A Comparison of the Lifetime Economic Prospects of Women Informal Carers and Non‐carers,Australia, 2007

Informal care provided at home to family members with a disability is a major part of the disability and aged care system in Australia. Using data from the 2007 Household Income and Labour Dynamics in Australia survey, this study provides an updated comparison of the financial wellbeing, or lack thereof, over the working life of women primary carers and non‐carers. This study focuses on selected groups of primary carers and non‐carers disaggregated by partnership status, level of education and self‐assessed health status. While women primary carers tend to be more financially disadvantaged than non‐carers, having a post‐school education and being in good health contribute positively to bridge the gaps.     

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.     

It's frustrating! Managing emotional dissonance in aged care work

Performing paid care work requires workers to simultaneously negotiate care and waged relationships. Mediating contradictions between the two often causes workers to experience frustration, a form of emotional dissonance. Drawing on semi‐structured interviews with 100 workers in Australian aged care organisations, this research identifies aspects of the work environment that enable care workers to successfully juggle or synthesise the emotional demands of their work. The research demonstrates that employers have an important role in alleviating frustration, and can do this by creating work environments which: give care workers relative autonomy; allow care workers to construct themselves as professional carers providing quality care; provide workers with support to manage their emotions and develop emotional resilience; and promote client recognition of workers' roles. Providing such work environments has the potential to not only alleviate workers' frustration, but also to increase job satisfaction and retain workers in aged care.     

A New Postnatal Home Care Worker: Challenges for Training,Implementation and Policy

The rise in paid care workers has not, until very recently, included carers specifically trained to provide domiciliary postnatal care. In 2002 a new occupation of domiciliary postnatal carers was introduced in the catchment area of a large metropolitan hospital in Adelaide, South Australia. The carers work with professional midwives to provide home based postnatal support to women discharged early from hospital following childbirth. Carers were trained in a short, six month program, and were recruited from long term unemployed young women from the same geographically disadvantaged catchment area as the hospital. In this paper, findings from the evaluation of the program are described and analysed. These include its implications for the postnatal care workers themselves and for the professionals involved in training and working with them. In addition, the implications for birthing women of a program using young, minimally trained carers are considered. Finally, the more general lessons for the training and ‘insertion’ of paid carers into domiciliary work with professionals are reflected on.     

Young people leaving care in Sweden

The transition from a placement in care to an independent life can be a problematic phase for young people. In Sweden, special care‐leaving services are almost non‐existent. What then happens to young people when they leave a placement in out‐of‐home care? This paper draws on the results of a study in which 16 young care leavers between the ages of 18 and 22 years were interviewed. Telephone interviews were also performed with the young care leavers' parents, social workers, foster carers and institutional staff. The aim of the study was to investigate how young care leavers perceive the transition from care to an independent life. The Swedish welfare model, the prolonged transition to adulthood and the family‐oriented welfare discourse have been used as analytical perspectives. The results show that young care leavers have a pronounced need for social, emotional, practical and financial support. Whilst such support is occasionally provided by foster carers and residential staff, it is seldom given by social services or biological parents. This group is at risk of facing severe problems in the transitional phase from care to independent life, a fact that is not acknowledged by the Swedish welfare system.     

What changes in ‘parenting’ approaches occur over the course of adolescent foster care placements?

An overview of the parenting skills and strategies utilized by foster carers looking after adolescents was given in an earlier paper. This paper focuses specifically on the relationship between the behaviour of fostered adolescents and the quality of parenting provided by the carer. In particular, the paper considers the consequences of situations in which fostered young people have a detrimental impact on other children within the foster family, as this was an especially difficult situation for foster carers to manage. Similarly, foster carers appeared to find it difficult to maintain good parenting skills with young people who were at risk due to their own sexual behaviour although, conversely, caring for a young person whose sexual behaviour put others at risk was connected with improved parenting. The quality of parenting provided by the foster carers was also influenced by the level of stress they were experiencing, with increased levels of stress leading to poorer parenting of the fostered adolescent.     

