Principles of Community Care Provision Reflecting on the Roles of Carers - Case Study Example

1. Introduction The World Health Organization (WHO) defines health in a broader and holistic approach. Health for the older person has to be defined clearly so that necessary care and solution to a problem can be applied. Considered an authority on health of humanity is the World Health Organization which suggested that health is the wellbeing of an individual’s physical, social and mental capabilities, and it is not just the absence of disease or infirmity. (Squire, 2002, p. 8) The definition can be considered a holistic description of health, but it can aid health promoters in presenting their goals. The definition also looks at the different aspects of health of human beings that should be addressed quickly when one aspect is not working well. An example that can be presented in the description above is if an older person who has osteoarthritis lives alone, she cannot be considered a healthy person. She needs care from the community where she lives. On the other hand, age is also considered a determinant of health. Old age is associated with a slow and gradual deterioration in a person’s health, disability, and consequently, the need for health and social care. Older persons need social and health care more than any other. It is logical and proper that the government and society focus their resources – time, effort, talent and finances – for the provision of health care for older people. (Basford, 2003, p. 42) There has been a tremendous increase in clients (older persons), estimated at 1.72 million, receiving services in the UK. These patients or service users have been supported by the CSSR (Councils with Social Services Responsibilities) during the period 2004 to 2005. From this number, about 1.47 million clients (85%) were provided community-based services, while the rest were served in their residences after they were assessed by the NHS. These figures provide a picture of the need for care services, both from formal and informal carers. (Health Knowledge, 2011) 2. Values and Philosophy 2.1 Philosophy During the period after World War II, the NHS underwent three broad periods wherein each period was characterized by a particular philosophy that underpinned social policy. The first period was the beginning of the creation of the welfare state wherein older citizens were provided the basic needs in life, such as want, treatment from disease, education, work, and squalor. The state’s response was to provide these basic necessities from birth up to adulthood and death (‘cradle to grave’). This principle is known as the Keynesian economics – the State manages the economy in order to attain economic growth and generate jobs. (Edgar, 2010, p. 44) The Keynesian economics failed and led to new approaches in economic management and the emergence of libertarian ideologies. This emphasized individual independence from community involvement. The 1990s saw the birth of the ‘third way’, which corrected the welfare state philosophy and the dangers of inequality and social exclusion in society. (Giddens, 1998 cited in Edgar, 2010, p. 44) The new approach focused on the new concept of the patient and citizen who have rights and responsibility in the policies formulation and health care provision. The welfare state promoted social inequality; there were inequalities associated with health provision (Black et al., 1980; Townsend, 1979 cited in Edgar, 2010, p. 49). Additionally, there was no popular support for the welfare state and a stigma emerged for the older people. On the other hand, the second period characterized by the ‘New Right’ promoted respected and autonomy for the individual person or the older person. The third period sees the patient as both a consumer with human rights that should be upheld by the state and the carer. The Patient’s Charter 1991promoted the rights of the patient with respect to the NHS, the patient is seen as a consumer with rights. Health care becomes a commodity that an older person possesses and which can be insured. Insurance can provide ‘repair and replacement’ if healthcare is lost (Seedhouse, 1986 cited in Edgar, 2010, p. 51) New NHS structures were launched by the Government at the turn of the century which emphasized on primary care plan. This was to carry on the provisions of The Health Act 1999 (legislation.gov.uk) providing for the principles of community and primary care services for all of the UK. The principle underlying the new thrust of the government was to ensure partnership and assessment between government agencies, service users and independent sectors of society and organisations to provide the necessary services. The emphasis of this government policy is to provide care nearest the home of the person needing care. The policy also reduced the patient or service users dependency on long period of in-patient care, rather the patient can choose several options that can be provided by local people. (Sines, 2005, p. 1) Another program of the