Growing numbers of elderly people, combined with falling birthrates, have generated increas ing interest within most western European and Scandinavian countries in measures which might increase the supply of care-giving labour while at the same time reducing the unit costs of that labour. To what extent, and how, might expensive formal service provision be replaced by less costly and more plentiful help from informal sources; and what is the role of the welfare state in protecting and regulating the different interests of those who give and those who receive care on an informal basis?
Al?StractAlthough there is extensive literature on carers and their care-giving role, the circumstances of carers after care-giving remains largely uninvestigated. This paper documents the socio-economic and psychological legacies of care-giving among 157 ex-carers who were included in a larger national study of the effectiveness and targeting of social security help to carers, which was carried out in 1989. Therefore, the sample included only those whose care-giving responsibilities had been relatively substantial, that is, over 35 hours a week. Survey data covering the employment status and income levels of these ex-carers are presented, as is in-depth interview material on the psychological and social circumstances of a small group of ex-carers. The article concludes that there are long-term negative financial effects of caring, which the social security system appears to ignore. In addition, the psychological, social and physical health consequences of caring may leave some carers poorly equipped for life after care, a situation which might call for the development of support services in the immediate post-care period. Further investigation of the material and non-material circumstances of ex-carers, preferably on a longitudinal basis, should be a priority in health and social care research. Without such research, our knowledge of the costs of caring borne by individuals, and our assessment of the appropriate contributions that should be made by statutory welfare agencies, remains incomplete. Finally, given the prevalence of informal care-giving, our lack of knowledge of the legacies of care-giving limits our understanding of the causes of income and health inequalities between people approaching pension age and older.
Concerns over growing numbers and proportions of older people in
industrialised societies have prompted interest in the development of cheaper
ways of providing long-term care for older people. While debate in the UK is
currently focused on the costs of residential and nursing care, other European
and Nordic countries have introduced schemes designed to encourage or
sustain the provision of ‘social’ care by family members, friends and
‘volunteers’, on the assumption that this can be
provided at lower net public
expense than either residential care or formally-organised domiciliary services.Drawing on material from a detailed comparative study, this paper describes
four different models on which such payments are currently based. These
models are discussed and evaluated, taking into account factors which include
the eligibility criteria for payments; maximising the autonomy of older people
and family care-givers; and the relationships between financial payments and
access to services.These models locate systems of payment within the broader context of
financial and service support designed to help frail older people and those who
support them. They therefore highlight the importance of considering both
financial support and services in comparative studies of social welfare
provision. However, further evaluation and policy development is hindered by
the lack of evaluation of different models of paying for care and a lack of
evidence about the experiences of older people and care-givers.
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