The extent and limits of solidarity in Dutch health care

Solidarity and equal access are twin principles in the Dutch health care system: solidarity between the rich and poor and among people with high and low risks formally guarantees equal access to health care services. However, in the past few years government policies, guided by the ideology of market reform and free choice, have resulted in patterns of inequality that favour privately insured over sickness fund insured. In the meantime, the level of public support for the principles of solidarity and equal access is dropping. A significantly larger portion of the Dutch people now believes that it would be too costly to grant everyone the right to all medical treatments possible. An important reason for the decline of solidarity and equal accessibility is the scarcity of resources. The scarcity of resources and the waiting lists resulting from it will reduce the extent of the benefits package and the access to the care services of the health system. The better-off will have the resources to receive care services that are not part of the basic package. Moreover, the scarcity of resources will affect the readiness in society to provide informal care. Opposed to the compulsory macro solidarity of the health insurance system, informal care is based on a voluntary kind of solidarity in which personal choice plays an important role. Waiting lists and diminishing professional support weaken this readiness, as such support is a necessary condition for informal carers to keep caring for their relatives and friends. Because the informal care system is a necessary supplement to the formal system of care, the lack of help offered by the latter will in the end endanger the solidarity not only in informal care, but in the institutional care system as well.     

Health care insurance in Japan: Beyond a binary vision of State and family

Despite significant regional diversity in household structures and the existence of community solidarity in Japan, caring for elderly dependent persons has traditionally been considered an exclusively family, and female, responsibility. However, as a result of socio-demographic changes during the second half of the twentieth century, a public system of health care insurance was introduced in 2000. The objective of this development was to "socialize" family and female care activities. This article presents a critical analysis of Japan's health care insurance system and the context that gave rise to its introduction. An important issue is whether the system meets the needs of the elderly and their carers (family and non-family). A further issue is whether the system can take account of regional diversity, diversity in household situations (above and beyond financial concerns), and societal values and beliefs. The article concludes by arguing that demographic ageing presents a societal requirement for the ongoing adjustment of behaviour patterns and living arrangements.     

“Unexpected and Distressing”: Understanding and Improving the Experience of Transferring Palliative Care Inpatients to Residential Care

The survival of patients with advanced cancer, coupled with the increased presence of end-stage chronic illnesses in an aging population, is leading to a demand in palliative care. Due to the ongoing need for acute-pain and symptom control in hospice/palliative care units, few are able to offer long-stay admission for those whose symptoms have stabilized. When a patient no longer requires specialist palliative care services, transfer from an inpatient palliative care facility may then be necessary. A core component of the role of palliative-care social workers involves working with patients and their families/carers when the care pathway shifts and the option of residential aged care facility (RACF) needs to be considered. This research explored several issues, including the impact of this transition on the patient and their families and on the interdisciplinary health care team treating the patient. An investigation was undertaken to identify concerns and barriers regarding the transition from hospice care to RACF and opportunities were highlighted to improve clinical practice in this area. A tripartite approach was adopted conducting face-to-face interviews with patients, their families/carers, and health care professionals. Members of the interdisciplinary team were interviewed and social workers working in similar inpatient palliative-care facilities undertook telephone interviews to gauge their experiences. A thematic analysis discerned a number of themes highlighting the impact of this transition on key stakeholders and incorporated recommendations to improve or best manage this process. The research has highlighted the difficulties that patients/families encounter in this transition, as well as the emphases of protecting the integrity of the patient and family. This is achieved by holding open and ongoing dialogue, particularly through family meetings and working in collaboration with the patient, the family, and the team. Understanding the experience and impact of this transition on key stakeholders is helpful in building up a knowledge base and to ensure a more effective relationship occurs. This research incorporated the voices of terminally ill patients, families, and members of the health care team in order to understand their views and recommendations for best managing the transition from a hospice/inpatient palliative-care facility to a RACF. This enables their input to have some real impetus in clinical practice and service delivery.     

Challenging Professional Roles: Lay Carers' Involvement in Health Care in the Community

The bulk of care in the community is carried out by lay carers. Recent policy initiatives to support them in the United Kingdom are outlined. There remains evidence of significant gaps in support from professional health and social‐care workers including community nurses. This paper reports three studies of lay carers: those caring for older people, carers of technology‐dependent children, and home‐care workers involved in the “direct payments” scheme. Findings are reported in the areas of decisions about appropriate caring roles, the lay–professional boundary, training and respite opportunities and the expertise of lay carers. Recommendations for policy and practices are made.     

