Working with Adult Carers - Term Paper Example

Working with Adult Carers Care shapes our everyday’s relationships and lives. Caring practices and relations influence different society’s economies. Care giving varies across various aspects of race, social- economic status, families, and gender differences. These aspects intersect in crucial ways in the people who provide care. Over the lifespan, unequal opportunities shape various negative and positive trajectories for caregivers and those cared for (Harris 1990, p.56). Research conducted on gender and care giving has shown that women are the majority caregivers. Adult daughters take the responsibility of caring for their elderly or sick parents while wives give care to their elderly or sick spouses. Studies on care that were linked to the feminism show that the society assumed that care was an activity naturally for women. This was a result of creating awareness of how women carried out various chores of caring for their families and homes without any pay, just because it was believed by the welfare and economic state that it was a natural obligation for them to the labour with no pay. Theories and research that were conducted aimed at investigating the position held by women in the state and at home. The society at that time believed that married women should care for the disabled, elderly, spouse and other family members without pay. Women offered informal care, but opportunity, material, and personal costs they incurred were not catered for by the state. Due to this feminism approach, research at that time focused on the burden of care as described by feminists. Some negative effects were highlighted and documented about caring for the elderly, disabled, and sick people. Emotional effects, limitation, and stress associated with caring were documented (Dent 2003, p.303). The feminism approach thereafter led to the welfare state paying attention to women who were married and were in the bracket of working age. At the same time, male carers were used in various studies but there was tremendous evidence that they were supported by the state welfare more than the female carers (Adams & Porteus 2003, p. 136). The issue became a political one, and this led to many advocacy organizations emerging. Support programs for carers were used by various policy initiatives to respond to this issue. These feminism developments led to the introduction of the term Carer. Another approach that emphasized on features of caring that is socially desirable and positive emerged in America. The approach focused on care ethics rather than the burdensome reflected by feminism theory. Furthermore, it described the relationships formed during care. An activity of relationships formed when one sees and responds to another person’s need is, therefore, caring. This action ensures that there is interconnectivity because the world is taken care of and no one is left without help (Gilligan 1984, p. 73). Activists of disability argue that the policies and languages used upon care are objective and oppressive. There have also been arguments about the issue of dependency and has been used widely in the field of care. Cognitive and physical incapacities are the reasons many people suffering from Alzheimer and old age seek assistance either from the family members or care institutions. In the year 1981, Parker termed care as tending. This is because people are made to believe that the caregivers and the people who provide care for them are different. The needs, interests, and perspectives from both participants are seen to be radically different. This disparity comes because of theories and studies related to care giving and dependency emerging from theoretical perspectives that are very different. The study of the two concepts has also proceeded along different directions. The terms dependency and care, although studied as different entities, they serve to explain and explore the same phenomenon from different perspectives. The caregivers are seen as having influence to provide care for the needy while the dependants are seen as having powerless dependency (Doraiswamy, Gwyther, & Adler 2008, p.300). Dependency is assumed negative and cold especially when it is used to describe care for the elderly. Care, on the other hand, is assumed positive and heart-warming. The dependency that arises from elderly or sick is a social construction, and it is depicted as shameful in most societies. In 1994, Fraser and Gordon came up with various registers of dependency. These registers were social, legal, moral, political, psychological, and economic dependency. Gentological research shows that these registers play a role at specific stages of course of life (Harris 1990, p.356). As indicated, the elderly and the sick people experience psychological and physical dependency, as in the case of Don and Mavis. Don, who is suffering From Alzheimer disease, needs both psychological and physical support since he cannot remember and do all his chores. On the other hand, Mavis is old, and her mental and physical health is deteriorating. Social and political actions are assumed to create dependency among the elderly. The state welfare can create dependency among the elderly by inadequate pensions to the retired people and support for health services. In addition, the society assumes that people who cannot perform their daily chores due to physical or psychological inconsistencies need care, and are, therefore, dependent. Conventional approach to caring oppose the social construction perspective and describes dependency as an individual attribute. Between dependency and care are overlaps, parallels, and causal interrelationships. For example, Don is dependent on his wife’s caring due to his condition. A need to be assisted denotes dependency, and the need can only be met through care provision. Additionally, dependency might increase due to increased care. Studies conducted on informal care argue that gender is not an influential