Posts Tagged ‘informal caregiver’

“Supportive policies such as respite care or training and counselling may […] be needed in order to sustain informal care as an important resource of our health care systems.” The quote comes from Ellen Verbakel et al in their paper on informal care in Europe[i]. But is it just “respite care or training and counselling” what is needed? The paper indicates that, on average, one in every three people in Europe are informal care givers. What is more, one in every six of those care givers is 65 or older. In a back of the envelope calculation, 22 million Europeans are informal care givers and over 65. I do not think that respite, training and counselling is enough.

In Europe, when reaching 65, most of the population looks forward to a nice peaceful retirement but instead, 22 million face a continuation of their dedication to somebody else with bad heath or ageing deterioration. This happens at a time when the carer is going through ageing himself. We need to manage the situation from a holistic point of view. The interrelation between carer and cared takes place in a particular environment: the home. Even if some aspects are outside of the participants’ control, such as the neighborhood, some others are within their reach. I am referring mostly to those aspects of the household that can make life easier and safer for both carer and cared. Aspects that are not only geared towards the comfort of the cared, but also to the comfort of the carer.

Ergonomics was born in the workplace. Its aim is to design the workplace taking into consideration the characteristics and limitations of the worker. The result is that, by reducing risk factors, the worker improves his performance. The workplace of the carer is the home. By introducing ergonomic design into the home, we can create a safer place for both carer and cared and a more efficient care process. And last, but by no means least, a more enjoyable life for the carer.

[i] Ellen Verbakel, Stian Tamlagsrønning, Lizzy Winstone, Erlend L. Fjær, Terje A. Eikemo, Informal care in Europe: findings from the European Social Survey (2014) special module on the social determinants of health, European Journal of Public Health, Volume 27, Issue suppl_1, February 2017, Pages 90–95, https://doi.org/10.1093/eurpub/ckw229

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When we talk about healthcare, even if nominally we are focusing on the patient, the reality is that we program the care process based on the capabilities and needs of the healthcare professional. If we didn’t do that, we still would have the family doctor coming home or, more realistically, Primary Care would be the prima donna of the healthcare process instead of the ugly duckling.

When we talk about social care, we rarely focus on the caregiver. We take for granted that the dear unmarried daughter will take care of her parents; is there anything better that she can do with her life? With that goes the assumption that the public purse does not need to divert its valuable resources to care for old people; there is always a family member willing to take care of the ageing person.

And this is the norm all over the world, and certainly all over the European Union.

In a previous post, “Beyond Covid-19”, in a back-of- the-envelope calculation, I estimated that Europe needs 23 million persons per year to work as caregivers. Let us assume that 10€ an hour is a reasonable medium wage in the EU, and we will get to a staggering 354,200 million € a year, roughly twice the annual budget of the EU.

I am not very optimistic about countries in the EU adding 2% of their GNP to their budgets. From now on, we will have to rely on imaginative approaches to care for our old people’s caregivers.

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I am taking the title from one of the chapters of the book New Ageing by Matthias Hollwich. The introduction to the chapter reads “At some point in our lives, things will get a bit harder and we will need help in one way or another. The best kind of help eases the way forward without replacing the capabilities we still have”.

It is this last sentence that has been haunting me for years. And not only in reference to informal care but also with formal care, including institutional care. Many years ago, I directed a study for nursing homes all over Spain. Of the many months I was involved in the project one comment from the director of one of the nursing homes has been engraved in my head. He told me, and I quote, “We are a factory of dependent persons; put an independent person in a nursing home and, in less than six months, that person will become dependent”.

Add to that, the above average incidence in the mortality rate that Covid-19 has caused in nursing homes all over Europe, from Sweden to Spain, and you will get a much less  rosy picture of nursing homes as a recourse for old people’s care.

A recent paper by the European Commission, Informal care in Europe: Exploring Formalisation, Availability and Quality, states that “Informal care forms a cornerstone of all long-term care (LTC) systems in Europe and is often seen as a cost-effective way of preventing institutionalisation and enabling users to remain at home”.

What I see as a problem is that, because of their lack of proper training, informal caregivers, and more if they are family members,  tend to overpower the old person: “Don’t do that”; “I’ll get it for you”; “Be careful, you’ll fall”, etc.. So, we go back to the beginning: the problem is to help the old person “without replacing the[ir] capabilities.”

We need to train informal caregivers. Basically, we need somehow to care for informal caregivers, to train and support them, even provide financial support for them, as the EC maintains. But training should be the first objective, since a properly trained caregiver will know how to take care of the old person and, equally important, of him or herself.

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