Karteikarten
K101 Unit 1.
Karten in diesem Stapel (95)
- 1Service UserA person receiving care.
- 2Key points 3.4Health care has been completely transformed by biomedical science.
For the purpose of acute care. priority is given in hospitals to the biomedical model - focusing more on the treatment of the body than the person and their life.
Being a hospital patient is an extreme version of the sick role.
The traditional patient role is at odds with the more active expert patient role.
As acute care has changed, registered nurses tend to spend increasing amounts of time working with advanced medical equipment and computer systems, and have taken over some of the former tasks of doctors.
Meanwhile HCA have increasingly taken over bedside caring tasks from RN's although continuing to work under their supervision.
Health care roles in hospital were traditionally organised in a hierarchy of biomedical expertise, but new forms of team working have emerged in recent times. - 3Consultative and collaborative system of working in hospitalsIn which knowledge is shared
The strengths of all participants are brought into play.
The work is driven by team ethos. - 4Medical Hierarchical way of workingInvolving instructions being given and carried out.
In which communication is from the top down.
So it relies on all knowing doctors, obedient nurses and passive patients. - 5When in hospitalHospital takes over responsibility for all aspects of health i.e. when a person needs to eat or drink, what they wear, personal cleanliness, when they go to the toilet.
You shed your identity as an active competent member of society.
Acquiring a passive identity as someone with a particular medical condition. - 6Role of hospital patientHe is no longer just seeking advice - he has handed himself over entirely to a medical regime.
He is not just excused normal duties - he is completely removed from normal life. - 7Hospitals not all hi-techYour bodily functions can be kept under systematic observation through routine monitoring and recording temperature, heart rate and blood pressure
The healing of a wound can be monitored when dressings are changed
medication can be administered and recoreded - 8HospitalIs a place where you expect to have access to;
diagnosis and treatment by specialist consultants.
Complicated treatments requiring teams of different specialists (e.g. surgeons, anesthetists, nurses)
advanced, hi-tech, medical equipment
Intensive, round the clock nursing care for critical conditions
Specialist nursing care for rare or complicated conditions
Strictly controlled medication, along with close observation of changes in condition. - 9Key points 2.3To be effective, health care needs to take account of the 'service users perspective'
Health care for long-term conditions needs to be attuned to the cultural background of the service user.
It also needs to take account of the service user's social circumstances: for instance their ability to afford a prescribed programme.
And it needs to take account of the service users psychological reactions to illness and to treatment.
Successful health care for long term conditions involves more than health are professionals applying biomedical science. It also involves engaging service users as partners in their own care programmes.
This includes supporting them in becoming 'expert patients' who can take an active part in understanding and managing their own case. - 10What are white papers?These are documents produced by he government setting out the details of future policy on a particular subject. It allows for feedback before it is implemented as policy/bill.
- 11Biomedical approach to healthcareThe doctor diagnoses what is physically wrong with the patient and prescribes treatment. The patient plays a passive role in this.
- 12Chronic diseaseA disease that is long lasting or recurring
- 13Appropriate servicesServices that take into account the cultural, biological and psychological needs of the service user.
- 14Key Points 2.2The term primary care refers to all the health services which people can access directly, without being referred.
A visit to the Gp provides a first point of contact with the health services.
Most primary care is provided through primary health care teams, made up of GPs and a variety of other health care professionals, plus administration staff.
The medical world has it's own distinctive culture, which is different from most peoples everyday lives, so a doctors surgery can be an unsettling place.
A condition such as diabetes has lifelong consequences for the person who has it, and requires a major commitment to participation in self care.
For common chronic diseases here are usually networks or support within the community. - 15DiabetesAffects over 2 milion people in the UK and there may be as many as 1 million more people who have the disease but do not know it. 9 out of 10 people with diabetes have type 2 diabetes and over 80% of these are overweight (NHS direct 2007)
- 16G.PFirst point of contact for most medical services. Provide a complete spectrum of care within the local community.