factor when it comes to older men or women acting as carers. Older Receivers and providers of care are very difficult to distinguish in terms dependency based on social, emotional, personal, and health needs, from the carer who meets those needs. Don and Mavis are old, and both of them have some needs. Their needs seem to be balanced since Don is suffering from Alzheimer and Mavis is suffering from old age. In 2000a and 2000b, Shakespeare argued that the concept of dependency and care were negatively loaded, therefore, a need for their replacement. He said that the term care was best- replaced by the term help. The term help according to him reflected the possibility of more informal practices and networks of the community and social forms of alternative support. However, this approach was criticized, as it did not address the issues of inequality and the role of the state in regulating and managing risks, behaviours, and resources. Although this approach has some limitations, it offers some insights in caring. Individual’s experience interdependence through multiple episodes of dependency. According to Ferrell & Osterwell (1990, p.411) people feel a sense of completeness through social cohesion that is achieved through people depending on each other to succeed. Thus, exchanges between the social worker and the sick person over time, reciprocity between them, and networks generated from the exchanges, forms interdependency. Studies that have been conducted recently argue that caring is dominated by reciprocal dependence qualities. Moreover, care is best described by relationship between care providers and receivers. Early studies suggested that caring was unidirectional activity. They reflected the role of the caregiver as active and that of the care receiver as dependent and passive. Don and Mavis are intrinsically involved in the production of care, since they both depend on each other’s support. Caring for people with Alzheimer and the elderly takes place in the social and historical context. Studies conducted in the past and the ones conducted today suggest that friends and family at home provide most care. However, there have been changes occurring in the structure of the family that have led to care receivers looking for and using formal care. These changes are delayed child bearing, decreased family size, single parenthood, and rise in divorce cases. In addition, the number of women in the labour force denotes that care receivers will use nursing homes, care homes, and assisted living. Majority of people who give informal care do that with the support of formal support. The state provides various services to the people with psychological and physical inconsistencies, including support services, community care, social security, and residential care services. The state ensures that there are community centres that offer training, education, counselling, referrals, meals, and drop in services. The state also ensures that care services are subsidized for a longer term. Gerontologists over the years have argued about the importance of understanding the relationship between informal and formal care around the world. Mavis and Don need both family and formal care since both are elderly, and Don is suffering from Alzheimer. Studies show that both informal and formal care intersects. Conventional models of caring suggest that caring is created through social relationships with close family members and formal workers. It further argues that close members, especially kin are preferable than formal workers. The spouse is the most preferred, then children, then relatives, and then followed by friends (NAPA 2005, p.70). The substitution model by Green in nineteen eighty-three, suggest that informal care is replaced by formal care once it is introduced. Thus, there is existence of an interface between the informal and formal care since the informal carers use formal care as a substitution to their care. In 1985, Litwak task specifically model argues that the type of the caregiver is determined by the care task. According to this model, trained and skilled caregivers characterize formal care. Informal carers, therefore, work with formal carers. The complementary model by Chappel and Blandford in 1991, argues that informal care can be supplemented and compensated for by formal care based on the urgency of needs of the care receiver. The feminism approach argues that the two concepts are overlapping. Alzheimer Association (2013, p.230) suggest that most gender studies on caring elderly and people with Alzheimer suggest that women provide more care than men do. Feminism perspectives argue that women took the responsibility of caring for their spouses, children, and relatives, reflecting caring as a burden. Recent studies show that there has been a rise in men carers today. Although women give more care, both men and women experience the burdens equally. Patterns of caring behaviour amongst families or social groups distinguished by class or ethnicity are learned over time, through relationships between individuals in place and space. Recent findings also suggest that men experiences difficulties in assuming responsibilities related to multiple roles. On the other hand, women have learned new and important roles besides the ones assigned to them as natural carers. Being gay, bisexual, transgender, and lesbian carer can be problematic due to fear of discrimination. Such caregivers experience difficulties of getting support services that are friendly to them, and the people they care for. Many of them fear to come out due to fear of being discriminated against. Today, the LGBT carers are more visible and confident because awareness has been created about their needs and many social support services are ready to welcome them. Training about non-judgmental caring has also been a key to many social services. LGBT people have also been able to access services that are culturally appropriate and supportive to their