be used to guide future policy development. The article draws on Australian and international literature as well as findings from a recent Australian study on young carers. The proposed framework groups young carer support services according to three overarching goals: assisting young people who provide care; mitigating the care‐giving responsibility; and preventing the entrenchment of a young person's caring role. The framework is applied to an audit of Australian support services for young carers, illustrating how it can be used to assess existing supports for young carers and inform future policy development. The findings suggest that most services in Australia fall into the categories of assistance and mitigation, while few contain preventative elements.     

Improving outcomes for children in out‐of‐home care: the role of therapeutic foster care

How best to support children and young people in foster care remains a challenge for child welfare. There has been little Australian research on the outcomes for children and young people placed in therapeutic foster care (TFC). This article aims to address this knowledge gap, presenting the evaluation of a state‐wide model of TFC known as the Circle Program operating in Victoria, Australia. Data sources for the study were case assessment analysis; surveys of foster carers, program workers and other stakeholders in the sector; and both focus groups and individual interviews with foster care workers. The evaluation found that the Circle Program lessened the number of unplanned exits of children from foster placements compared with generalist foster care. Another important finding was that the Circle Program positively influenced foster carers' decisions to stay in the carer role. Key components perceived as contributing to outcomes of the Circle Program included enhanced training of foster carers, intensive carer support, specialist therapeutic support to the child and carer, therapeutic service to family members and a network of services to provide support to the child.     

Carers of People with Learning Disabilities, and their Experience of the 1995 Carers Act

Summary This paper seeks to highlight the impact of the Carers (Recognitionand Services) Act of 1995 on carers of people with learningdisabilities. It draws on research conducted in the south westbetween 1997 and 1999, which examined the views and experiencesof carers who had an assessment of their needs, together withthose of the person they care for and the professional conductingthe assessment. It concludes that the Carers Act is not widelyused, or understood, by this group of carers. Recommendationsfor improving practice include changes to the current terminology,new triggers for a carer's needs assessment, and a greater inputfrom other agencies, especially health services. Although thecurrent paper focuses on the views and experiences of carers,an exploration of the Carers Act, and its effect on potentialconflicts of interest with the person with learning disabilities,is available elsewhere (Williams and Robinson, 2001).     

'Your friends don't understand': Invisibility and unmet need in the lives of 'young carers'

This paper is based on a study of the experiences of people identified as ‘young carers’, commissioned by the National Assembly for Wales as part of a wider review of carers’ needs and services. Following a brief review of some of the previous research in this area, the paper reports key findings of the research, using the words of children and young people as much as possible. It then goes on to explore some of the wider implications of this and other research for the identification and support of ‘young carers’ and their families, and for the understanding of the needs and wishes of children and young people so defined. The paper concludes with an alternative definition of a ‘young carer’ and with some recommendations for professional practice, suggesting that the role of social work is crucial in this area of service.     

Nonfamilial kinship carers—Who are they and what support do they need to nurture children?

There is a growing body of literature about kinship care in the Western world; however, much of it focuses on grandparent care. A lesser known aspect of kinship care is the care of children by nonrelatives known to the child or their family. What little research exists about this group suggests that such placements are less stable than familial kinship care. This article reports a research study in Victoria, Australia, that explored nonfamilial kinship care through analysis of administrative data, interviews with young people and carers, and focus groups with kinship care support workers. It emerged that current administrative databases are not yet able to reliably identify the carer relationship, and thus the extent of such care arrangements cannot accurately be determined. Interviews and focus groups revealed that nonfamilial kinship care is diverse and qualitatively different from familial kinship care, bearing some similarities to foster care yet managed very differently. It is suggested that policymakers need to pay more attention to conceptualizing nonfamilial kinship care within kinship care policy frameworks and that greater attention is needed to the individual support needs of children in such placements and their carers.     

What can agencies do to increase foster carer satisfaction?

Stable, long‐term foster care homes are critical to ensuring a safe and nurturing childhood for many children worldwide. Greater foster carer satisfaction is associated with increased carer retention and is therefore critical in securing such stable homes for children. The purpose of this study is to determine which factors associated with foster care agencies contribute to higher levels of foster carer satisfaction. Results from a longitudinal study of 137 foster carers indicate that perceived adequacy of agency support, preplacement training, money to cover placement expenses, and a good match between the carer and the child are predictive of higher foster carer satisfaction. A mediation model further points to the provision of preplacement training as key to ensuring higher levels of satisfaction. Results offer new insights into factors related to foster carer retention and provide guidance to foster care agencies about actions that they can take to maximize the retention of foster carers.     

The nature and prevalence of kinship care: Focus on young kinship carers

Young kinship carers tend to be overlooked in kinship care policy and practice. This Australian research project explored the prevalence of kinship care households in Australia, with a particular focus on households headed by young kinship carers. Census data were utilized to explore the number of kinship care households across the carer age spectrum and some of their characteristics, including households with Indigenous carers and carers with a culturally and linguistically diverse (CALD) identity. Characteristics of households headed by carers aged 16–30 years were explored in some detail, and comparisons made with young parents. The data pointed to particular challenges for young kinship carers in relation to post‐secondary education, employment and income security. Implications for policy and practice are discussed.     

