Careworn country

Informal carers used to plug gaps in the system of state social provision. Now we are coming to depend on them, say Keith Brown and Emma Matthews

We live in an ageing society. Findings from the 2001 census show that one-fifth of Britons will be older than 65 by 2025 and, for the first time, there are more over-60s than under-16s. The implications for the provision of public services are far-reaching as the Wanless report on social care highlighted last week. Under the current system the estimated cost of providing long-term care to older people with cognitive impairment will more than double by 2031 from £4.6bn to nearly £11bn.(1)

Surveys show that most people aged 60 or older want to stay in their own homes for as long as possible. However, the resources needed to make this possible are often lacking, increasing the pressure on informal carers of whom there are six million in the UK; half of them older than 75.

As the number of single-parent households increases so the burden of caring for older people may fall increasingly on their children. Reviewing results from British Household Panel Surveys in 1985, 1990 and 1995, Hirst highlights an increase in spouse care (particularly by men) and “heavy” co-resident caring relationships, and a decrease in non-residential caring.(2) In effect, informal carers are spending more time looking after those they live with and less time caring for friends, neighbours and those requiring less intensive support.

The green paper, Independence, Well-being and Choice, acknowledges the role of informal carers in service delivery. In addition, their contribution is recognised through the Carers and Disabled Children Act 2000 and Carers (Equal Opportunities) Act 2004, giving them rights to assessments and access to services to meet their needs independent of the person for whom they care.

With the government placing so much emphasis on the care provided by informal carers, any threat to this resource and to the duty to care could have serious implications for the care of vulnerable groups.

One possible threat could come from the changing patterns of family structure and continued high level of divorce. In England and Wales in 2003 there were 153,490 divorces, a rise of 3.9 per cent on the 2002 figure. This is the highest number since 1996.

The increasing divorce rate and the parallel changes in family structure have several implications alongside other societal and technological changes. For example, increases in separation and single-person households may leave more older people living on their own and smaller families could result in less availability of informal care. Changes in patterns of migration and economic circumstances could add to this decrease in availability of relatives to undertake caring responsibilities at a time when modern medical technology lets people live longer with chronic illnesses that require care in the home.

This changing family structure undermines informal care as the major source of social care in two ways.

First, it reduces the moral obligation to care for members of a family which has been split by divorce. For example, children of divorced parents may not feel obliged to care for the parent who left the family home. This is supported by research which identified that “the major determinants of the caring decision are likely to be non-economic factors, such as the closeness of the kinship bond between the potential carer and dependent”.(3) Of course, remarriage and second families may go some way to remedying this situation but the divorce rate for second marriages is also high.

Second, divorce is likely to make drastic changes to the economy of the family which is also likely to affect the ability and the willingness to care. Traditionally, informal care has been provided by women. But women are now more likely to work, and often, in the case of divorced women, are the sole providers for their families. Research has shown that working-age female informal carers earn less per hour than would be expected. Also, female carers are less likely to be in paid employment than non-carers and the likelihood of working and earnings in paid work decline as the caring commitment increases.(4)

Single parents could find themselves in the untenable position of having to choose between providing care for elderly relatives, which could reduce their income and have a detrimental effect on their ability to support their own family, or putting immediate family first and not providing this informal care. Added to these pressures is the fact that society increasingly expects individuals to make provision during their working life from their pensions. This is difficult to achieve if individuals take time out from paid employment to provide informal care. Further, there has been an explosion in property prices in the past 10 years which makes housing less affordable and often requires all adult members of a household to work to earn enough to pay the mortgage.

We are seeing unprecedented pressure on resources within our society with family breakdown and reformation occurring at historical rates on one hand and little thought given to the implications for informal care on the other.

Hirst points out the associated costs of current and predicted future levels of informal care, arguing that extra resources will be required for the identification, assessment and support of carers.But Independence, Well-being and Choice argued that changes in the way we care for and support adults in society should be cost-neutral. Wanless suggests this is not possible as even maintaining the current level of provision will require a massive cash injection.

Even with a promotion of actively involved citizens (as opposed to passive recipients of care) and the promotion of the family and family obligations (as opposed to the obligations of the state) it is likely that we are going to see a significant growth of demand for services.

Notwithstanding the Wanless recommendations, it is possible that this increase will have to be restricted to needs assessments as required by various legislation. Provision of support and services may have to be further prioritised and provided only to the most vulnerable. If this is the case many adults may find they are not vulnerable enough to meet the priority groups for services.

The issue of informal care, particularly in light of changing family structures, has major implications for the role of social workers and others in social care. The green paper states that social work has historically been seen as a “gatekeeper or rationer of services” but that the future aim is for people to have increased choice with some support for those who need it most. However, without significant extra resources to support those on whom the burden of care is increasingly falling, it is difficult to see how social care workers will be anything but “gatekeepers”.

Keith Brown is the head of  post-qualifying social work at Bournemouth University. He holds professional qualifications in nursing, social work, and teaching and academic qualifications in nursing, social work and management.  Emma Matthews  is contracts officer for the Supporting People team at Worcestershire Council. She has previously worked as a senior practitioner in teams for older people, physical disabilities and sensory impairment.

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This article considers the provision of informal care and how it is likely to be affected by changes in the population and in family structure. It argues that, even with a promotion of actively involved citizens, there is likely to be a significant growth in demand for social care services as the structure of society shifts. This will have major implications for the role of social workers and for social policy.

(1) Alzheimer’s Research Trust, A Biological and Social-Economic Assessment of the Consequences of an Ageing Population, London School of Economics and Political Science, 2003
(2) M Hirst, “Trends in informal care in Great Britain during the 1990s”, Health and Social Care in the Community, 9(6), pp348-357, 2001
(3) F Carmichael, S Charles, “The opportunity costs of informal care: does gender matter?”, Journal of Health Economics, 22 (5) pp781-803, 2003
(4)F Carmichael, S Charles, “The labour market costs of community care”, Journal of Health Economics, 17 (6) pp645-795, 1998

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