Means and Resources
Supporting informal carers as a resource for LTC
funding of services, training and other in-kind support directed at informal carers
COUNTRY / LOCATION: Spain
Keywords: informal carer, burden, quality of care, respite, home help
Keywords: informal carer, burden, quality of care, respite, home help
Funding for home help for caregivers (CASTILLA Y LEON)
Summary
Caring for a dependent person creates a burden that can exceed the informal carer’s physical and mental capability many times over. This situation causes psychological and physical health problems to caregivers, decreasing the quality of care given and increasing the risk of early institutionalisation of the dependent relative and of violence against her/him. Respite services, especially home help services, have been proven to be one of the best measures to reduce caregiver burden thus allowing care to continue at home.
In 2006, the Castilla y Leon Spanish Autonomous Region identified a need to provide help at home for informal caregivers. The objective of the aid was to fund a support person for the household chores. The purpose of this was to enable informal carers to have more personal time alongside the task of caring. In addition, an important social impact was that this support role provided additional employment opportunities for women, and also had the potential to add to the national health and social care tax contribution. This in turn could reduce carers’ social assistance needs, resulting in savings in social and health costs and resources.
The measure was funded by the Social Services of the Regional Ministry of Castilla y Leon, the European Social Fund and the municipalities providing the service. It ended however in 2009 because of changes in the law which allowed informal carers to receive remuneration for their caregiving duties, thus rendering the programme redundant.
What is the main benefit for people in need of care and/or carers?
The main benefit for informal carers is that they are able to count on a support person for the household chores, permitting the carer to have more personal time.
What is the main message for practice and/or policy in relation to this sub-theme?
The specialised support of the carers is important as it helps to maintain older people in their homes for longer, reducing the need for instituionalisation. In this way it contributes to reduced government costs in LTC.
Why was this example implemented?
Caring for a dependent person creates a considerable burden and very often, providing the required care exceeds the informal carer’s physical and mental capability, which results in chronic stress. It has been proven that home help services for dependent people and their caregivers increases their quality of life (Carretero et al., 2007; 2009; Garcés et al., 2009).
The aim of this programme was to bridge the gap between informal carer’s need for support and assist with maintaining older people in their homes for longer periods. With this in mind, the purpose of the programme was to fund employment for a third person to support the informal caregivers by carrying out daily house chores, providing them with more personal time away from their caring activities.
The beneficiaries from this programme were informal carers of people with LTC needs who live in a municipality belonging to Castilla y Leon Autonomous Community.
Description
In 2006 the Social Services department of Castilla y Leon identified a need to provide help at home for informal carers. It came to their attention that there was an increasing demand in the Social Action Centres (CEAS) for this kind of help. Consequently, the Regional Ministry of Castilla y Leon decided to add this kind of support to the Framework Agreement. This Agreement sets out the co-funding of basic Social Services performed by Local Entities and it regulates funding for different actions.
The aid funded the employment of a third person to support informal carers in household chores. Even though the informal carers could ask for aid for themselves, the most frequent way of including caregivers within this programme was through the CEAS. In these cases, the CEAS social worker was responsible for identifying families in need of aid and for delivering the application to the municipality. Eligibility criteria for the informal carer included being a relative of the older person, caring for a person over 65 years with a high level of need to undertake activities of daily living, and living in the same household. The caregiver could also not be in receipt of any remuneration for providing care. Eligibility criteria for the older person included establishing a level of dependency according to an assessment scale specific to this Spanish region. This assesses eight activities: getting out of/into bed, bathing / showering, dressing / undressing, personal hygiene, eating, mobility, negotiating stairs, and continence. To access help the older person has to score three points (total dependence) in at least five of the eight activities.
The amount of funding received by each family was dependent on their level of income and on the size of the family. The maximum amount funded was 100%.
This application process was very simple and could be made at any time. After the aid was approved, social workers were in charge of monitoring the family and the aid was given as long as needed. It was only refused if the social worker identified a reason to stop it.
The resources allocated to fund this action came partly through the European Social Fund, by the Castilla y León Autonomous Community and by the municipalities (who had to fund 10% of the aid given to their citizens) with a total budget of €1,408,362 in 2009.
What are/were the effects?
