Social security support for informal caring in the Republic of Ireland

This article looks at the policies of social security support for informal carers in the Republic of Ireland. The demographic context and the overall policy context are first outlined, with a brief summary of the available institutional and community care services. The development of social security policies is subsequently examined, tracing the development of specific social security support for informal caring since the late 1960s and looking, in particular, at the recent establishment of a means-tested carer's allowance in 1990. Some of the issues surrounding social security and informal carers are then discussed, including the different strategies which can be adopted in providing support for informal caring and the factors which influenced the development of support in Ireland.     

‘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.     

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.     

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.     

Income support for Australian carers since 1983: social justice,social investment and the cloak of gender neutrality

Income support for carers has been available in Australia since the early 1980s. In contrast to most other forms of income support, eligibility for Carer Payment has been progressively expanded in recent years, and increasing numbers of carers are claiming the payment as a result. This article examines the history of income support for carers by reviewing changes in eligibility criteria in the social security legislation and considering how those changes were framed. We argue that reforms to carers' income support have developed within competing frames of social justice and social investment, with an increasing emphasis on a social investment discourse, which prioritises paid work over care. Neither of the dominant frames addresses gender equality, and in practice, income support policy has reinforced familial (women's) responsibility for caring. Given the gendered nature of caring in Australia, gender equality issues must be considered in future policy reforms to ensure that the competing pressures on women to care and to engage in paid work do not lead to greater disadvantage and inequality for women and the people for whom they care.     

Man-made Care: Community Care and Older Male Carers

Correspondence to Mike Fisher, Department of Social Work, University of Bristol, 8 Woodland Road, Bristol BS8 1TN. Summary Recent evidence about the extent of caring for older peopleby older people themselves, and about the importance of spousecare, has challenged existing debates about gender and care.Male carers, particularly older husbands, have been ‘discovered’.This paper attempts to reconceptualize the debate about genderand caring to take account of these developments, particularlyto develop an understanding of the caring activities of oldermale carers and to elaborate the implications for communitycare policy. The evidence suggests there are circumstances where men acceptthe obligation to care, undertake intimate personal care, andderive identity and reward from their caring work, driven bysimilar motives and experiencing similar struggles as women.Rather than seeking maximum distinction between the motivesand experiences of women and men carers, the paper suggeststhat one important way to promote non-sexist community careis to explore the conditions where men's caring is undertakenand how it can be understood and developed.     

The Impact of Caring on Informal Carers' Employment,Income and Earnings: a Longitudinal Approach

In Australia the policy balance has shifted away from institutional forms of health and aged care towards supporting people in their own homes. This change presupposes a significant and growing supply of informal caring labour. A large proportion of informal carers (40–60 per cent) currently combine paid employment with their caring responsibilities. Using the longitudinal Household, Income and Labour Dynamics in Australia Survey, the paper examines the effect of caring on employment, hours worked and earnings. The analysis shows that working age carers experience disadvantage. Carers are more likely than non‐carers to reduce their hours of work or exit from the labour force, and earn lower levels of income. In planning for an ageing population, policies will need to address these negative effects and privatised costs of caring if the supply of informal care is to be sustained in the future.     

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.     

Compulsory intergenerational family solidarity shaping choices between work and care: Perceptions of informal female carers and local policymakers in Estonia

Estonians are obliged by law to provide maintenance for family members who are unable to cope by themselves. As a result, 80% of fragile older people receive informal care. Whether this is because the carers themselves feel solidarity and choose informal caring or because they lack alternatives is the question. We applied the cultural approach for explaining the construction of compulsory family solidarity in care provision to older people through the perceptions of informal carers and policy actors. Our interest is in how filial norms framed by individual responsibilities of care provision required by law can influence (i) informal carers’ perceptions concerning their choices between work and care and (ii) impact policy actors’ perceptions concerning eldercare service provision. Analysing the empirical data produced during focus groups with female carers and interviews with policy actors, we demonstrate the triple‐fold pressure to informal caregiving as an expression of compulsory family solidarity. Key Practitioner Message: ? The article demonstrates how the national Family Law Act constitutes a compulsory requirement of family solidarity in society; ? The compulsory family solidarity norm influences local‐level policymaking and inhibits the development of formal care services for older people; ? Informal carers’ choices between work and care are shaped by their personal filial norms, familialistic policymaking, and pressure exerted by older people.     

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.     

Grounding Constructions of Carers: Exploring the Experiences of Carers through a Grounded Approach

Social and political constructions of carers have been criticizedfor undervaluing the complexities of the experiences of carers.However, relatively little research has attempted to generatemore meaningful constructions of carers by drawing these considerationstogether. The purpose of this article is to begin addressingthis need. To accomplish this, the article is presented in twosections. First, an overview is provided on the current constructionsof carers and suggested considerations for research. Second,with this overview as its context, a study, taken from the author’sacademic dissertation, is presented. The study sets out to generatemore meaningful constructions of the caring experience througha grounded approach. The findings are based on a focus groupand interviews with fourteen carers in total. A diverse rangeof participants were involved, in order to generate categoriesthat would hold more relevance across caring experiences. Fourcommon categories for carers emerged, along with propertiesthat explained differences in experiences. The categories ofwhen carers start to care, circumstances change over time, justifyingthe use of support and using support are subsequently discussedin relation to current constructions, practice and policy.     

Complex home care: challenges arising from the blurring of boundaries between family and professional care

Over the last 50 years, increasingly complex care (such as tracheostomy management, dialysis or enteral feeding) has shifted from hospital to home, with a concomitant rise in patient self-management and care given by family members. Recognition of the importance of the contribution of family care to the health system is also growing. This article reports the findings of a New Zealand study which explored the experiences of family carers who manage technical health procedures at home. It then draws attention to some broader issues raised by shifting complex care from professional management in hospital settings to family care at home, namely the ways in which complex home care blurs the boundaries between professional and family care (creating the ambiguous position of the expert carer) and questions of safety and responsibility in family care. We also discuss the implications for policy around family caregiving in New Zealand. Given the potential physical and mental health impacts of caring, it is time for renewed consideration of what family carers should be expected or allowed to manage and how the health system can support them in their important role.     

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.     

Exploring Social Care: Applying a New Construct to Young Carers and Grandparent Carers

Mainstream literature on paid care for children, frail elderly people and people with chronic illness or disability, and unpaid care provided usually by family members within households and kin networks tends to establish dichotomies: formal/informal, commodified/non‐commodified. Recent feminist literature rejects these dichotomies, developing models of social care in which the interconnections of paid and unpaid care are mapped within policy frameworks. This paper uses theoretical frameworks of ‘social care‘: care as labour; care as a relationship embedded in obligation; care incurring a range of costs; to explore two case‐studies: young carers aged up to 24 years who are most often caring for a co‐resident parent; and grandparents who are the primary carers of their grandchildren. The latter may occur under the aegis of child protection authorities, or Family Court orders, or in informal arrangements, not licensed by state authorities. This analysis of the international literature and Australian research data affirms the power of the social care framework, and also shows the influence of social policy settings on informal care provision.     

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.     

Combining Work and Care: Carers' Decision-making in the Context of Competing Policy Pressures

Issues related to paid work and care are of global importance, reflecting the twin pressures of population ageing and efforts to increase labour market participation. Informal carers of sick, disabled or older people can experience tensions between policies aimed at support for care and support for employment. This article discusses a study of carers’ decision‐making around work and care, drawing on evidence from interviews with 80 working‐age carers in England. Carers are not homogeneous; their circumstances and needs differ reflecting age, gender, ethnicity, labour market participation, and the condition and/or needs of the person they support. This diversity is illustrated by contrasting rural and urban carers’ decisions and experiences about work and care. Key factors that impact on carers’ decisions are: current and anticipated financial need; the constraints arising from receipt of carers’ and other means‐tested income maintenance benefits; personal identity; job opportunities and scope for flexibility; social services provision; carers’ own health. Distance, travel times and transport are unique additional challenges for rural carers who (wish to) work. These difficulties are further intensified when they intersect with other factors such as the Carer's Allowance, the local labour market and social services provision. The findings are evaluated in terms of the adequacy of current government policy measures.     

Informal care in Sweden: a typology of care and caregivers

This study describes and analyses the types of informal care provided in Sweden and whether it is possible to distinguish different types of carers. Data were collected in a Swedish county in 2000, by means of telephone interviews. The net sample consisted of 2,697 individuals 18–84 years old, and the response rate was 61 per cent. The results showed that there were large differences in the numbers of male and female carers when the data were divided into a typology of care categories based on different caring tasks. Women were much more likely than men to be involved at the 'heavy end' of caring, i.e. providing personal care in combination with a variety of other caring tasks. Men were more likely to provide some kind of practical help for a mother or a neighbour/friend. Even though the Swedish welfare state has been described as universal and characterised by an extensive system of benefits and services intended to cover the entire population, the results here indicate that informal care plays an important role and that the gender role patterns are similar to those observed in other types of welfare state. When discussing support systems it is important for social policy to develop programmes that take into account the support needs of both caregivers and care recipients, and not to see their needs in isolation from the social care system as a whole.     

Change and Adaptation in Families with Young Carers

Using grounded theory methodology, members of nine families with 'young carers' were interviewed to explore their experiences of caring. A dynamic theory of change and adaptation emerged in relation to changes in who cares within families, in external support and in the attitudes of young carers towards caring. Adaptations included becoming used to the way life is, knowing how to care, balancing and trading off, rewarding care, and anticipating future adaptations. A model has been developed to offer an explanation of factors which influence young caring in families. These include family expectations about caring; who is available to care; the willingness and capability of young carers to help; and the degree of choice or obligation they experience. Formal and informal support services from outside the family, and environmental adaptations, can reduce the amount of family caregiving required, increase choice and contribute to balancing life for carers.     

The Right to Take Risks: Alcohol and Older People

This paper examines policy and practice regarding the purchase of alcohol for older clients of home carers in three local authorities in the Greater London area. Data were gathered from interviews with home carers and their managers, focus group discussions, and a postal survey. None of the local authorities had a written policy or written guidance on alcohol purchase or on appropriate responses to the identification of problematic drinking in older clients. The findings illustrate the problem of balancing "rights" and "risks" within a philosophy of community care which emphasizes client choice and autonomy, and show how policy and practice are "tailored" by local contexts. It is suggested that both home carers and other domiciliary workers, as well as their older clients, could benefit from a clear code of practice regarding responses to alcohol consumption and problematic drinking by older people.