The majority of the stakeholders believed that the model would help reduce waiting times for assessment and care, hospital bed blocking and antagonistic relationships between social workers and family members. It could equally reduce re-imbursement fees (DH 2003) and enable social workers to concentrate on core and complex case management. The model could generate some savings to the county council in the long run. The family caregivers would be involved from the onset, planning and providing care for their older relatives as soon as possible. Such an early intervention would reduce stress, anxiety, and frustration and would promote psychosocial wellbeing amongst the users and their family members.
Intimate Knowledge of the Person Providing Care
Most stakeholder groups, particularly the family caregivers, service users, one of the two councillors, five of the seven practitioners and three of the four managers acknowledged that knowing the caregiver very well could potentially reduce the tendency of care breakdown. The older relatives would be assured that they would not be seeing different faces visiting them to offer care, consequently they would not be repeating themselves all the time to explain their care plan to strangers. This opportunity would enhance family relationships, as they would be in a better position to share their family norms and values, history and culture. Almost all the practitioners and mangers claimed that knowing the caregiver would reduce any complaints arising because of missed visits, lateness or poor quality of care giving.
Shared Care Packages
Almost three quarters of the stakeholder representative’s thought that the model would promote shared responsibilities. Most thought that shared care packages would reduce reliance on the state and delegate responsibility to the family. The families would play a crucial role in the system by assuming responsibilities and being accountable for their part in the process. Most managers, family care givers, service users and one councillor thought that the model would promote partnership and collaboration between the state and the family; as a result, blame culture would be reduced. Some of the managers, and one of the two councillors in particular thought that the model would enhance capacity within the welfare system as well as the distribution of scarce resources to all users.
Cost Benefits/Savings
The study indicated that the proposed model could save the County Council some money in comparison with the existing service frameworks. This view was shared by three quarters of the managers, and the two councillors despite differences in their political opinion, and a large number of the practitioners. The managers, the councillors’ thought that the difference in unit cost would be significant, and any savings could be reinvested into the system to support more service users. The councillors and managers as well as some practitioners highlighted some of the attractions of the model as including no overheads and variable costs because the £8.00 per unit cost would be a fixed cost for the financial year. Since the unit cost would be above the national minimum wage, this could attract more family members into the social care market and give the council a competitive advantage over other potential employers.
Individualised Care
A large number of the stakeholders thought that the care model would facilitate individualised care. This would enable the older relatives to see themselves as individuals who have rights, choices and opportunities to achieve their aspirations in life. Most service users and family caregivers acknowledged that because strangers have limited time available they are unable to offer quality care to service users, and this could be depressing and frustrating. Family caregivers know the standards of care their older relatives are used to and would endeavour to facilitate that. This means that family care giving would promote person centred care, giving the users the opportunity to enjoy their holistic functional activities of daily living, like any other person (Equal Opportunity Act 2006).
Respect and Dignity
Respect and dignity were seen as essential components of care giving by most stakeholders. The majority of the family caregivers and one of the two councillors thought that family caregivers are better positioned to accommodate and respect their older relatives, irrespective of their character or behaviour than strangers. Most acknowledged that some families have a particular lifestyle which may not be tolerated by strangers but which their family members were used to and have tolerated throughout their lives. Family care giving in this respect would help to reduce care breakdown, complaints, stress and breaking relationships between the cared for person, family members and social workers. Payment to the family caregivers was seen as a justifiable incentive for them to undertake assessment of care needs, planning and providing care for their older relatives.
Maintaining Quality of Care
The study uncovered some differences of opinion between the groups regarding standards, and the quality of care giving to the service users. Most practitioners, managers, and one of the councillors pointed out that social care workers carried out their role within professional guidelines. Almost one half of the practitioners argued that the Commission for Social Care Inspectorate and In-house Quality and Development Section of the County Council monitored the services they provided for older people. As a result, the professionals are in a better position to maintain quality standards than the family caregivers. However, most family caregivers and service users argued that family caregivers knew their relatives better than they knew social care workers. Most felt that their in-depth knowledge of their older relatives had given them the advantage to maintain quality care standards over and above that provided by strangers
Sensitive Nature of Care Giving
Eleven of the fifteen service users thought that care giving (e.g. personal care) can be sensitive and they would prefer their family members, mainly their spouse, daughters or daughters-In-law to assist them rather than strangers. Some felt that it would be embarrassing for strangers to assist them, as they have no bond with them, whereas their spouses, daughters/daughters In-law are part of their family with whom they have some form of relationship and that would be more accommodating. In contrast, four out of the fifteen service users, one third of the practitioners, two of four managers, one of the two councillors, and a few family caregivers, argued against family caregivers assisting their older relatives with personal care. This on the ground that offering intimate personal care to some one very close is sensitive and could influence their relationship.
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