needs. Lesbians, gay, bisexuals, transgender have other aspects that define who they are like race, age, faith, and disability; thus, social orientation is not the only aspect that determines their identity. Specialist services and sensitive mainstream services have been accessible to LGBT caregivers and care receivers. Therefore, practitioners, providers, and commissioners should ensure that LGBT carers and care receivers are treated with respect, dignity, and give equal opportunities like any other carer (Adams et al., 2003, p.45). Lesbian, bisexual, and gay people suffering from Alzheimer and their friends, carers, relatives, and partners faces more problems than people of different sex. In traditional support groups, older lesbians, gays, and bisexuals feel uncomfortable and anxious. Most of them fear that to access support services due to fear of their various needs not met. A holistic approach that recognizes that older and people suffering from chronic diseases have other cultural, social, sexual, religious, and emotional needs should be adopted by care services. People experiences complex situations as they progress through life. People need physical care in a different point in life through the lifespan. A child depends on its parent care, and an adult depend on physical competence, while the elderly dependency is brought because of mental or physical needs. The work of a social worker is to ensure promotion of community and human wellbeing. The lifetime perspective ensures that social workers understand the relationship between human behaviour and time. For a social worker to understand the life of his or her client, it is recommendable to begin by analyzing an event history, transitions in the life a person, significant events sequences, and life experiences. Erikson’s theory describes development of life in eight stages that each individual passes through life. A crisis occurs that in each stage of development and according to him, it must be resolved in a positive way for a healthy life. The age at which Mavis and Don are in is described as the stage of Ego integrity versus Despair. At this age, they both review their life experiences and analyze the significant of these experiences. At this age, people experiences mental and physical deterioration. As in the Case of Don who is 68, he suffers from Alzheimer and his wife who is older than him is suffering from physical and emotional needs. The life expectancy of People suffering from Alzheimer is Unpredictable thus much care should be provided to them for maintenance of integrity at this point in life. The equality act 2010 was welcomed well by the Alzheimer society. This act replaced discrimination laws that were previously developed. The act argues that it is illegal to treat people unfairly due to their disability, age, gender, race, sexual orientation, transgender, or religion. The introduction of equality act was done in 2010, and its application was done in 2012. The equality act is, therefore, important in dealing with people with Alzheimer since it addresses the effects Alzheimer has on capacity and communication (Alzheimer Association 2013, p. 238). During decision-making, professionals overlook people’s preferences. In addition, the act addresses the mistaken and negative assumptions about age as a contributor of Alzheimer. Alzheimer society works to create awareness on the rights of people suffering from Alzheimer and people who care for them. Don, who is suffering from Alzheimer and his wife Mavis, should be treated with respect and dignity. They both have a right to care of high quality. The care provided to them should be based on personal preferences and needs assessment. The stigma associated with dementia should be dealt with, for carers and sufferers to be comfortable and play a supportive role in the community. Although the Equality act was introduced, people who suffer from Alzheimer disease and their carers are seen as zombies thus the discrimination against them is still high today. The stigma associated with this disease is not only associated with disability and age, but also to the discrimination against the condition itself. Consequently, the support services, care delivery, and historical design of people with dementia have been affected. This has led to limited access to care support and low care quality. Research shows that the majority of carers have high ratings of capacity and motivation at the beginning of the caring process. After some months, the capacity and motivation rating is reduced. In the case of don and Mavis, the rising physical, emotional and mental needs experienced by Mavis are making her to lose motivation and capacity to care for her husband. Her age, the behaviour problems by her husband, and their relationship also contributed to her low motivation. Don becoming angry on various occasions and hitting out on her led to her feeling a sense of helplessness, and she was found crying in various situations. Thus, a social worker should offer professional practice that meets the needs of Mavis, Don, and their families. To care for a person with Alzheimer requires capacity and commitment for caring by the caregiver. These capacities unfold over time through various phases. First, a carer develops a caring capacity for the sufferer. Second, he or she develops capacity for self-care and finally develops capacity to care for others. Others also become caregivers of humanity to expand their self, due to the experiences they encountered as caregivers at home. Some caregivers reported that the motive behind their caring for people with Alzheimer was concern for these people. Others reported that love and moral obligation as behind the motive. Caregivers should use the person-centred approach in caring for people suffering from Alzheimer and old age. The aim of this approach is to define the care receiver as an individual rather than defining a care receiver in terms of their lost capacities or illnesses (Gwyther et al., 2008, p .33). There