Archive for the 'Ageing society' Category

Variations and Innovations in Care Services: Reflections on the Debates and Issues papers in the new themed issue of the International Journal of Care and Caring

Alisoun Milne

Alisoun Milne

By Alisoun Milne, Debates and Issues Editor, International Journal of Care and Caring

Issue 2, Volume 2 of the International Journal of Care and Caring is the journal’s first themed issue. It is edited by Karen Christensen and Yueh-Ching Chou and is entitled ‘Variations and Innovations in Care and Care Work: Critical Perspectives’.

The articles in this issue explore the relationships between formal care services and ‘informal’ care work and how they are being affected by change in different parts of the world. The Debates and Issues section is written by committed practitioners who want to improve the lives of service users and carers. They offer a lens on how two different countries have engaged with two contemporary challenges: ensuring cost effective user driven support for people with intellectual disabilities in Norway and how to offer creative accessible support to carers.

Two papers from Norwegian practitioners ‘User-controlled personal assistance ‐ the case of persons with intellectual disabilities’ and ‘From institutionalisation via good intentions ‐ and back again?’ explore innovations in the care and support of people with intellectual disabilities, specifically user controlled personal assistance and community based alternatives to long stay hospital care. The third paper, ‘Making a world of difference for carers: the Pathways for Carers project’ introduces us to an exciting new model of carer support – a ‘Pathways for Carers walks’ project – based in Victoria, Australia.

“discusses the tensions that exists between policy goals and offering a service that offers ‘value for money’ (sound familiar?).”

The two Norwegian authors discuss the tensions that exist between policy goals such as personalised care and the operational realities of offering a service that offers ‘value for money’ in a time of reduced funding for welfare services (sound familiar?). Balancing the rights of people with intellectual disabilities to independent living and personalised decision making with the risk of them being expected to accept a narrow reductionist service is also explored. The second paper raises the question about whether group living community-based alternatives to long stay hospital care are genuinely less institutionalised. Cuts to staffing and reduced funding for support of people with intellectual disabilities have resulted in the introduction, by stealth, of institutionalised elements to the caring regime e.g. reduced access to community facilities. The advantages and disadvantages of ‘group living’ are also discussed raising a second question – whether this model suits everyone. Accommodating more challenging needs whilst ensuring that all users are able to live an ‘ordinary life’ is a specific issue.

The ‘Pathways for Carers walks’ project brings to the fore the importance of developing services that are in tune with the local needs of carers and utilise community intelligence and resources. The ‘walkers’ that lead the service passionately believe in the power of carers’ sharing experiences and the therapeutic and physical benefit of walking in lovely open space whilst learning about the variety of support services available to them. Part way along, there is a Carers Seat dedicated to carers’ contribution to community and family life in the region; the seat is enjoyed by many carers participating in the walks.

“offers insights into the value, benefit and challenges of delivering three creative models in two different parts of the world”

The papers offer us insights into the value, benefit and challenges of delivering three creative models in two different parts of the world, brought to life through examples of users and carers experiences. The authors helpfully reflect of how policy ‘meets’ practice and the pivotal role that families and carers play in supporting and advocating for their relatives and the importance of recognising, advising and supporting carers themselves.

International journal of care and caring [FC] - smallThe Debates and Issues section is free to access in all issues of the International Journal of Care and Caring

Read the articles for free online:

User-controlled personal assistance ‐ the case of persons with intellectual disabilities

From institutionalisation via good intentions ‐ and back again?

Making a world of difference for carers: the Pathways for Carers project

Explore the themed issue:

Variations and Innovations in Care and Care Work: Critical Perspectives

Write for the Debates and Issues section:

The Debates and Issues section of the International Journal of Care and Caring attracts articles (up to 2500 words long) from a number of different stakeholders in the fields of care and caring on a range of contemporaneous issues of interest to an international readership. Authors are drawn from the third sector, the fields of policy and/or practice as well as students and academics. If you are interested in writing a paper for the section please contact a.j.milne@kent.ac.uk and read our guidance to authors.

 

Social forms of care: Changing relationships of support

Mary Holmes

Mary Holmes

Mary Holmes, Co-Editor of Families, Relationships and Societies, discusses the new special issue of the journal which is now available on Ingenta.