Since this aid was managed and promoted independently through the municipalities, there was not a body of evidence available to assess the worth of this programme for the whole of Castilla y Leon. Only some data is available about specific municipalities.
Even though there are not specific studies about the impact on the quality of life of the beneficiaries of this programme (caregivers and dependent people from Castilla y Leon municipalities), home help services have been identified as a suitable way of reducing the caregiver burden, reducing the stress suffered and increasing their quality of life in studies with similar services to those in this example (Carretero et al., 2007; 2009; Garcés et al., 2009). It had the potential therefore to impact on the lives of the recipients.
From the beginning however this regional aid was incompatible with a number of other public benefits for the older person, particularly with the home help service. This included economic benefits (third person support for Social Integration of Disabled people, severe disability contributory pension and the economic complement to the non-contributory pension, through the need to help others to perform ADLs); and support services to informal caregivers (such as respite care, with temporary income in a nursing home or day stays in a day centre). The National Dependency Law in 2007 introduced new financial aid, including the provision of direct support to family caregivers, including them in a special social security scheme which allowed them to care for older people with care needs, and receive remuneration for their work.
Because of the latter, the action ended in 2009. The reason was that this aid became incompatible with the Spanish Dependency Law, which considers that informal caregivers also have specific needs that must be addressed. This incompatibility set out in the New Law in effect rendered the programme redundant and meant that in 2008 and especially in 2009 the demand for the aid decreased until the Castilla y Leon Regional Government decided to terminate it.
For example, in Burgos, a city with nearly 180,000 inhabitants, 29 caregivers were supported by aid in 2008. This number was reduced to 19 in 2009. In Valladolid (in excess of 300,000 inhabitants), the number in 2007 receiving aid was 51, while in Zamora (nearly 70,000 inhabitants) there were 8. The pilot programme was only applied in some municipalities.
What are the strengths and limitations?
Strengths
- While the evidence is scant, this programme can enhance the relationship between the informal carer and the person being cared for and the quality of care provided.
- Potential to increase the inclusion of informal carers in the labour market.
- Increased inclusion of the unemployed in the labour market. According to regional government data, during the period 2006-2009, the programme allowed the recruitment of 467 people, mainly women.
Weaknesses
- Low budget for the programme.
- Low demand for aid during the last years.
- No proper evaluation of the programme to establish its value.
Opportunities
- Easily transferable to other Regional Governments.
- Potential for decreased expenditure to governments by reducing the need for institutionalisation of dependent people in day care centres and residences. For example, the savings for the government could be very high, since the average cost per person of the programme was €1,374 per year, with an average duration of 4 months, while a place in a nursing home for a single month exceeds this amount (average price €1,550 per month).
Threats
- The low budget for this programme means that few people were involved.
To obtain an effective programme, the duration of the aid must cover all the time necessary for caring. In some cases this does not happen and there is a break in the providing services, without solving the problem.
Credits
Author: Stephanie Carretero, University of Valencia (Spain) – Polibienestar Research InstituteReviewer 1: Rastislav Bednarik
Reviewer 2: Ricardo Rodrigues
Verified by:
Links to other INTERLINKS practice examples
External Links and References
Contact:
Peer reviewed journals/systematic reviews:
- Carretero, S., Garcés, J. & F. Rodenas (2007). 'Evaluation of the home help service and its impacto n the informal caregiver’s burden of dependent elders' in: International Journal of Geriatric Psychiatry, Vol. 22: 738-749.
- Carretero, S., Garcés, J., Rodenas, F. & V. San José (2009). 'The informal caregiver’s burden of dependent people: Theory and empirical review' in: Archives of Gerontology and Geriatrics, Vol. 49: 74-79.
- Carretero, S., Garcés, J., Rodenas, F. & M. Vivancos (2009). 'The care of the informal caregiver’s burden by the Spanish public system of social welfare: A review' in: Archives of Gerontology and Geriatrics, Vol. 50: 250-253.
Policy Documents:
- http://bocyl.jcyl.es/boletines/2009/06/10/pdf/BOCYL-D-10062009-37.pdf
- http://www.redtcue.es/export/system/modules/com.tcue.publico/resources/DescargasTcue/FEDER_Castilla-Leon_2007-2013.pdf
Unpublished/web-based documents:
