This publication reflects the findings of a fieldwork carried out in Essex, which looked at the views of older people service users, their caregivers and the County Council representatives. Besides, practice observations has also revealed that a large number of the stakeholders (service users, family caregivers and staff and councillors) are of the view that family caregivers have the potential to offer more emotional and practical care for their older relatives, rather than strangers. They cited a number of reasons (fear of strangers, knowing the person providing care, sharing family norms and values as well as fulfilling duties and responsibilities) as to why the family care system would be more appropriate than direct provision or direct payments (Ugwumadu 2011).
A high proportion of the stakeholders claimed that enabling support systems (aids and equipment, respite and day care, shared care packages) would encourage family caregivers to continue care giving to their older relatives. They thought that aids and equipment would reduce dependency levels, accidents, falls and potential deterioration in health amongst the family caregivers. Day and respite care would enable carers to have breaks from care and increase their commitment to continuing care for their older relatives. Offering carers respite care would bring about shared responsibilities between the social service and the family, enabling the State to concentrate on the commissioning of other services, while the family take a lead responsibility to offer care for their older relatives.
Reflecting on assessment of needs, the study revealed contrasting views amongst the three groups. A high proportion of the service users and the family caregivers felt that families are best placed to carry out needs assessment rather than social workers. They said that they know the service user and their needs better, and would be able to draw up a flexible care plan that would accommodate a holistic need for their older relatives. Some argued that social workers do not have enough time to spend with the cared for person to obtain the in-depth information necessary to prepare a wide ranging care package. In contrast the majority of staff and councillors thought that social workers are professionally trained and have wide ranging practice based knowledge, skills and experiences to meet older people needs, in line with legislation and availability of resources. Some stated that family members lack basic knowledge and skill and their involvement might encourage potential abuse and poor quality of care for older people.
In terms of a payment to family care assessors and caregivers, the study found contrasting views amongst the stakeholders. A large number of the service users and family caregivers felt that family care assessors and caregivers should be paid. For them a payment would help them maintain their lifestyle and at the same time assist their older relatives with their care. A payment on the other hand would otherwise act as an incentive and that could attract families who would not have thought about offering care to their older relatives. For some of them the payment that they receive would be used to buy extra care to support themselves in their caring role, as well as giving them the time to undertake other activities in order to support their nuclear or reconstituted families. Yet a high proportion of the staff and councillors thought that a payment to family care assessors/caregivers is not the best preposition with which to redesign the welfare system, in line with the 21st century community care for older people. What is needed is joint investment between the welfare institutions (e.g. health, housing, Works and Pensions) to tackle the new demand for care from older people.
The study found that a large number of the three stakeholder groups expressed some ambivalence over family care giving. Most of them stated that care giving would impose a lot of difficulties on some of the family caregivers and their nuclear or reconstituted families. This is a decision most of them would not take in haste. They cited a number of reasons (employment, ageing and poor health, distance, potential abuse) why they need to take time to think it over before embarking on it. On the one hand some of the staff and councillors raised the issue of compliance to legislation, policies and procedure and lack of knowledge by some of the family caregivers to undertake assessment and care. A large number of the family caregivers said that despite the difficulties they are committed to care giving to their older relatives.
Consistent with the conceptual dimensions, the majority of staff and councillors expressed concerns over family care giving; this was in contrast with both the service users and family caregiver’s views. For them family care giving would mean abdication of duty and responsibilities by social services. Some felt that social service should continue to meet the obligations, bestowed to it by Parliament and that social workers are best placed to deliver those services to older people and their families. These views were supported by a fewer number of the service users who claimed that family care giving means interfering with their family and their livelihood. They prefer to seek support from social services, friends and neighbours; their family would be the last resort, when other opportunities have failed.
Those stakeholders (users, family caregivers, staff, managers and councillors) who do not think that family caregivers should be the sole assessors also think that family members are unlikely to provide quality care during care giving. Some family caregivers lack knowledge and skills to undertake assessment and might be unable to maintain standards of care. The framework might encourage abuse (financial, physical, deprivation, exploitation) during care giving.
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