industry & reform
Carers being sidelined
The status of unpaid carers in a
competitive aged care market.
By Michael Fine
I
s the unpaid assistance provided in
the main by family caregivers or other
close relatives, friends or associates
still necessary, or have carers become
a problem?
Do they require a new specialised
management approach to ensure they
don’t get in the way of the competitive
process of service provision or go on to
become long-term welfare dependents?
It is commonly, if wrongly, argued that
formal services substitute for unpaid carers.
We’ve all heard this argument before – for
example, that the reason we need so many
residential care facilities is that people no
longer help their own family members.
Could that be the logic behind the new
approach in Australia where carers are
no longer part of the target group for
support by the services that assist those for
whom they care, but are instead directed
to specialised support services designed
to help them cope better and to seek
employment ASAP?
One of the key characteristics of carers
is that they share a personal relationship
with the person they assist. Informal
care has long been understood as an
expression of the sense of long-term
reciprocity, responsibility and familiarity
that arises from a close familial, marital or
intimate relationship. That’s how people
start caring and why they keep going
once specialised services come in to play
their part.
Even when services are used, experience
in Australia and overseas has consistently
shown that family support remains
strong in old age. This is reflected in data
collected by the ABS over the past 30 years
that clearly demonstrates that informal
and formal care are not mutually exclusive
alternatives.
But carers will tell you today that they
are no longer consulted when individuals
they assist are assessed for the Home
Care Package and for residential care. Nor
are they included in the decision making
about what is needed by the intended care
recipient, the consumer.
Instead, they are referred to their own
specialised support available through
the online Carer Gateway. In the coming
months, it is planned to extend this with
the launch of the Integrated Carer Support
Service (ICSS). The ICSS, we learn from the
website, will provide “digital counselling
services to help carers manage daily
challenges, reduce stress and strain, and
plan for the future”.
Carers are now eligible to access online
peer support, online coaching resources
that help them develop “simple techniques
and strategies for goal-setting and
future planning”. This is in addition to the
educational resources intended to help
carers build confidence and improve their
wellbeing.
A second-stage rollout is currently
scheduled from September 2019. A
network of “regional delivery partners”
will help carers access local services such
as carer needs assessment and planning,
support packages that focus on supporting
participation in employment and
education, coaching, counselling and peer
support provided by phone and in-person,
as well as information and advice, access to
emergency crisis support, and assistance
with navigating relevant local services.
My goodness, what must the politicians
and officials who designed such an
approach think of carers?
Informal caregivers no longer seem to
be recognised as an important source
of support or as a team member to be
consulted and included in decision making.
Carers Australia has noted that carers in
the ageing and disability care fields have
become what is termed ‘collateral damage’
as policy has sought to develop markets
based on the concept of consumer choice
in Australia.
The concern no longer seems to be
about recognising and supporting carers
by providing assistance to those for
whom they care. Instead, we have what
is perhaps most kindly described as a
therapeutic approach that focuses on a
carer’s supposed deficits.
A consequence of this is that it has left
many carers feeling that they are now
being excluded, stigmatised, patronised
and targeted as just another problem that
needs fixing.
Instead of being pathologised, carers
must be recognised as a resource and
acknowledged as team members to be
consulted and included in decision making
when issues of assessment and service
delivery are considered. Skilled assessors,
especially those seeking to elicit a clear
expression of the consumer’s choice,
need to learn to hear from both the care
recipient and their carers. This needs to be
very clearly put back into the objectives
of the aged care legislation and the
associated regulations.
An emphasis on individual consumer
choice must not be used as a justification
of the failure to recognise carers as
important co-clients in aged and
community care. Nor should it be the
basis for excluding carers from direct
engagement with the support services
received by those who rely on care. ■
Michael Fine is honorary professor of
Sociology at Macquarie University.
agedcareinsite.com.au 17