DoH titled “Tackling Health Inequalities: A Program for Action” focused on health improvement by requiring local health personnel and primary health care trusts in providing the specific needs of the indigenous population, emphasising on the social and environmental aspects and needs of this particular sector. An important provision of the policy is to develop partnership between service/care users and care providers and to ensure that all UK citizens acquire the necessary health care services. (Sines, 2005, p. 1) Societal changes influence the institutions and carers in responding to the needs of older people. Demands cannot be forever the same so that the National Health Service has to adapt to the changing demands. Examples of these changes include: Needs of the ageing population; Reduction in the number of people who can provide care Successes in scientific knowledge and technology, and Awareness of ethical issues in areas like genetics, embryology and euthanasia. Government policies also change over time and this shape the carers’ perception in their role as care providers. 2.2 Values Values underpinning care management include: Independence Citizenship Empowerment Social inclusion Diversity Care and protection for vulnerable people. (Waine et al., 2005, p. 7) Independence means older people should be provided valuable information with respect to facility and the care that they are going to receive. If the older person is not well enough to understand, he/she should assisted by a relative or carer. Carers and nurses should be able to explain and the options that the older person has. (Department of Health, 2001, p. 5) Diversity refers to the differences of people living in a particular place and setting. There is diversity in the UK society in that people have diverse cultures, with different beliefs, customs and mores. Diversity refers to race, ethnicity, culture and religion of people. Carers should know that different religions, cultures and ethnic backgrounds affect the care a person wants. Social inclusion means older persons should not be ‘excluded’ from the rest. They are a part of society, they have the right to be a part of the community; thus they the right to deserve care that the community can offer. To be treated as equal with others is another social value. In social care, there are stakeholders involved. The stakeholders are the shareholders, workers, service users, local communities and local governments. Carers are also stakeholders in that they have personal contact with patients or service users. Older people and their carers want that their dignity and privacy be respected throughout the time that the carer is providing service. (Department of Health, 2001, p. 3) Community care is provided to anyone in the UK who needs social care and this includes older people, younger adults and children. Care can be provided at home or day centres by the community or carers. This brings to the discussion on the role of family carers and their ability to provide support to people in need of care (Mallik et al., 2009, p. 2). The government has been motivating communities to focus on service users, particularly older people, the disabled and children ‘in need’. (Waine, 2005, p. 8) How to provide adequate care for older persons is the responsibility of both formal and informal carers. The government must provide the tools and the motivation. As patients and clients are regarded as consumers in the new set up, there has to be a good communication process between the various stakeholders. (Crawford and Brown, 2009, p. 21) 3. Roles of formal and informal carers Health care in the new millennium consists of professionals and informal carers. There can be little success if only a portion of this sector is present. Each sector contributes to the success of care giving for older persons. (Dann, 2003, p. 64) Carers have a duty to prove the best care that they can to clients or service users. With no exception, formal and informal carers have to provide quality service. This is an obligation and a duty under the new principle and philosophy of care management. Carers have to provide reasonable skill and care in their relationship with employer and colleagues. The government has the primary responsibility of providing care by way of local authorities. Care will be in the form of domiciliary services, respite care or day care, and as a form of supplements to family care. The dependent elderly will be provided care by both formal and informal carers. (Health Knowledge, 2011) Some studies found that there are more informal carers than formal ones. Informal carers are the unpaid members of the family, friends and other relatives. Long-term care can be supplied by informal care. Patients and older persons dependent on informal care could reach up to 2.5 million up to 4 million by the year 2020. (Chang et al., 2006, p. 89) Due to scarce human resource for formal carers, much of the care for older persons will depend on informal carers. Studies by the Wanless reports (2002; 2004 cited