It may seem obvious to most of us that we rely on other people for care and support, but how has that changed given the fragmenting tendencies of contemporary life? In the latest issue of Families, Relationships and Societies we look at some of the different ways in which people care and are cared for from Finland, to Sweden, the UK, to the Phillipines. Whether it is caring for children, grandchildren, teenagers, or the elderly, care calls upon our bonds with other human beings.

Whatever the kind of bonds or location, social forms of care include state provision and welfare services, as well as informal care arrangements. People use family, friends and other connections to get the support they need. It is not always easy and may require negotiation and involve conflict. Some informal arrangements may be ad hoc and fragile, but some may contribute to community building and be good alternatives to more institutionalised care provision.

“Childhood, sickness, frailty and old age mean receiving care at times of vulnerability, but even in these cases the cared for might offer some support to others”

A lot of care is mutual. Childhood, sickness, frailty and old age mean receiving care at times of vulnerability, but even in these cases the cared for might offer some support to others – be it financial or emotional. In everyday terms, we give and take care. A friend makes us dinner when we are busy, we look after their children when they have a meeting. A colleague offers to help with our marking and we take a class for them to return the favour. Older children may take a turn to cook, or listen to their parent’s small woes. Caring changes. Parents care for children together and then perhaps alone; help from grandparents disappears as they die; supportive friends move to another town or country. Alongside these ‘private’ forms of caring are changing public provisions and policies that impact on how people care.

The impact of the rolling back of the welfare state in many countries shifts care responsibilities back on to the private sphere.  For example, we see in one article how austerity has made lone mothers in Finland more reliant on informal support networks. In another, Swedish parents have to deal with pressures to control their teenagers’ alcohol consumption. These are changes in what care means and in ideas about who should care for whom and how.

“The articles reveal generational and cultural differences in expectations around care.”

What care means in different kinds of relationships also changes, and the articles look at parents and teenagers, children and child carers in institutions, social workers and clients, parents and parent-in-law, grandparents, children and grandchildren within multigenerational families. In one instance, we see Filipino daughters-in-law making efforts to create affinity with their mothers-in-law to help them balance a sense of autonomy with caring according to cultural norms around obligation to parents. The articles reveal generational and cultural differences in expectations around care. Women also still have to make sense of having the greater part of the burdens and satisfactions of care. Yet people work at caring for each other.

Different contexts of care affect how it is given and received. For example, one author argues that institutionalised care can give children a different sense of time to ‘private’ forms of care. Meanwhile, in social work practice, care becomes difficult if always concentrating on risk prevention, especially within child protection. The articles do not glorify informal or private care as innately superior, but point out the difficulties of caring in the current climate. The social pressures on ‘private’ forms of care can be acute as people try to look after each other around the demands of work, changing demographics and shifting social norms. Fear-oriented assessments of risk, emphasis on responsibility and self-reliance and the withdrawal of various public services have different impacts according to gender, age, disability, class and race/ethnicity. Limited availability and problems within publicly provided care forces people to find support within often already overstretched networks or communities.

Self-reliance is a fantasy, albeit a powerful one, and it is imperative to know how families, friends and public bodies navigate around it to provide support. Here we see them using a range of ways to maintain relationships of support at a time when vulnerability and care are often degraded. Care remains a social achievement.

FRS_OFC_Feb2016_72.THINBORDER

 

Read the special issue “Social forms of care: changing relationships of support”.

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TripAdvisor helps us choose hotels and restaurants – so why not where we end our days?

Originally published by The Conversation on August 1st 2017. 

Tony Walter

My 91-year-old mother was deeply unhappy at the geriatric hospital in which she found herself after breaking her ankle.

But we knew little of the alternatives. Official inspection ratings offer impersonal information. So how were we, her children, supposed to gauge the quality of other establishments offering care?

Our saviour turned out to be Alison – my mother’s hairdresser. As a specialist in older, housebound clients, she had continued to do her customers’ hair as they moved to various hospitals or care homes.

Alison gave us the names of three places nearby that our mother might prefer, and we arranged her transfer within 36 hours. It was a move which transformed the quality of her last few months of life.

Unlike formal inspectors, Alison was an unthreatening, secret observer of each of the institutions she visited. She proved to be a knowledgeable and reliable guide. Without her, my mother’s life could have ended very differently.

The trouble is, not every family is lucky enough to know an Alison.

In the UK, people are expected to make their own choices about their own care in the final months and years of life. But how can people become well informed about different care providers, especially when a crisis forces decisions to be made at short notice? Alison revealed the importance of informal contacts and social networks in allowing individuals and families to make good choices.