The dynamic,complex and diverse living and care arrangements of young New Zealanders: implications for policy

The living arrangements of young people in New Zealand are diverse and often complex. In this article we report the range of care and living arrangements of 209 15-year-old New Zealanders, 47 of whom identified as Māori. These young people were participants in the second generation of a cohort study. Data were collected from their parents via a life history calendar and analysed for variety and consistency of care arrangements, household membership and transitions. Few participants had a consistent pattern of parental care arrangements and most had experienced multiple changes in household composition and frequent changes of address. We conclude that the whānau/family lives of many young New Zealanders are complex and dynamic. These observations contrast with the conventional notions of family life that form the basis for New Zealand’s family policies. We argue that social policies and services impacting on young people need to reflect the lived reality of young people if they are to meet young people’s needs.     

Safeguarding adults at end of life: audit and case analysis in a palliative care setting

This paper reports an audit of safeguarding adults' cases arising over two years from the introduction of an adult protection policy in a UK palliative care service serving a diverse area with 48 beds, over 600 home care and 100 day care patients. Twenty cases were identified, involving institutional, physical, verbal, and financial abuse and neglect. Most patients wanted protective work, but some did not want to disturb personal care and relationships in spite of abuse. Protection from abuse increased support for patients and carers. An analysis of cases where neglect was associated with physical abuse identified a large proportion of cases where difficulties in existing family relationships, sometimes associated with alcohol and drug misuse and histories of mental illness, exacerbated the stresses of caring at end of life, leading to abuse allegations or concerns. Assessment of family relationships and interventions to clarify and organize family caring responsibilities, and deliver services that can support carers and monitor potential abuse are useful social work contributions.     

Professional Perspectives on Decision Making about the Long-term Care of Older People

With the increasing pressure on social and health care resources,professionals have to be more explicit in their decision makingregarding the long-term care of older people. This groundedtheory study used 19 focus groups and nine semi-structured interviews(99 staff in total) to explore professional perspectives onthis decision making. Focus group participants and intervieweescomprised care managers, social workers, consultant geriatricians,general medical practitioners, community nurses, home care managers,occupational therapists and hospital discharge support staff.The emerging themes spanned context, clients, families and services.Decisions were often prompted by a crisis, hindering professionalsseeking to make a measured assessment. Fear of burglary andassault, and the willingness and availability of family to helpwere major factors in decisions about living at home. Serviceavailability in terms of public funding for community care,the availability of home care workers and workload pressureson primary care services influenced decision ‘thresholds’regarding admission to institutional care. Assessment toolsdesigned to assist decision making about the long-term careof older people need to take into account the critical aspectsof individual fears and motivation, family support and the availabilityof publicly funded services as well as functional and medicalneeds.     

COVID-19: Impact on children living in out-of-home care and their carers

Children enter out-of-home care (OOHC) having experienced significant childhood adversities and trauma. Little is known about the short-term impacts of the COVID-19 pandemic on this vulnerable group. To gain some insights, we analysed the early impacts on the well-being and experiences of children in OOHC and their carers using the Pathways of Care Longitudinal Study data prior to and post the first lockdown restrictions. A total of 862 children, young people and their carers were interviewed either pre-COVID-19 restrictions (n = 567) (April 2019–March 2020) or post-COVID-19 restrictions (n = 295) (June–December 2020). While the two groups showed no significant differences in socio-emotional well-being, both the pre- and the post-COVID-19 restriction groups of children in OOHC had slight reductions in socio-emotional well-being. The interviews with the post-COVID-19 group showed that the pandemic restrictions affected children's well-being and behaviour, education, social and physical activities, as well as time spent with their birth family. Likewise, interviews with carers post-COVID-19 found a negative effect on carers' well-being, their ability to manage financially and their capacity to care and access services and support. The article contributes new evidence to inform OOHC policy and practice to support service systems facing unique challenges arising from a pandemic.     