- 17Secondary servicesAre services that are available through being referred by a primary service i.e dietitian.
- 18Primary CareHealthcare in the Uk is divided into primary and secondary services.
Primary care services are provided by the people you normally see when you first have a health problem. It might be a visit to the dr or dentist, to an optician for an eye test, or a trip to the pharmacy. NHS walk in centres and NHS direct are also primary care. (NHS direct 2007) - 19Key points 2.1We tend to think of illness as something wrong with a person's body.
However, illness also has social and moral aspects, because it affects how you play your part in life around you. To deserve the 'privileges' of being ill, you are expected to fulfill the obligation of the sick role.
Illness has a psychological aspect too. People 'read' their bodies signals differently and react to the differently.
Recognising illness involves coming to terms with the personal consequences of taking the sick role. - 20Anwar Malik54, lives with wife Hansa,youngest son Iqbal in the Midlands. Muslim. speaks Punjabi and Urdu, he and wife speak English in shop. 4 children all born in England.
Being feeling unwell for a while, tied, lethargic, always thirsty. Hansa noticed less active, frequent toilet visits, urges him to go to Dr, he says just his age as he no longer a young man.
Notices eyesight deteriorating gets eyes tested for stronger glasses. Optometrist notices signs of degeneration and he should urgently see dr. Writes note for Anwar to take. Anwar reluctant to go, Hansa says must go, as does Iqbal, Iqbal phones for appointment. - 21When claiming the sick role is difficultClaiming can be easy if you have vomiting or a broken limb, but some illnesses such as a bad back that can't be seen 'a lack of proof, and visible disabilities, can lead to accusations both felt and enacted, of malingering, hypochondria and/or mental illness' (glenton, 2003)
- 22The sick roleBeing ill mans not being in your normal state of health, this has 2 aspects
not feeling normal (biological)
not being able to act as normal (social)
In other words when people accept that you're sick they grant you certain privileges, but you also have certain obligations;
You are not blamed for being ill, but you are expected to want to get better quickly
You are let off your normal duties, but you are also expected to stop doing things that you normally do.
You are expected to seek medical advice and to follow it. - 23Talcott Parson's sick role.First a state of illness is not regarded as the sick persons fault, the individual is exempt from responsibility for their condition, yet has a moral responsibility to regard being sick as undesirable, as something that should be overcome as soon as possible.
Second, the ill individual is temporary except from ordinary daily obligations and expectations, an exoneration that is not only a right but an obligation... it is not uncommon for people to resist admitting they are sick and for others to legitimize to them their condition by telling them they ought to be at home in bed.
Third, the sick role incorporates the expectation'of seeking help' from the appropriate 'technically competent' health profession and co-operating with them in the process of recovering and returning to full social functioning. - 24Key points 1.4Although caring has long been done within families, it only became a matter of public interest in the late 20th century.
In some communities in the mid 20th century, care was accomplished by a network of family members living near to one and other. Daughters took the main responsibility for caring.
Changes in the way families live have led to caring becoming less of a shared responsibility between family members.
However, there is little evidence that families have rejected the idea that they have the responsibility to care for family members as they grow old and frail, but smaller families and greater distances mean that the type of contact has changed. - 25Key points 3.4It is important to understand why carers may take a long time to recognise their own needs and ask for help.
Before assessing home care services, users and carers need to undergo an assessment of needs. This will set out what they are entitled to expect in a care plan.
Home carers work to the care plan. Users are not able to direct their work beyond that.
Support from others in a similar situation is often critical to carers well-being.
Specialist services are often available, but not necessarily known about.
Aids and adaptations to the home can be of incalculable assistance to people with disabilities and long-term health conditions.