How could her role be made available to all families seeking similar information? Care settings for those nearing the end of life are, in terms of inspection, a bit like restaurants. Technical medical and nursing procedures, like a restaurant’s kitchen, need inspecting by technical inspectors. But most of the care provided at the end of a person’s life is not of the technical kind. It involves hard to measure factors like respect, a sense of belonging, and relationships with staff. It is in many ways like assessing a restaurant’s ambience. In the hospitality trade, this is something best considered by mystery customers who collectively author good food guides, or by informal online ratings like on TripAdvisor.

Such assessments rightly abandon the myth of objectivity embedded in formal inspections. Potential consumers perusing TripAdvisor ratings understand them as subjective experiences to be taken on balance.

So collective, honestly subjective, online ratings should be available for families to make informed choices about different care settings. For well-being over the course of life, we need to be able to read about customer experiences of health and care agencies just as much as we need to read about experiences of restaurants, hotels and holidays.

A great example of what is needed is carehome.co.uk, which gathers and publishes reviews of care homes, along with other information provided by the home. Many of the care homes listed, however, have no reviews. Care at home is reviewed by the online database homecare.co.uk, although the vast majority of organisations that look after people in their own homes have no reviews.

Those two websites are funded by industry subscriptions. Proposed reviews are authenticated and vetted before publication, and reviewers are advised not to publish complaints but send them direct to the agency. These safeguards should eradicate vexatious reviews, although they may also present an unrealistically positive overall view of user experience. The sites are, however, a step in the right direction.

Of course, TripAdvisor-style ratings for the “last journey” tend to come not from the actual service-user or patient. Most reviews are from family and friends, which could be an issue. Complex family dynamics – such as guilt at putting parents into care, or anxiety that care costs are eating up the inheritance – can mean families are rarely the baggage-free observers that Alison was.

Reviewing the situation

Of more concern is that even the most loving, attentive and observant family member may know little about the person’s experiences at the hands of their paid carers. This might only be achieved by CCTV cameras, but do we really want care homes, hospital wards and (in the case of home care) even the person’s own home to become zones of electronic surveillance?

No way of monitoring or collecting information will be perfect. And we should acknowledge that the trajectory of frail elderly dying is always uncertain. No one can predict how they will feel as bodies and minds fail, so all choices will entail a degree of guesswork.

Rigorous formal inspection – and public enquiries when things go dramatically wrong – are of course essential. But if people nearing the end of life (or their families) are to adopt the prescribed role of informed consumer, comprehensive collations of user experiences are vital.

End of life care is more important than booking a restaurant or the next holiday – so information needs to be just as good, or better.

What death means now by Tony Walter is available with 20% discount on the Policy Press website.  Order here for just £7.99.

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The views and opinions expressed on this blog site are solely those of the original blog post authors and other contributors. These views and opinions do not necessarily represent those of the Policy Press and/or any/all contributors to this site.

Care and caring: challenge, crisis or opportunity?

SusanMYeandle

Sue Yeandle

As the first issue of the International Journal of Care and Caring publishes, Sue Yeandle, Editor-in-Chief, highlights the global space that care now occupies and introduces the journal as a new forum where world-class knowledge about care, caring and carers can be shared.

Issue 1 of the International Journal of Care and Caring is free to access on Ingenta until 30 April.

“From Nairobi to Tokyo, Sydney to Bogota, Montreal to Stockholm and Gdansk to Glasgow – and beyond – care is more visible than ever, and an issue of growing importance all over the world. It is central to human life and relations. It underpins the world’s health, employment and welfare systems. It affects every family and human being on the planet.

“In all its horror, glory and daily realities, care touches us at every level.”

Continue reading ‘Care and caring: challenge, crisis or opportunity?’

Age-blaming and the EU Referendum

In today’s guest blog, author Caroline Lodge looks behind the post-Brexit headline ‘age-blaming’ to reveal a different and more nuanced story behind voter choices…

Caroline Lodge

Caroline Lodge

Age-blaming is the practice of blaming older people for social, economic and political problems.

In popular discourse the problem of the old is that they take up too many resources, take more than their fair share of benefits, block beds in hospital, wont move out of their large houses and are responsible for taking Britain out of the EU. This post explores what lies behind the age-blaming that followed the EU referendum result. Continue reading ‘Age-blaming and the EU Referendum’


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