The number of older carers is growing significantly in the UK; over a third of carers are aged over 60 years. The group growing most rapidly are those aged over 75. Older carers tend to care for many years, do not ‘identify’ as carers and disproportionately provide intensive care. They may also have their own health problems and tend not to ask for help from services. There is an urgent need for policy, research and practice to focus on understanding and meeting the needs of older carers.
This awareness underpinned a seminar entitled ‘Focusing on Older Carers: Exploring the Research and Practice Axis’ which was held at the School for Policy Studies at the University of Bristol on June 16th http://www.bristol.ac.uk/sps/. The seminar was funded by the British Society of Gerontology and was led by Dr Liz Lloyd and Professor Alisoun Milne https://www.kent.ac.uk/sspssr/. The aim of the invite only seminar was to: highlight the distinctive needs of older carers; discuss research about, and practice with, older carers; and showcase local initiatives. The 25 participants included researchers, practitioners, third sector representatives and commissioners.
Jo Moriarty deftly presented recent research findings about the shape and nature of the older carer population. She focused specifically on the characteristics of older carers who use social care services, critiqued the often rather limited nature of ‘support services’ for carers and summarised evidence about ‘interventions’ for carers. The different ways that services for carers are ‘rationed’ e.g. by dilution, was also raised as was the negative impact that reduced services have on the quality of life of carers. She concluded by noting that older carers as a group are growing in number and diversity, their roles are increasingly complex and the ways support is offered needs to be more personalised and proactive to prevent carer breakdown.
Alisoun Milne‘s paper explored ‘what matters’ to older carers. Evidence suggests that older carers tend to protect the cared for person by resisting framing what they are doing as ‘caring’: as a consequence they are less likely to recognise the impact caring has on their health and wellbeing. The ‘emotional work’ older carers are involved in e.g. bolstering their relative’s identity, tends to dominate how they ‘become’ carers. It is not instrumental care tasks that defines their role and yet this is how most agencies conceptualise caring and what determines service allocation. That care is embedded in a relationship and a shared life-course is also important to older carers. The shift towards direct payments is linked not only to devolving responsibility for care decisions to carers but is also associated with the devolution of stress. Although there has been a reduction in the amount of contact social workers have with older carers their skill & knowledge ‘set’ dovetails closely with that of older carers. Issues include: knowledge about legal issues and services, recognition of the carer’s rights and concerns, and awareness of care related challenges. More emphasis needs to be given to working with older carers in social work practice and education. For research to be meaningful it needs to face towards the more complex realities of older carers’ lives and capture the emotional work they do.
A panel discussion between a number of local partner agencies – Bristol & South Gloucestershire Carers Support Centre, Bristol City Council and Age UK Bristol – outlined the nature of a well-established partnership model that characterises Bristol’s approach to working with older carers. Statutory and third sector agencies work together to prevent carer breakdown, identify carers at an early stage, and offer effective support. A hospital based service that offers support to carers before their relative is discharged is one example.
Small groups explored the question: ‘What are the key factors in developing good practice and effective support for older carers & their relatives?’ Key issues that emerged included: a greater focus on the skills needed for social work with carers; adopting a lifecourse & relationship based approach to assessment; engaging with local communities in terms of identifying and supporting carers; and a need to recognise that social class influences a carer’s capacity to engage with issues such as ‘choice’.
Liz Lloyd reported early findings of a NIHR funded project exploring the impact of the Care Act on support for older carers. Stage 1 of this project is a review of current web based information of all local authorities in England, using a data extraction tool to assess the accessibility and user friendliness of website as well as comprehensiveness; and accuracy and consistency of information. The overall picture is complex and varied. Whilst the majority of LAs have generally accessible websites that give accurate information about how to get an assessment of need many give contradictory and confusing advice. Types of support available include respite breaks, ‘training courses’ and (via a third sector agency) emotional support and advice. Over 50% of local authorities do not mention older carers at all and those that do discuss end of life care, isolation and carers support groups. Thus far the findings show that older carers are not generally recognised as having distinctive needs and that support for them is fragmented and uneven.
Mary Larkin’s paper focused on former carers, a growing number of whom are older. Although there are a number of ‘routes’ into becoming a former carer, most experience a number of care related ‘legacies’ relating to money, employment, social isolation, and health and wellbeing. Influences on the post caring legacies include: problematic caring experiences (e.g. dissatisfaction with services), bereavement, care home admission, and limited support. We have little knowledge about older former carers. This is mainly due to the fact that the current evidence base is characterised by: small scale local studies, terminological variation and a lack of theoretical underpinning. If we are to extend knowledge research needs to engage with the distinctive profile of older former carers, challenge their invisibility and adopt a longitudinal lifecourse informed lens.
A new online resource entitled ‘Social work practice with carers’ – hosted by Research in Practice for Adults – was the focus of the last session http://carers.ripfa.org.uk/. Lyn Romeo outlined the importance of social work with older carers, especially in circumstances characterised by complexity, change and transition and their need to develop knowledge about the needs and experiences of older carers. Lisa Smith then outlined the resource and shared a number of case study clips in which carers identified ‘good social work practice’. Important issues included: empathy and communication skills, time to listen and understand the carer’s perspective and needs, appreciation of their stresses and concerns and knowledge about services. The seminar concluded with a round-up of key issues and a shared sense that we were at the beginning of a journey to improve support for, and research and practice with, older carers.