In reality care services are unlikely to be able to provide for all the needs of people and their carers - 26K101 principals of care practice1. Support people in maximising their potential
2. Support people in having a voice and being heard
3. Respect peoples beliefs and preferences.
4. Support peoples rights to appropriate services.
5. Respect peoples privacy and right to confidentiality. - 27Values and ethicsService users have the right to
be respected
be treated equally and not discriminated against
be treated as an individual
be treated in a dignified way
privacy
be protected form danger and harm
be cared for in a way that meets their needs and takes account of their choices
access to information about themselves
communicate using their preferred methods of communication and language - 28Key points 4.3Although individual workers often give excellent service, there have been many criticisms of home care delivered by agencies.
Direct payments, in which people who use services hold the money and choose and pay their own personal assistants, are a way of changing the power relationship between users and workers in home care.
People who use direct payments report much greater satisfaction than people who use more traditional home care services. Workers also report greater satisfaction and less stress.
PAs are low paid and lack opportunities for training and career progression.
Direct payments may be suitable for some groups of people but not others. - 29Direct paymentsIs a cash payment made by a local authority to a person assessed as needing certain services, such as home care so that they can buy services for themselves.
Drawbacks - boundary between work and friendship tricky. particularily acute when pa is an existing friend or a family member.
Meeting higher order needs - Users more able to take ore responsibility for their own lives.
Suitability or all - Not suitable for all, more suitable for those with long term illnesses or permanent impairments. - 30Key points 4.4Providers of home care are commissioned by public bodies, usually local authorities.
Recruitment, management, and training of well-motivated staff is core to the provision of high-quality home care.
However well managed home care agencies struggle to provide the care their clients want and need in the context of cost constraints set by commissioners and managing competing demands from large numbers of clients. - 31Key points 4.2Home care workers provide a vital service in enabling people to stay in their own homes.
Home care workers work to a care plan which determines what they do for each clients
Home care workers need to manage relationships with clients so that there are clear boundaries between being friendly and being a friend. At times this makes considerable emotional demands.
Personal qualities are important but not enough. Home carers need technical skills too.
People value home care that is reliable and flexible and which is delivered with kindness and with respect for them as individuals. - 32Home care - service users perspectiveSome where dissatisfied due to;
Inflexibility they would have liked more say in when carers came, what they did and how long for.
Unreliability of services. Care workers did not always come when they were expected.
Frequent changes of staff. This meant that service users did not get to know workers
Poorly trained staff. Staff did not always have the right skills or attitudes or did not treat service users with respect. - 33Key points 4.1Publicly provided social care services are not universal - to qualify for them people usually need to be at substantial or critical risk
The boundary between health and social care is difficult to draw, but hotly contested because health care is free to users where as social care is not.
Long-term or continuing care is increasingly seen as social care rather than health care, meaning that the costs fall on individuals.
Local variations can mean a postcode lottery for both the quality and the costs of care.
Although the aspiration is for services to maximize independence for care recipients and carers in practice this is rarely achieved because of lack of resources. - 34Health or social careThe division between health and social care is increasingly a division between care that is free to the individual, and that which has to be funded from his or her own purse. (Twigg 1997)
This means that some people will have to pay to be bathed at home as they are defined as needing social care, where as those who need health care will get the same service free. - 35Social care who pays?Social care through social services is means tested.
Annually more than 1 milion over 65 receive publicly funded care.
This costs local authorities around 8 billion about 1/4 (1.6 billion) paid for by service users.
The NHS provides some care for the elderly (continuing care). This costs around 3 billion a year. NHS care not charged for.
3 major factors which determine whether provision of social care is public or a private responsibility;
a persons income and overall wealth
whether they are assessed as needing health or social care.
where they live - postcode lottery. - 36Social care who decidesAccess to social care is restricted and not everyone is eligible, and even if they are eligible they may have to pay some costs. This also means that someone who is eligible this year may not be next year.
In 1993 about 500,000 people received home care through local authorities.
In 2005, only 354,600 people received home care, but on average they got ore than 10 hrs each. - 37Do families still careResearch has found that most family member seem to accept that they have a responsibility to their older relatives. It's just that many families are more scattered than they were in the past and are smaller, so there are fewer numbers of relatives to help care.
