Problems of long-term care in the family
Is it possible to shift a large part of the need for care to the families of the elderly themselves, encouraging their increased efforts, thereby reducing the costs of social insurance or income from taxes? Sometimes it is assumed that in the past, families have been more caring for the elderly and that part of the problem is "refusal" from family support. Although, of course, it is true that different generations want to live separately - this is a matter of choosing those who are concerned. However, the thesis of the "golden age" care in the family is not supported. At the beginning of the century, there were far fewer weak and feeble elderly, who were cared for by a much larger number of adult children. If something happens, then the family now, perhaps, has the same care as before, but in other ways. After the measurement in the hours of direct care and the time devoted to observation, it became apparent that the majority of the assistance received by the infirm elderly living outside care facilities for the elderly was provided by family members. This is without a doubt the most important "service" received by the infirm elderly, although it turns out to be people who are mostly unprepared (in the usual sense) and, as a rule, it is not paid for. Formal home help services and home visits would be mostly inadequate to support the elderly in their own homes without such a regular source of assistance.
Most studies emphasize that the very presence of one primary caregiver is often the most important factor in supporting an elderly person. This person providing "primary care" can be named in various ways: as the most direct contact person for the elderly, as the person who dedicates the most hours of the week to care; As the person acting as the organizer of the whole "package" care, involving other persons who provide either informal services (for example, home repairs and other housework), or special services if necessary. The primary care provider is in most cases a member of the family, rather than a hired employee of one of the care services for the elderly.
In Australia, New Zealand and the United States, for example, studies have shown that people providing primary care for infirm elderly people are approximately 3/4 of the family members living together.
In Japan, over 80% of people are family members living in the same house. In some other countries, for example, in the Nordic countries, Germany, the UK, although family members living together remain the single largest category of primary caregivers, family members who live separately also play a significant role. Neither the watercountry has been found to have persons who are employed to provide care for primary care for the majority of the infirm elderly people living in their own homes, although in Denmark, where there is the most developed network of formal care services, this proportion reaches 44% .
The quantitative importance of family caregivers for welfare indicators can be demonstrated through detailed studies conducted in three countries.
In France it was found that 90% of care received by the most dependent elderly living outside institutions is carried out by informal persons. Only one in ten people in this group receives services at home from official services.
In Sweden, one of the richest countries for such services, it is established that informal care is 2/3 of all care received by the elderly at home. However, while informal care accounted for more than 80% of care received by those who live with other family members, formal services were 3/4 elderly, living separately.
In the UK the national survey covered 6 million adults; one in ten people provided some kind of care for the elderly or disabled. About 1 million people were given at least 20 hours per week to care for the elderly.
In the future, in smaller families and with a larger number of feeble elderly, it is difficult to imagine that there will be an increase in informal care; indeed, the main question is how best to maintain that informal care that already happens. There are reasonable prices for care, taking into account the time spent, stress and other factors. The point is that the services should be organized in such a way as to be complementary to family care, and it is necessary to treat people who provide basic care as clients with their own rights.
In recent years, funding for certain areas of care for older people has changed. A special place in them is allocated to the financing of long-term care. Thus, a number of countries pay cash benefits to elderly people in very high dependence, for example, Austria, France, Spain and the United Kingdom. Until recently, they did not receive the necessary funds to cover the costs required to provide personalized home care, having only the opportunity to receive only institutional services. Cash benefits were in part a help to pay for additional expenses for the daily maintenance of the elderly and partly a means of compensating a family member or neighbor who provides care and support. The level of care needs was used as a condition of the right to care, and not as a criterion for setting benefits at the level giving the opportunity to buy care.
In Austria, such payments helped pay for treatment in the hospital, as the family caregiver was seen as a direct substitute for formal services. In the Nordic countries, there existed pay terms for those who provided such services as an alternative to formal services, but the application of these conditions is very limited and there is a tendency to decrease. Similar payments are made in New Zealand, when the carer is considered a substitute for services, the size of the payments is limited.
A number of countries, such as Australia, Ireland, and the United Kingdom, have recently introduced benefits for the provision of services to the social security system on a legal basis. In the United Kingdom, these benefits are directed at people of working age who provide services, and most people who received these benefits were children or spouses of disabled people. In Ireland, benefits are paid to persons caring for elderly incompetent people, and this group represents the majority of cases. And a number of countries extended protection to retirees for working-age people who refuse to work to provide care for an incompetent person.
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