PPA 419 Aging Services Administration

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PPA 419 Aging Services Administration

• Lecture 8b Informal and Formal Care of the
  Elderly

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Source

• J. Wiles. (2002). Informal caregivers
  experiences of formal support in a changing
  context. Health and Social Care in the Community,
  11 (3), 189-207.

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Introduction

• As the location of long-term care of elderly
  people moves to homes and communities, and
  responsibility for care shifts families,
  understanding the experience of people in this
  situation is necessary to ensure that support is
  appropriate, accessible and effective.

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Methodology

• The present paper explores informal caregivers
  and recipients relationships with formal
  support, drawing on thematic and narrative
  analysis of 30 in-depth interviews with
  self-identified family caregivers conducted over
  a year in a mid-size city in Ontario, Canada.
• The semistructured interviews explored
  caregivers knowledge about, and perceptions and
  experiences of accessing and using formal support.

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Findings

• All but six of these caregivers had some
  interaction with formal support.
• Interpretation reveals how confusion and lack of
  knowledge about services, the inflexibility and
  lack of availability of services, and increasing
  pressure on the quantity and quality of publicly
  funded community-based resources combine to
  impact negatively on the experience of accessing
  and using formal support.

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Findings

• Different ideas about the relative roles and
  responsibilities of seniors, informal caregivers,
  and family in general, and the state both shape
  and are shaped by policies and the situated
  realities of the provision of formal support.
• Providing care creates both opportunities and
  constraints for caregivers in their interactions
  with formal support.

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Conclusions

• Lastly, this paper highlights the difficulties of
  interacting with publicly funded formal support
  as the costs of care are moved away from the
  state and onto families and individuals.
• The prevalent theme in caregivers reflections on
  their experiences of using publicly funded
  support services is that their use of those
  services is an ongoing and constantly negotiated
  process.

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Conclusions

• Formal support was effective where services were
  good quality, where the relationship between
  health professionals and those receiving help
  were respectful and continuous, and where
  services perceived as appropriate were provided.
• But the professionals are under pressure to
  limit, control, and reduce expenditure on the
  services provided.
• This means that a significant amount of the work
  is passed on to caregivers, both to maintain the
  quality and amount of those services which are
  provided, and to make up shortfalls where
  services are lacking.

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Caveats

• Based on community-based services in Ontario,
  Canada, which has the most extensive services in
  Canada. Canada has a more extensive set of
  services than the United States.
• But, based on a system that assumes that most
  care will be provided by informal caregivers.
• Also, initiated in an era of shrinking budgets.