- 38Report from Commission for Social Care Inspection (CSCS 2006)Social are users are often frustrated by inflexibility of services, frequent changes of staff, poorly trained staff.
- 39Maslow model of human needsSaw human needs as a hierarchy in other words human beings have many different needs, but until basic needs for food, drink, sleep and security are met, people are less likely to be concerned about higher order needs. Such as the need for social activities, love and friendship, the need for self-respect and recognition by others and the need to develop and grow (self-actualization)
- 40Barriers to asking for help with caringLack of knowledge - not knowing where to look, what they are entitled to expect.
Pride in being able to manage, fear of being labelled as failing by asking for help.
resistance to recognising the severity of the situation.
Resistance of the care receiver
Resistance of the care giver to allowing someone other than a family member into the house.
Pessimism over the type of help available.
Uncertainty of cost - 41Key points 2.5health is not a straightforward concept. It involves minimizing disease and maximizing psychological and social well-being.
Levels of health are affected by biomedical advances and also by social change such as income levels, quality of housing, diet and pattterns of exercise
As society changes the paternalistic relationships of the traditional biomedical model of health care are giving way to partnership and support for patient expertise.
Recent government policy supports these less hierarchical forms of health care relationships.
Government policy aims to break down barriers between hospital and community care, shifting acute care where possible close to the everyday world of the service use.
Recent trends in diabetes care provide excellent examples of these policies in action. - 42White papers in England and Wales2003 Partnership for Care: Scotlands white paper published
2006 Our health, Our Care, Our say, A new direction for community services published.
Both white papers set out major changes in the way health care services are provided. - 43Changes in societyDisease of poverty have been overtaken by diseases of plenty i.e. malnutrition replaced by obesity.
Instead of the physical stress of hard labour more people suffer from psychological stress and diseases of inactivity.
However health has improved significantly, higher income levels, better housing, improved diet.
More older people and a growing need to care for them.
A lot ore people are surviving conditions that require long term health care.
In other words doctors can no longer rely on patients being overawed by their education and status.
Patients increasingly feel they have the right to high quality health care.
Three trends, each representing a shift away from biomedical model of a generation ago.
From hierarchies to team working among health care professions
from paternalistic to partnership in doctor - patient relationships
the rise of the expert patient - 44Social model of healthHealth is not just connected with curing illness but is also concerned with preventing illness and promoting good health. Does not abandon the medical model but enhances it.
- 45Normative pressurerefers to the strong expectations of others that family members were responsible for caring for their relatives when they need support.
- 46Expert patientAdvocated in community healthcare i.e Anwar who controls his diabetes by self medicating (insulin, blood testing regime), diet and exercise.
an expert patient is one who in the community has been responsible for the management of their own condition i.e in diabetes blood sugar monitoring, insulin injecting, diet etc. - 47ConcordanceBased on the notion that the work of the prescriber and patient in the consultation is a negotiation between equals and that therefore the aim is a therapeutic alliance between them
- 48WHO definition of healthHealth is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity
WHO 1946 - 49How is care divided?Annually more than one million people over the age of 65, like Angus receive publicly funded social care.
This costs the local authorities around £8 billion. Almost 3/4 of this sum is raised from national and local taxation: about 1/4 £1.6 billion is paid for by users.
The NHS provides some care for older people (known as'continuing care'. This costs around £3 billion per year, less than half the money spent by local authorities.
NHS care is not charged for.
A lot of people arrange and pay for their own care needs. Hard to estimate how many, as their is no system for collection info. Sir Derek Wanless' report estimated that the private spending on social care for over 65's was around $3.5 billion a year.
