support services for carers of elderly people living at home

172 Pages·2000·7.59 MB·English

SUPPORT SERVICES FOR CARERS OF ELDERLY PEOPLE
LIVING AT HOME
SUPPORT SERVICES FOR CARERS OF
ELDERLY PEOPLE
LIVING AT HOME
By
Patricia Finucane
Joan Tieman
Geraldine Moane
Chapter Three has been prepared by Joe Larragy, former Research Officer
with the National Council for the Elderly
NATIONAL COUNCIL FOR THE ELDERLY
REPORT NO. 40
This report has been accepted for publication by the National Council for the Elderly,
which is not responsible for either the content or the views expressed therein.
© NATIONAL COUNCIL FOR THE ELDERLY 1994
Price £8.50
Table of Contents
Foreword 13
Authors’ Acknowledgements 15
Chapter 1
Introduction 17
Government Policy Regarding Care of the Elderly 17
Factors Affecting the Availability of Carers 19
1. Increase in the Elderly Population
2. Changes in Family Structure
3. The Age of Carers
The Present Study 21
Focus and Specific Aims of the Study
Terms and Concepts Used in the Study 22
Format of the Report 25
Chapter 2
General Trends in the Literature Pertaining to Carers of the Elderly 27
Irish Studies of Care in the Community 27
Overview
Provision of Informal Care
Support Services
General Trends in the Literature Pertaining to Carers of Elderly
People Living at Home and Carer-Support Services 30
The “Carer” - a Recent and Growing Phenomenon
The Effect of Carer-Identification Failure and Perceived
Support Needs on Provision of Support Services
Carer-Gender and its Effect on Service Provision
Family Carers and Support Services
Carer-Stress and Support Needs - The Need for Different
types of Support at Different Stages of the Caring Sequence
Elderly Spouse Carers - Their Special Needs and
Reluctance to Seek Help
5
The Suitability of Services
The Need to Advertise Available Services
The Experience of Caring in Britain and the United States 35
Britain
The United States
Programmes to Help Carers in the Workplace
Summary and Conclusions 39
Chapter 3
Institutional Services and Informal Care 41
Introduction 41
Trends in Institutional Care for the Elderly 41
Long-Term Care Beds for the Elderly
Acute and Psychiatric Hospital Beds
Long-Stay Institutional Services and the Support of Carers 45
Institutional and Informal Care Comparisons
Attitudes of Carers and Others to Institutional Care
Institutional Placement - Effect on Carers
Improvement of Long-Term Care
Towards the Community Hospital
Alternative Forms of Long-Term Care 53
Sheltered Housing
Boarding Out
Developments in Acute Hospital Care 55
Specialist Departments in Old Age Medicine
Day Hospitals
Psychiatry of old Age
Other Specialist Hospital Services
Summary and Conclusions 59
Chapter 4
Methodology 61
Phase 1: Census of Indirect Support Services for Carers of Elderly
People Living at Home 62
Respondents
Questionnaire for Census of Indirect Services
The Community Care Area as the Unit of Analysis
Pilot Study for Phase 1
Sample and Administration of Indirect Census Form
Response Rate
6
Phase 2: Survey of Direct Support Services for Carers of Elderly
People 68
Identification of Carers’ Groups
Questionnaire for Survey of Direct Services
Piloting of the Direct Survey Form
Results of the Present Study 72
Chapter 5
Community-Based Services Which Support Carers Indirectly 73
General Practitioners (GPs) 75
Availability: Ratios
Accessibility: Priorities
Public Health Nurses (PHNs) 77
Availability: Ratios and Provision of Service
Accessibility: Priorities
Additional Community-Based Service Providers 80
Availability of Service Providers
Accessibility: Waiting Lists
Accessibility: Decision Making and Prioritising Services
Home Help Services 89
Availability: Ratios, Organisation and Provision
Accessibility: Referral Priorities and Eligibility
Meals Service 94
Availability: Ratios
Accessibility: Referral Priorities and Eligibility
Day Centres 98
Availability and Accessibility
Transport Services 100
Availability and Accessibility
Summary and Conclusions 101
Chapter 6
Direct Support Services for Carers 104
Introduction 104
Profile of Carers’ Groups 105
Degree of Involvement with Carers and Distribution by Area
Membership of Carers’ Groups
Meeting Activities of Carers’ Groups
Funding and Fund Raising Activities of Carers’ Groups
Services and Activities Provided by Carers’ Groups
Information from Interviews and Field Contact
7
Perception by Carers’ Groups of Services Provided by Statutory
and Non-Statutory Bodies for Carers 115
Summary and Conclusions 117
Chapter 7
Key Findings, Analysis and Conclusions 119
Priorities and Decision Making Regarding Indirect Services 120
Carer Not a Priority in Assigning Services
Services Reduced or Withdrawn when a Carer was Present
Predominance of Medical Criteria
Availability of Service: A Health Service Under Pressure 123
Scarcity of Resources
Distribution of Resources
Lack of Services which Cater for Carers
Lack of Services with a Preventive Orientation
Interdependency with Voluntary Organisations
Co-ordination of Services
Adequacy of Existing Community-Based Support Services 125
GPs and PHNs
The Home Help Service
Meals Service
Day Centres
Transport Services
Hospital and Residential Care 127
Direct Services for Carers 128
Summary and Conclusions 129
Chapter 8
Authors’ Recommendations 131
The Policy of Community Care 131
The Value of Providing Support Services for Carers
in the Community
Impact of the Carer on Provision of Services
Support Needs of Carers 134
Financial Support
Information, Advice and Social Support
Respite and Relief
Variety and Choice of Support Services
8
Recommendations for Long-Term Planning and Policy 136
The Carer as a Key Element in Community Care Provision
Case Management and Co-ordination of Services
Household as the Unit for Planning
Allocation of Resources
Recommendations Regarding Community-Based Support Services 139
Professional Service Providers
Home Help and Meals-on-Wheels
Transport
Day Centres
Institutionally-Based Care 142
Voluntary Services
The National Carers Association
Summary and Conclusions 144
Appendix A 145
Appendix B 156
Appendix C 158
Bibliography 165
9
List of Tables
Chapter 3
Table 3.1: Long-term care beds for the elderly in 1988 by health
board area 43
Table 3.2: Elderly psychiatric in-patients per 100,000 in 1971, 1981
and 1991 44
Table 3.3: Recent trends in respite bed provision in selected health
boards 52
Table 3.4: Sheltered housing schemes in Ireland in 1988 54
Table 3.5: Day hospital beds and day beds in other centres for the
elderly by health board region in January 1990 57
Chapter 4
Table 4.1: Number of CCAs and number of respondents by health
boards 68
Chapter 5
Table 5.1: Elderly people as a percentage of the population by health
board for 1986 and 1991 74
Table 5.2: Number of GPs and ratios of GPs to elderly people in the
population by health board (for year ending December
1990) 76
Table 5.3: Percentage and number for priorities used to assess the
provision of GP services to elderly people 77
Table 5.4: Number and ratio of PHNs to elderly people in the
population by health board (December 1990) 78
Table 5.5: Type of nursing service/aids, service provider in CCA
and availability of service on medical card - percentage
and number of CCAs 79
Table 5.6: Percentage and number for priorities used to assess the
provision of public health nursing services to elderly
people 81
10