in Chang et al., 2006, p. 88) state that self-care should be encouraged in order to reduce informal, paid or professional care. Training for practitioners, with the help of self-diagnostic tools, is recommended but there are drawbacks and possible problems on this kind of solution. Self-care or self-medication requires some training. Surveys also found that one in five people in the UK will have a chance to become a carer sometime in their life, and that women have a fifty-fifty chances of becoming carers at age 59 (Carers UK, 2002 cited in Chang et al., 2006, p. 89). The young are also involved; those aged 17-19 have been carers (Princess Royal Trust for Carers, 2004 cited in Chang et al., 2006, p. 90). If there is a shortfall of formal carers, there is also shortage of informal carers in the UK. Social care depends on the capabilities of informal carers. This could have significant economic effect since people will have to spend some time caring for their older persons instead of working for the economy. One strategy or solution is for the government to provide state support to informal carers. Conclusion There are worrisome implications in care giving for older persons in the UK. There is shortage of human resource, both from formal and informal carers. Informal carers’ state of health can suffer while he/she is providing care. The informal carer will bear the burden and place the health needs of his/her loved one ahead of his/her own health (Guberman et al., 2003 cited in Chang et al., 2006, p. 90). Informal carers suffer fatigue and also ill health after long hours of care giving. Formal carers are the paid carers. They can supplement their expertise to informal ones, and this is mandated under the law. They can visit homes and patients or older persons who depend on members of the family. Twigg (1996 cited in Burau et al., 2007, p. 24) distinguishes the types of relationships between formal and informal carers: carers are used as resources but are taken for granted; carers are regarded as co-workers only to ensure that they work for longer period; carers regarded as co-clients; and carers that agencies would want to replace with paid carers. Home care needs support from local authorities because of the many contradictions underlying their services. (Burau et al., 2007) The government through local authorities should do something. Although it has initiated programs to provide adequate care for older persons, still this is not enough. More funds should be poured to bridge the gap between formal and informal carers. Coordination between formal and informal carers must be in the area of how to provide a perfect care for older persons. References Basford, L., 2003. The context of care. In: L. Basford and O. Slevin, eds. 2003. Theory and practice of nursing: an integrated approach to caring practice. United Kingdom: Campion Press Ltd. pp. 42-60. Burau, V. et al., 2007. Governing home care: a cross-national comparison. UK; USA: Edward Elgar Publishing, Inc. Chang, L. et al., 2006. Who’s going to care? In: Z. Morris et al., eds. 2006. Policy futures for UK health. United Kingdom: Radcliffe Publishing Ltd. pp. 87-99. Crawford, P. and Brown, B., 2009. Communication. In: M. Mallik, C. Hall and D. Howard, eds. 2009. Nursing knowledge and practice: foundations for decision making. Elsevier Limited. pp. 21-43. Dann, K., 2003. Empowering care. In: L. Basford and O. Slevin, eds. 2003. Theory and practice of nursing: an integrated approach to caring practice. United Kingdom: Campion Press Ltd. Department of Health, 2001. Standards and indicators: a resource tool; caring for older people: a nursing priority. Available at: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4077575.pdf [Accessed 28 November 2011] Edgar, A., 2010. Why do changes in society and institutions matter for professional values? In: S. Pattison, ed. 2010. Emerging values in health care: the challenge of professionals. London, UK: Jessica Kingsley Publishers. Ch. 2. Health Knowledge, 2011. Section 2. The Role of informal carers in community care. Available at: http://www.healthknowledge.org.uk/public-health-textbook/medical-sociology-policy-economics/4b-health-care/section9 [Accessed 28 November 2011] Mallik, M. et al., 2009. Nursing knowledge and practice. In: M. Mallik, C. Hall and D. Howard, eds. 2009. Nursing knowledge and practice: foundations for decision making. Elsevier Limited. Legislation.gov.uk, 1999. Health Act 1999. Available at: http://www.legislation.gov.uk/ukpga/1999/8/contents [Accessed 28 November 2011] Sines, D., 2005. The context of community health care nursing. In: D. Sines, F. Appleby and M. Frost, eds. 2005. Community health care nursing. Oxford, UK; USA; Australia: Blackwell Publishing Ltd. Squire, A., 2002. Health and well-being for older people: foundations for practice. London: Elsevier Science Limited. Waine, B. et al., 2005. Developing social care: values and principles. Available at: http://www.scie.org.uk/publications/positionpapers/pp04/values.pdf [Accessed 27 November2011] Read More