Te contribution of family carers is by far the largest. - 50Importance of care in familiesImportant not only to the estimated 6 million carers an d those they care for but also the government which recognise that if they were not available it would cost a huge amount of money to pay workers to do the role of family carers
- 51Complicating Factors 4 NetworksNumber of people help care for Angus, Ann does the most but Zoe and Bob also help by keeping him company, getting him things, Bob helped him when Angus was struggling on the stairs. If Bob and Zoe helped a lot it could go against Ann being recognised as a carer.
- 52Complicating Factor 3 InterdepedenceCaring not always simple and one way.
Families may give care to each other so becomes difficult to say who is the carer or cared for. - 53Complicating Factor 2 Labelling and identityTerm carer a label and to get support you need to accept this label, by being labelled a carer you shift from seeing yourself as a Mum, Daughter, Wife.
Some reluctance in accepting this change of identity (Ann when asking for help from social services initially reluctant to accept this role)
Also difficult for Angus to accept that he is a cared for person, wants to retain sense of himself being a homeowner, family member rather than someone who is seriously ill and needs his daughters help. - 54Complicating factor 1 Duration and frequencyIn order to decide whether someone is officially a carer the amount of time spent caring needs to be counted.
The government says to receive carers allowance a person must care for someone for more that 35 hours a week.
Ann recons she cares for Angus for more that 35 hours.
Washing and Toileting 2hrs daily X 7 = 14hrs
Helping Angus manually 1.5 hrs daily X 7 = 10.5 hrs
Giving Angus his medication/applying cream to piles as above
Total 35 hrs.
Ann also keeps Angus company, makes him tea, switches on TV etc. But as Angus's condition fluctuates she sometimes does less caring than others. As pointed out to Joyce Cavaye (reader) some of the work she does for Angus she does for the whole family so counting exact hours is bound to be an inexact science. - 55Four Complicating Factors of careThere are four complicating factors of care:-
Duration and frequency
Labeling and Identity
Independence
Networks - 56The Carers Equal Opportunities Act 2004Came into force in England and Wales in 2005.
Put carers in England and Wales on equal footing with Scotland.
Gives carers the right to assessment of their needs, with regard not just to their caring role.
Also their needs for leisure, training and work.
In addition places a duty on local authorities to let carers know about support they are entitled too. - 57Carers Allowance.Paid at £45.90 a week. (as of July 2007)
Does not increase the more you do.
o qualify for carers allowance she would need to
Be caring for someone for at least 35 hours a week.
Be over 16 and not a student.
Be caring for someone formally recognised as 'disabled' (e.g. someone who qualifies for DLA care component - higher or middle rate) or someone over 65 (to qualify for Attendance Allowance)
not earn more than £95 per week. - 58Is Ann officially a carer?Ann fulfills the directgov definition of a carer.
However if she was to apply for financial help she would need to meet a more vigorous definition.To qualify for carers allowance she would need to
Be caring for someone for at least 35 hours a week.
Be over 16 and not a student.
Be caring for someone formally recognised as 'disabled' (e.g. someone who qualifies for DLA care component - higher or middle rate) or someone over 65 (to qualify for Attendance Allowance)
not earn more than £95 per week.
Under this criteria Ann qualifies as a carer. - 59Why does being defined as a carer matter.Ann could apply for financial and practical support.
To budget holders who need to be able to plan carer services.
To employers who are obliged to take account of employees' caring (Directgov. 2007) - 60Social and Health CareGovernments have increasingly defined long-term care as 'social care' rather than 'health care'. Sociologist Julia Twigg puts it 'The division between health and social care is increasingly a division between care that is free to the individual and that which has to be funded from hos or her own purse. (Twigg, 1997, p.214)
- 61Challenges of defining what carers doCare may be broadly defined in way that encompasses most situations where members of families or friends contribute to the care of someone. However official definitions define eligibility for financial and practical support, these are important but also exclude people who fall below the threshold.
- 62Who gets local authority help?In 1993 about 500,000 people received home care through authorities.