An Outcomes Focus in Carer Assessment and Review: Value and Challenge

Correspondence to Elinor Nicholas, Research Fellow, Social Policy Research Unit, University of York, Heslington, York YO10 5DD, UK. E-mail: en2{at}york.ac.uk Summary A focus on outcomes and a desire to improve assessment and supportto carers are central to government policy, crystallized inthe 2000 Carers and Disabled Children Act. This paper exploresthe benefits and challenges of implementing an outcomes approachto carer assessment and review, highlighted by a research anddevelopment project, undertaken in partnership with one localauthority. The project developed and tested research-based practicetools which aimed to promote carer-centred practice, togetherwith clarity in communication and recording of outcomes intendedand achieved. Findings indicated that practice could be enhancedwith the help of a clear conceptual framework and tools, flexiblyand sensitively used to assist discussion and decision-makingwith carers about outcomes. Information about outcomes, aggregatedfrom individual records, was perceived as potentially usefulfor informing service development. Some significant obstaclesand challenges also emerged; not least, the subtle but significantculture shift required, and the additional time needed to effectivelyidentify and address outcomes with carers. A number of factorswere highlighted as important in introducing such an approach:collaboration with, and between, all stakeholders; trainingand support for practitioners to include practice in recordingoutcomes, and opportunities for continuing discussion and reflectionduring implementation.     

Carer Break or Carer‐blind? Policies for Informal Carers in the UK

This article examines three policy statements on informal carers published in the UK in 1999—the National Strategy for Carers, the report of the Royal Commission on Long Term Care and the note of dissent by two members of the Royal Commission. These three documents contain two rather different approaches to policy for carers. On the one hand, the National Strategy and note of dissent emphasize respite care or short-term breaks for carers, and are concerned with sustaining the well-being of carers as well as ensuring the continuation of caring itself. The Royal Commission, on the other hand, emphasizes support for the older or disabled person who is being cared for, as a means of supporting the carer, and advocates "carer-blind" services. It is argued that this policy contains within it the potential to substitute for or replace the carer and that this represents a radical new departure for social policy for carers in the UK. The advantages and disadvantages of the two policy approaches are explored. It is argued that policies for carers should include both services specifically for carers, like breaks from caring, and services provided for the cared-for person, like domestic and personal care services. Wider issues about the proper boundary between family and state care are explored.     

An investigation of the needs of grandparents who are raising grandchildren

Evidence suggests that children in out‐of‐home care function better when placed in kinship compared with foster care. Less is known about the functioning of children in the unique form of kinship care where grandparents are caring full‐time for their grandchildren in informal care arrangements. As grandparent carers are increasingly taking on this role, it is timely to investigate the functioning of the children in this form of care and the characteristics of the grandparents themselves. We compared the functioning of children in the two types of care. We also investigated carer characteristics, including the relationship between child functioning, social support and daily hassles on carer stress. One hundred fourteen cares and 180 children were assessed on a range of demographic and clinical measures. Children in grandparent care were displaying better behavioural and adaptive functioning than children living with foster carers. Grandparent carers reported higher levels of distress in the carer role. Predictors of carer stress included severity of child behaviour problems and daily hassles. Both group of carers and the children in their care would benefit from increased support from treatment services.     

Parenting fostered adolescents: skills and strategies

This paper discusses findings from a recently completed study of adolescent foster care, which included a detailed assessment of the parenting approaches and strategies used by the foster carers of adolescents in long‐term placements. Sixty‐eight foster carers were interviewed at two points in time. The first interview was conducted two months after the start of a new adolescent placement and the second after the placement had been continuing for a year, or at the point of disruption if this occurred earlier. The interview schedules were designed specifically for this study and were based upon well‐established techniques developed in other studies of parenting. They enabled the researchers to make summary ratings for each carer on established dimensions of parenting such as control and discipline, responsiveness and the level of engagement with the child. The researchers assessed how these strategies changed and developed in relation to the young person's behaviour and whether these approaches influenced either the likelihood of placement disruption or the quality of the placement for the child. This paper describes the parenting strategies used by the foster carers, highlighting the areas of parenting that significantly affected the placement outcomes and the corresponding implications for policy and practice.     

A four factor model predicting likelihood of foster carer retention

This study used a self‐report method to test a conceptual model for predicting the likelihood of retention of foster carers for children requiring out‐of‐home care. It was hypothesized that satisfaction levels of foster carers would be determined by locus of control and social support, and that the decision to stay or leave fostering within the next 18 months would be influenced by foster carer satisfaction, and commitment to a child/ren in care. Participants were 185 Queensland foster carers. Results supported the proposed model. Logistic regression analysis revealed that an increase in either satisfaction or commitment would result in foster carers being more likely to decide to stay in fostering. Multiple regression analysis found that both locus of control and social support made a significant contribution to the prediction of carer satisfaction. The findings were further supported by qualitative data. Implications of the findings are discussed.     

