Families, neighbourhoods, communities Flashcards
Learning outcomes
Describe the role of families in providing informal care Discuss the link between neighbourhoods, communities, social capital and health
Describe care that is integrated, person-centred and sustainable at a national and global level
Lay referral
The family members, friends, and neighbours who assist individuals in interpreting bodily changes and deciding on a course of action are called ‘the lay referral system’ (Eliot Freidson1960).
How do families influence health?
•Health behaviours e.g. diet, exercise, health beliefs •Social determinants Socio-economic resources / wealth Geographical location Housing
•Biological
Genes
Life-course
Families as informal carers
- Informal carers are people who, without payment, provide help and support to a family member or a friend who may not be able to manage without this help because of frailty, illness or disability.
- Informal carers form part of ‘Care by the community’ / community care.
- Community / social care has been around from the 1950’s, but was overhauled by Sir Roy Griffiths in the report ‘Community Care: Agenda for Action‘, which led to the 1989 White Paper ‘Caring for People’, becominglaw in the ‘NHS and Community Care Act’ (1990).
Background to community care
Prior to the 1990 Act…. - the elderly were cared for in residential homes;
- People with learning disabilities and mental ill-health were cared for in long-stay hospitals;….all of which were funded through social welfare benefits.
Incentives for changes to community care:
•reduce the financial strain on the social welfare budget;
•evidence of poor quality of life in residential homes;
•policy of deinstitutionalisation.
Organisation of community care
Community care is provided by….
•Local Authorities (GB)•Health Trusts (NI)
•Adult social care (domicillary& residential) is means-tested.
•Domiciliary care / home-help (household tasks; personal care)
•Other services are meals-on-wheels (flat fee)
Pressures on social care
Growing elderly population
Decreasing workforce
Funding constraints e.g. long-term care Parkinson’s, dementia, end of life care now under social care
High workforce turnover in residential & domiciliary care
Impact of Brexitfor migrant workers, who make up a large proportion of the adult social care workforce.
Informal carers
•The majority of community care is provided by unpaid informal carers.
•80% of all care across the European Union (EU) is given by family and friends.
•It has been estimated that unpaid carers in Northern Ireland saves the local economy around £4.4 billion every year.
Who are informal carers?
•58% of carers are female and 42% are male (UK Census 2011) NI Census 2011
•approximately 12% i.e. 1 in 8 people.
•33% aged 35–49; 31% aged 50–64.
•6,700 young people (aged 0–17) provide between 1 and 19 hours of unpaid care per week; 960 provide 20–49 hours; 820 care for 50 hours or mo
Social welfare support
TheNorthern Ireland Single Assessment Tool (NISAT) is an integrated form that all relevant health professionals complete for older people.
•Carer’s Allowance is currently paid at £67.25 a week (2020-21)
•Direct Payments enable a person to choose and purchase the services they feel that they needinstead of support arranged by council or trust.
Impacts of social care
Hidden Carers
•In the UK 54% of carers took over a year to recognise their caring role; 24% took over 5 years; 9% took over 10 years, which delays their access to financial & social support.
Physical health•72% of older carers report feeling pain or discomfort (Source: AgeUK).
•Back pain,neglecting their own health care appointments, poor-quality diet.
Mental health•High levels of antidepressant prescribing in NI.“You tend to isolate yourself as the stress and tiredness you feel everyday exhausts you physically and mentally.”
Financial difficulties•Balancing caring with paid work; •Cutbacks in social provision and increases in direct costs;
Young carers – impact on development of social skills, family relationships, and education/career prospects.
Positives •it can elevate the carer ’s confidence and provide a feeling of “being needed”, “doing something important” (Doebler; Schulz and Sherwood 2008
Legislation
Northern Ireland
•NI is lagging behind the rest of the UK in addressing carers’ issues.
•Caring for Carers(2006) is the most recent NI strategy.
•Trusts retain discretion to decide whether or not to provide service(s) to meet a carer’s identified needs.Great Britain
•The Care Act 2014 and Children and Families Act 2014 in England: places adutyon local authorities toprovidethe services required, within a national eligibility criteria. It has broadened the eligibility criteria for respite care to allow carers to engage in work, training, education, volunteering or recreation.
•The Carers (Scotland) Act 2016: provides a strong focus on young carers, with the intention that they should be able to have a childhood similar to peers.
•The Social Services & Well-being (Wales) Act 2014.
Community centred approaches to making the NHS sustainable
The ‘NHSfive year forward view’ (2014)set out the vision for the NHS….
1. to create a sustainable, community-based health and care service
General Practice is integral to promoting sustainable, public health system that is community-based health because it….•provides the majority of healthcare; •is based in the community.The NHS’s new long-term plan sets out ambitions to…. •‘boost “out-of -hospital” care, dissolving the historic divide between primary and community health services’; •strengthen and co-ordinate health services outside hospitals to deliver ‘more care closer to home’ and•support social rather than medical models of care.Example:Social prescribing i.e. GPs refer people to voluntary sector / community services.
2.communities to take an active role in managing their health.
The communities we are born, live, work and socialise in have a significant influence on how healthy we are.•The social determinants of health have a much greater influence on our health than health care. For example, •social isolation is as bad for health as smoking;•there are many ‘assets’ within communities, such as skills and knowledge, that can promote health and wellbeing;Community-centred approaches to health is more than involving individuals as patients in health service decisions or providing services in the community. It is broader and focuses on bringing together people who share common experiences
Examples of community centred approaches to health in NI
•Human Health Project (HHP) trains volunteer patient advocates to help people to navigatehealthcare, focusing on the underserved and vulnerable population groups, the elderly and their caregivers.https://humanhealthproject.org•Community-Pharmacy Partnership Health Literacy Pilots•Community based Suicide Prevention Project to signpost local communities and increase community involvement in suicide prevention, bereavement support and self harm initiatives.•Networks Involving Communities in Health Improvement (NICHI) Project links the Public Health Agency (PHA) and local communities to address health and social wellbeing issues and reduce health inequalities to develop healthy, sustainable communities.
Examples of social networks
Different Types of Social Networks•Bonding:strong supportive ties which occur within a group, e.g. a family, circle of friends, club, religion, ethnic group etc.•Bridging:weaker ties that connect people across group boundaries, for example with work colleagues, acquaintances, individuals from different communities etc. These are critical to providing access to new ideas, resources, communities and cultures.•Linking:connections between those with different levels of power or status. They connect people that may have similar i