In 2005 only 354,600 people received home care, but in average they got more than ten hours each (Wanless, 2006). Increasingly, resources are targeted at the people with the highest level of risk. - 63Who gets support?Although the categories 'severe', 'moderate' and 'low' are defined by the English Government each local authority decides which categories to include as budgets get tighter, so do the criteria.
- 64Problems with home carersAccording to a report from the Commission for Social Care Inspection (CSCI) (2006), social care users are often frustrated by inflexibility and unreliability of services, frequent changes of staff and poorly trained staff.
- 65Care planA written record of the care that someone can expect. The recipient will also sign the care plan to confirm that they have agreed to it. Record of all care given should also be written in the plan.
- 66Care ManagerA person, often a social worker or community nurse, who manages the care package, decides the budget, finds the people and the organisations to provide the services, and reviews how well it's all working.
- 67Care packageA set of services that will meet the needs of the of the service user and carer as decided at the care assessment.
- 68Care assessmentA process where the individual is assessed as to what their needs are. Both carer and the person they care for are assessed, to see what their individual needs are. Assessment is carried out by a qualified professional called a care manager, usually a social worker, OT, or nurse.
- 69Why might a carer not look for help?Lack of knowledge: not knowing where to look, or what they're entitled to.
Pride at being able to manage (Ann)
Resistance on Angus's part as the person being cared for.
Reluctance on Ann's part, as the carer to accepting help
Other family members may not want someone they don't know in their house.
Pessimism over the type of help available.
Uncertainty of costs. - 70Family caring - Part 2Because caring is often hidden within families, as in Anns case, cares are not always known about. At what point does someone stop being a family member and becomes a carer, is not easy to decide. This is more difficult when the person who needs care condition fluctuates. As in Ann's case sometimes she does more caring than others.
- 71Ann and Angus - family careAnn became a carer when her mother died, she asked Ann to take care of Angus who had been diagnosed with Parkinson's. She promised her mother she would do it.
Ann did not at first see herself as a carer but as doing her duty and what was expected as it was a 'woman's job'
She was living with her husband Bob and daughter Zoe in Angus's house rent free so, felt obliged to carry on the role after her mother died.
She did not recognize herself as a carer but simply a wife, mother, daughter. - 72Importance of family carersMost of the care of the millions of people with long-term conditions such as arthritis, Parkinsons, diabetes, or who are too old or disabled to manage without support is provided by families.
6 million people in the UK providing unpaid support
Their work saved £57 billion a year (Carers UK, 2006)
Carers play a vital role - looking after those who are sick, disabled, vulnerable or frail. The government believes that care should be something which people do with pride. We value the work that carers do. (DH, 1999, p.11) - 73Key points 1.2Care relationships can be stressful and demanding.
The quality of the relationship between the person who is cared for and the carer is influenced by the dynamics of family, past and present.
Lack of information about alternatives, and a sense of duty, often means that family members do not feel they have a choice about taking on the role of a carer.
It often takes a crisis before people ask for support. - 74Suitability of Direct PaymentsTom Shakespeare, argues that Direct Payments are most suitable for people with permanent impairments and for people with long term illnesses and are less likely to be a solution for babies and young children, people who have severe learning difficulties or mental health problems and older frail people or people with dementia (Shakespeare, 2006)
- 75White paper 2006The White Paper Our Health, Our Care, Our Say (DH 2006) sets out a vision of active intervention when people's needs are only low or moderate to ensure that people have the best quality of life possible.
- 76Benefits of direct paymentThe people who used Direct Payment described it as more flexibility: being able to come and go more freely: familiarity with the personal assistant: empathy and understanding: companionship: control: confidence, not having to explain needs each time a new person appeared.
- 77ProvidersThese are the private profit making companies such as somebody cares, or non profit volunteer orgs. They contract with the commissioners to provide services for a given period of time and an agreed price. They employ and manage staff.
- 78CommisionersThese are the agencies which contact and pay for services. Their budgets come from local or national taxes and they spend them on commissioning services for people eligible for them.