Foster carer perceptions of support and training in the context of high burden of care

The challenges of providing sensitive and structured care for children in foster care go well beyond normative experiences of parenting. The present paper describes a mixed‐methods study of foster carers' perceived need for support and training, referenced to estimates of their burden of care. Semi‐structured interviews were conducted with 17 foster carers in the Canterbury region of New Zealand. Carers' perceived need for support and training were identified through qualitative analysis of interviews using domain analysis method. Carers' burden of care was estimated from the Parenting Stress Index and from a measure of carers' encounters with children's emotional, behavioural and relationship difficulties that was designed for the present study (the Caregiver Behavioural Encounters Index). Foster carers reported substantive, unmet needs for support and training. Foster carers also reported high parenting stress and encounters with a wide range of children's mental health difficulties, including both uncommon and severe difficulties, which together represent an exceptional burden of care. Carers' highest priority need was for training and support on managing and responding to children's mental health difficulties, while their greatest existing support came from Caregiver Liaison Social Workers and other carers. The findings suggest a number of critical implications for practice.     

Social Exclusion, Inequality and Social Work

This paper sets out the environment of inequality in which social work and the poor have recently operated. It explores pragmatic and idealist arguments concerning whether or not the poor need social work. Finally, policy solutions developed in consultation with social service users and carers are suggested in relation to poverty and social exclusion. Social exclusion can be linked to relative poverty as exclusion from economic and social norms. However, there is a wider brief in our own government’s publications and those of Europe, of examining how people are excluded from actions and policies of agencies who are there to support them. This paper will retain the concepts of poverty as lack of material income, and inequality as the gap between the rich and the poor, while being aware of the policy implications for social service users and carers of the more comprehensive process of being shut out partially or fully from social, economic, political and cultural systems. The debates around social work, social exclusion and inequality that follow establish: that some of the poor do need social work; that the poverty of social service users is related to policies that have restructured welfare in Britain; that the reason for individuals approaching or being referred to social services are complex but are likely to include financial deprivation as a key contributory factor; that if the poor do need social work, advocacy is essential rather than social work being seen as concerned only with social control—taking children into care, mentally ill people into hospitals, and advising the DSS on the suitability of claimants for benefits. Finally, the discussion turns to new policy agendas on social exclusion instigated by the Labour government. What positive difference can such policies make for social service users, their carers and social workers?.     

Well‐being among employed and non‐employed caregiving women in Taiwan

Chou Y‐C, Kröger T, Chiao C, Pu C‐Y. Well‐being among employed and non‐employed caregiving women in Taiwan This study addressed various groups of non‐employed/employed and non‐caring/caring women in Taiwan. Data from the 2006 National Taiwanese Women Survey (at age 16–64, n= 6,017) were analysed to determine whether there are differences in terms of well‐being, as measured by self‐rated health and family life satisfaction, between women who work and/or care and between different carer groups. Other factors associated with well‐being of carers of young children (n= 1,697) were also analysed. The results showed that non‐employed carers of disabled adults stood out as the most disadvantaged group. However, the importance of work has been replaced by support among carers of young children. This study suggests that unpaid carers, particularly carers of disabled adults who are non‐employed, ought to be supported by policies. To improve carers' well‐being, care–work reconciliation among working‐age women needs to be included in the future care scheme in Taiwan.     

Admission to Nursing Homes in Taiwan

The population of Taiwan is facing a radical ageing process. A proportion of the growing number of people aged 65 and over is expected to need nursing home care. This research concerns the family context of decision‐making in the process of admission to a nursing home in Taiwan. Employing survey data from interviews with elderly people in nursing homes (235 interviews) and their carers/key families (265 interviews), the factors affecting their views about admission were explored. Bivariate analysis and a logistic regression model were also used to examine perceptions of alternatives to nursing home care among family members with elderly relatives in nursing homes. Most elderly people in Taiwan are cared for in their own homes by their families but, in some circumstances, entry to a nursing home seemed inevitable. This research found that the decisions were taken mainly within a family context. The adult children of the elderly people, carers/key families’ preferences and the availability of carers influenced the decision. Apart from the important need factors of elders, families’ views about alternatives to nursing homes were significantly influenced by their preferences. This study has important implications for long‐term care in Taiwan. It is hoped that this will be needs‐led, both by elderly people and their families.     

The nature of relationships between orphans and their kinship carers in Botswana

Generations of parents lost to AIDS and other causes have created a vacuum of care for the orphaned children they leave behind. This crisis has resulted in rapid changes in caregiving and family life, with extended family members, having to care for orphaned children. As a result of high numbers of vulnerable orphaned children residing with kinship carers, and the fundamental importance of the relationship between carers and orphaned children, we need to understand more about these relationships. This paper explores the nature of orphaned children–kinship carer relationships in Botswana. Interview guides were used to collect data from 15 caregivers and 15 orphaned children. The results indicate that the nature of relationships between orphaned children and caregivers is influenced by the way the parties communicate, how adolescents behave and the competing responsibilities of caregivers. Lastly, the paper recommends how positive relationships can be developed and nurtured between orphaned children and their caregivers in an African setting.