Adults with a Learning Disability Living with Elderly Carers Talk about Planning for the Future: Aspirations and Concerns

The majority of adults with a learning disability live withfamily carers, many of whom are ageing and have support needsof their own. Planning for the future thus becomes the key topreventing a crisis situation when family care is no longerviable because of death or ill health. Existing knowledge andpractice are largely based upon the perspective of professionalsand carers. This study explores the views, aspirations and concernsof adults with a learning disability, about living at home andplanning for the future. Findings show that participants werevery aware of the need for alternative housing or support inthe future and had clear preferences about their future options.However, they also showed extensive concern for their familycarers and this often impacted on their willingness to planfor the future or to move to alternative housing. Their demonstrableawareness of the inevitable death or ill health of family carers,and willingness to engage with the implications, emphasize theimportance of involving adults with a learning disability inplanning for their future, as well as providing them with bereavementsupport.     

Intergenerational pathways leading to foster care placement of foster care alumni's children

This study examined a path model that postulated intergenerational relationships between biological parent psychosocial functioning and foster care alumni mental health, economic status and social support; and from these to the likelihood of children of foster care alumni being placed in foster care. The sample included 742 adults who spent time in foster care as children with a private foster care agency and who reported having at least one biological child. A full pathway was found between poorer father's functioning to greater alumni depression, which was in turn associated with negative social support, and then a greater likelihood of child out‐of‐home placement. Other parent to alumni paths were that poorer father functioning was associated with alumni anxiety and post‐traumatic stress disorder (PTSD), and poorer mother's mental health was associated with PTSD; however, anxiety and PTSD were not implicated as precursors of foster care placement of the child. Findings support the need for increased practice and policy support to address the mental health needs of parents of children in or at risk of foster care, as well as the children themselves, as family history may have a lasting influence on quality of life, even when children are raised apart from biological parents.     

The significance of a secure base: a psychosocial model of long-term foster care

ABSTRACT Long‐term foster care has been a much neglected area of social work practice and research. Yet there are obvious challenges that need to be understood when building a family for life in foster care. Is it possible for foster families, where there are no biological or legal ties between carers and children, to provide care, concern and family membership not only through childhood but also into adult life? The study on which this paper is based set out to explore that question by investigating the experiences of 40 adults, aged 18–30, who grew up in foster families. Qualitative interviews were conducted, transcribed and analysed. Theoretical frameworks from attachment and resilience were brought together with concepts such as ‘belonging’ and ‘family membership’ to make sense of the narratives provided. An integrated and dynamic psychosocial model of long‐term foster care was developed, which emphasizes the significance of a secure base and has some important implications for practice.     

Traditional kinship foster care in northern Ghana: the experiences and views of children, carers and adults in Tamale

Surveys were employed to explore the experiences of children in care and their carers about traditional fostering. They also examined the perspectives of randomly selected adults in the community about the practice of traditional foster care in the Tamale area of northern Ghana. The 74 participants responded to closed- and open-ended interview questions about traditional foster care. Frequencies and thematic grouping of qualitative responses showed that the need to keep family ties alive was the key reason for placement of children with family and kin. Majority of the children expressed satisfaction with living in foster care, even though they had experienced physical and emotional abuse and intimidation. Although most carers were not formally employed and had little personal income, they were positive about having the care role, but faced challenges in providing for many children in a difficult economic situation. The report highlights the role of reciprocity, altruistic and socio-cultural factors in quality of care, and the potential for the traditional kinship foster care to provide suitable avenues of placement for children as recommended by the Ghana child rights law. It also identifies the need for education for carers around children's needs and Ghana's child rights law.     

Is cash allowance a way to ease child care burden? Views of carers in Hong Kong

Caring for the carers is not only a policy challenge for the government but also a global concern to achieve gender equality by restructuring welfare for care. Paying informal carers is one of the measures that address their needs, which is being practiced in Western countries for more than 10 years now. Financial support for care does not only value the contribution of carers but also compensate for the loss of carers caused by unpaid care duties. However, cash for care is a complex issue because it is located within a number of different policy domains that may be considered controversial. This study discusses the views of carers on cash allowance and identifies issues affecting the support provided to the informal care system in Hong Kong. The discussion is based on the findings from the focus group interviews with 11 groups of carers with different socioeconomic backgrounds.