- 79Bethnal Green: the late 20th century - families and caring.Geoff Dench, Kate Gavoron, Michael Young, revisited Bethnal Green in 1990s using same study methods as Townsend and local newspapers and reports. Biggest change was in the ethnicity, 1/3 of population were of Bangladeshi origin, & 3/5 of school enrollment. Using the same demographics as the original study they discovered that There were a lot of lonely people who didn't see anyone from one day to the next. Families were broken up, brothers/sisters/sons/daughters had own homes away from area. When people where poorer they tended to stay closer together.
Close knit extended families were fast disappearing within the white community this due maybe due to a change in the economy. - 80Main points from Townsend study.Most care was done by female relatives, grandchildren also feature.
One person - usually the daughter - was the main person who provided care
Care was made easier by families living near to one another.
There was reciprocity
People without relatives were most likely to need state support.
Improving the family's ability to provide care was the right way for state services to go. - 81Peter Townsend study of Bethnal GreenPeter Townsend Pub 1957 The Family Life of Older People. Book based on random interviews of 200 old people in Bethnal Green. He wanted to find out what is really going on in communities as a basis for meeting 'the social, medical and economic needs of old age'
He found plenty of examples of shared care across family members. Such sharing care made care for very sick people more bearable. It was possible because:
46% lived with younger relatives
Most others had relatives near by
Of the 200 between them they had 2,700 relatives living nearby
83% had adult children living nearby
Very few adult children had moved away
People kept in frequent contact
Until they became seriously ill, older women in particular were able to reciprocate the care they received by cooking meals or looking after grandchildren.
He found there was a lot of reciprocal care within families - the young generations caring for the older and visa versa.
He came to the conclusion that without what we call family care and what he called 'the care given by female relatives' the demand on services would be enormous. The people less likely to make demands on state-provided services for older people were those with daughters at hand. The greatest demand came from 'elderly isolates' people who had no relatives to support them. - 82Key points 1.3The case study is not typical, but there are many families in a similar postion
The majority of carers are women, and most people cared for are older.
The experience of caring varies when the people who are at the receiving end are young people, but there are many common themes. - 83Experiencing care as a younger person.Feeling a burden - No one mentioned this. However Fatima and Nasira commented on feeling loved and over- protected and constrained by their family.
Fear - Waheed was scared of a future when his parents would no longer be there for him
Isolation- mentioned by Nasira, Waheed and Jamila. Gurupal said how important it was for him to socialise.
Choice - Only Jamila mentioned they had a choice about remaining in the care of their families. - 84Carers - facts2001 census found 6 million people were carers
68% cared for 19 hrs a wk
11% cared for 20 - 49 hrs a wk
21% cared for over 50 hrs a wk
58 % of carers are women
42 % of carers are men
51% look after someone they share a home with providing personal care.
57% provide help with mobility
22% give medicines
7% provide other help
70% cared for are over 65
36% care for parents
18% care for spouses or partners - 85Definition of a carerOne of the definitions of a carer is an unpaid person, whether that be a family member or another individual outside the family, who cares for someone who requires help and support whether this is due to a disability, illness, old age or health problems
the word carer means someone who looks after a friend, relative or neighbour who needs support because of their sickness age or disability. It does not mean a professional care-worker in a nursing home, for example or someone employed by a disabled person. (Directgov, 2006) - 86What is it like to be cared for? 2Those who are cared for often have feelings of
Loss of power - dependent on someone else to exist.
Being a burden
Fear - That they are now reliant on others and 'at their mercy'
Isolation - Not seeing others/able to get about without help/no social life without help.
Lack of choice - Ann/Angus he wanted to wash himself but Ann insisted she do it,no choice in getting outside help ( home care) - 87What is it like to be cared for?Fobart (2005) notes that government announcements such as Governments National Strategy For Carers (DH. 2000) makes heroes of carers but labels the cared for just sick, disables, vulnerable or frail. There are groups such as Carers Uk but no Cared For UK to speak for all cared for people. These people have strong feeling about what it's like to be cared for.
