caring: paid and unpaid

block three week 1 socpop

paid/ ‘formal’ care

• help for people to live independently and stay well/safe

• personal care = support for washing, dressing

• wider support to stay active and engaged in community

• provision of information and advice (may include support for family/carers)

where paid/formal care can be

• home/ domiciliary care (support in own home)

• day centres

• residential homes/nursing homes

how long paid/formal care can be

• short term: limited time, optimise independence, reduce need for ongoing care

• long term: ongoing basis

• both long term and short term care are arranged by a local authority and could be described as formal care

who organises paid/formal care

• local authorities/councils are responsible for assessing needs/funding care

• people can also employ carers directly (personal assistant) using a direct payment from their local authority

who provides paid/formal care

• most services are provided by independent/private sector

• delivered by care workers but there are many other roles including registered professionals

who pays for care

• people are expected to contribute to their own care

• local authorities don’t have a set budget

  • cost is growing rapidly

many people requesting support don’t get it

• 4/10 receive care

• 3/10 receive signposting/advice

• 3/10 receive nothing

unpaid/informal care

• carer is anyone who looks after someone because of illness/MH/addiction and can’t cope without their supprot

• 1 in 3 will be a carer at some point

• jobs: washing, dressing, travelling, shopping, cleaning, medicines, supervision, companionship

numbers of unpaid care

• 9% of adults in UK

• 5.8 million people

• 59% female

• largest group: 46-65

• 1 in 7 are also working

adults that are cared for

• frail elderly (6.2 mill over 75, 1.4 mill over 85)

• chronic conditions:

  • cancer

  • mental illness

  • physical disability

  • learning disability

• needs may be complex and change over time

• multimorbidity

• carer has to adapt, learn and take on more

advantages of being a carer (unpaid)

1. identify need for services

2. recognition work and contribution of carers

3. sense of identity: more likely to attend support groups etc

possible disadvantages of being a carer (unpaid)

1. only seen in termsw of being a carer

2. lock people into a role they don’t want

3. may prefer to define themselves as a son, daughter, partner, wife etc

4. undermines the person being cared for

health impact from unpaid care

• carers are often pts too

• report poorer mental and physical health than non carers

• injuries due to manual handling

• lack of time to care for own health: don’t prioritise

• difficulty sleeping reported

• wore with more hours per week, more years of caring etc

• interaction between health of the carer and the cared for

• the lack of support for carers may contribute to unplanned hospital admissionsm prolonged hospital stays and delays in discharging pts

social consequences of unpaid care

• difficulty accessing holidays, leisure pursuits and other social activities

• may be harder to maintain relationships/social networks

• may get few/no breaks from caring responsibilities

financial impact of unpaid care

• worries about living costs

• lower incomes: more carers in deprived areas, doing more care

• higher costs: laundry, heating bills

• 1/3 report struggling to make ends meet

• quarter cut down on essentials

financial support for unpaid carers

• Carer’s Assessment

  • Care Act gives local authorities a responsibility to assess adult carer’s own needs for financial support

• Carer’s Allowance

• Carer’s Credit

  • NI contribution to ensure don’t lose out on benefits such as state pension

• Carer Premium

  • payable if carer is in receipt of means tested benefits, claimed via JobCentre

• Disability Living Allowance for children

unpaid care: local authority and health services support

• 2014 Care Act

  • gives local authorities a responsibiolity to assess adult carer’s own needs for uspport

• Carer Assessment

  • includes range of needs

• GPs hold register of carers linked to pt record

• Social Prescribers provide a bridge between services, organisations and individuals

non statutory sources of support for unpaid carers

• voluntary organisations (condition specific and general)

  • Carers Trust

  • Carers UK

  • Carers 4 Carers

  • local support groups

young carer

• someone under 18 who helps care for someone who can’t cope without their support

• young adult carer= someone aged 16-26

numbers of young carers

• 1/5 children/young people are carers

• more likely in single parent/non working household

• ethnic minority groups report more challenges

• 2x more likely in deprived areas

impact of caring on young people

• absence from school

• lower educational attainment

• behavioural problems/bullying

• social exclusion/isolation

• stress

• physical heath problems

• traumatic life changes

• poverty

• lack of support/benefits

holistic care- doctors need to consider:

• both the implications for carers and needs of carers

• identify if someone has caring responsibilities when discussing their health

• consider interaction between health of carer/person they care for

• give info about rights/entitlements

• signpost carers to local services

• involve social prescribers

for patients leaving hospital

• consider carer when planning care of pt and discharge planning

• involve carer in all stages of discharge planning

• carer can also have an assessment prior to discharge