- 88Parkinson's DiseaseAffects about 1/500. Result of loss of nerve cells in part of brain that coordinates movement, effects mainly but not exclusively older people.
Most common symptoms
Tremor - uncontrollable shaking
Muscular stiffness - making it difficult to do everyday tasks
Slowness of movement.
Can also affect sleep, balance, mood, leading to depression, loss of confidence. Fluctuating some days worse than others. - 89Caring a woman's roleCaring traditionally seen as a woman's role Ann herself says 'that's a woman's job'
- 90SupportCan be divided into 2
informal support from families and friends
formal support from outside agencies.
For Ann she doesn't get much informal support in caring for Angus Zoe/Bob tend to do own thing. Cheryl seems to be Ann's sounding board where she not only pours her heart out but where she gets independent advice.
Ann receives formal support from home carers. - 91ChoiceResearchers argue that if people make a positive choice to care more likely to be enjoyable experience.
Not always so Ann tells Joyce Cavaye she had no choice, unaware of what other alternatives apart from care home were.
People not often aware of alternatives to doing the caring themselves.
70% of those surveyed said they had not been offered a choice - not told about home care or services such as day centers.
Also complicated by questions of duty and expectations. Ann felt she didn't have a choice about giving up her job and looking after Angus when he deteriorated. many carers felt they would have liked to carry on working but felt they could not get the right kind of support to help them do so. (Carers UK 2003)
Financial also plays apart in whether people decide to care or not. (Angus reminding Ann that it is his house) Estimated that 1/3 of carers live in poverty, mot give up jobs, extra costs in heating, adapting home etc. - 92Quality of relationshipJane Lewis and Barbara Meredith (1988)
study of daughters caring for their mothers, previous relationship one of the most important that determines the attitude of the daughter to caring for the mother.
Liz Forbat (2005) also argues that caring roles and relationships need to be considered with regard to past history of relationship.
People become carer/cared for in the context of an existing relationship, so some of the strengths/weaknesses are played out within care relationship.
In short always easier to care for someone you like and get along with.
Angus always been domineering, Ann in past rebellious but curbed behavior as seeing her and Angus argue upset her mother. Now relationship is awkward, Angus doesn't appear to realise that Ann has own needs and that Bob/Zoe need her. Angus swings between domineering and childlike, hard for Ann to respond. - 93What affects care relationships?Researchers found three key messages from research that caring relationships are influenced by:
the quality of the relationship, particularly before caring commenced (Lewis and Meredith, 1988, Finch and mason 1992, Forbat 2005)
how much choice people have in becoming the carer, and in how they manage the caring (Lewis and Meredith 1988, Forbat 2005)
the amount and nature of the external support they receive (Lewis and Meredith 1988, Cares Uk, 2003, 2005) - 94What is it like being a carer?Hard work - Ann has to lift Angus on and off toilet, etc
Demanding skill - Ann has learnt how to manage Angus' care.
Restricting - Ann has given up her job
Stressful
Isolated
Emotionally demanding - Angus relies on Ann to be kind, cheerful, patient. Zoe/bob want more attention and affection. All take their frustrations out on her at times
Guilt provoking - An fells guilty about not giving Angus enough care, shouting at him, Zoe and Bob not getting sufficient attention.
Trapped by sense of duty
Obligation
Frightening - Angus's falls
Rewarding - 95Key Points Unit 1:1Carers are family members who provide care for another person who is sick or unable to manage daily life unaided.
Governments are interested in family care because, without family carers, providing care would be prohibitively expensive.
It is important to identify carers so that help, and in some cases financial support can be provided.
However, it can be difficult to identify carers because: much of what happens in families is private: many people resist being labelled as a carer or a cared for person: it can be hard to measure how much caring someone does;
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