is a need for social services to treat sufferers as a whole, instead of treating them as a collection of behaviours and symptoms that need to be controlled. Don has different unique qualities from those of her wife. During the assessment, their needs, preferences, interests and abilities should be treated as unique to individuals. Although they are married and old, does not mean that their needs are the same. Both should be treated with dignity and respect. In addition, the family members should not be treated as visitors but as part of caregivers. This is because family members might be having relevant information about the sufferer that can be of help to the caregivers. The assessment will be conducted to both Don and Mavis, and Don will be at the centre of the process of decision making. This will determine the care they need and how these needs will be met. The assessment will focus on the memory, living arrangements, care arrangements, physical inconsistencies, their worries, and support that they prefer. Mavis concerns will also be assessed. A self-assessment questionnaire will be administered to Don, and he will be assisted to answer the questions to ensure that all his needs are met. Care giving can be sometimes a burden and can cause psychological and sociological effects to both the carer and the person cared for. The carer of a person with Alzheimer not only meet the physical needs of the patient, but also ensures that the care receiver is stimulated by physical and social activity. Mavis has been taking care of her husband but due to ageing, she feels that she needs more support. For her not able to figure out how she can get more support, makes her teary most of the time. Faced with all these responsibilities, Mavis may become a victim of depression and illness. Studies conducted on family caregivers show that psychological and physical problems are associated with carers. Most of them suffer from depression, stress, alcohol and substance use, and illness. The cost of care services might also lead to psychological problems especially if the carer cannot afford. Resentment by carer can also lead to him or her neglecting the care receiver. Some also take advantage of financial possessions of patients suffering from Alzheimer. Therefore, caregivers should be provided with support from family members, the state, and the community as whole (Osterwell et al., 1990, p.414). Good communication is fundamental in assessing carers and persons suffering from Alzheimer and ageing. Effective communication between Don’s family and me will be of importance during assessment. Since communication is a two way process, I will ensure that my communication is clear and allow Don and Mavis to communicate with me. Good communication skills ensures that body language relate to what we are communicating since communication involves the activities of the body. Use of offending words that can create emotional arousal or anger to them will be avoided since they can interfere with communication between us. Accepting and actively listening to their needs will demonstrate a sense of warmth, which is a priority to empathy. Alzheimer Association (2013, p.218) having good knowledge about Alzheimer disease facts and procedures is also important to the social worker as it demonstrates confidence. The purpose of assessing Don and Mavis is to find out the circumstances they are in, and what are their needs are. The support they need will also be of focus. Decision-making will be determined by the needs of Don, who need support. Both Don and Mavis will be fully involved in their own care planning and assessments. A separate assessment will be conducted on Mavis to find out the care that has already been met and that which will be met by the caregiver. Moreover, to know whether she participates in any educational and training activities or whether she is willing to participate. Carers are entitled to an assessment of their specific needs as described by the Carers Act (Alzheimer Association 2013). This is if they intend to, or are providing care regularly. The assessment will take place at their home, so that I can get a clear picture of how they are coping and what support they might need. The assessment of Don and Mavis will be completed in one visit. Questionnaires assessing their living and care arguments, disabilities, health, worries, their preferred support services, and caregiver’s concerns will be administered (NAPA 2005, P.67). Assistance will be given to Don, who might be suffering from dementia. If their need falls within the local authority eligibility criteria, Don and Mavis will be given effective support that ensures that their needs are met. Together we will develop a care plan that list out the best services to be provided. A copy of the plan will be left with the carer or the service user to ensure a good followup. I would recommend community nursing, since Mavis feels that she needs more support to care for her husband due to complications brought about by her ageing. The ethical consideration of respect for autonomy can conflict with the social worker’s competence to provide effective safety and decisions. A person suffering from Alzheimer has a right to appropriate treatment. They should not be denied medical care due to their condition. In addition, they have a right to know about their diagnosis (Adler 2008, p.89). The developmental theory by Erikson suggests that development of personality is experienced through stages. Each stage is characterized by a crisis that is either resolved successfully or its fails to resolve. People suffering from Alzheimer are in the stage of ego integrity versus despair. At this stage, they review their life experiences to know its significance. Harris (1990, p.19) suggest that it is difficult for Alzheimer sufferers to review their past due to loss of memory. Therefore, they should be given care that promotes integrity for life contentment and satisfaction. Positive resolution brings wisdom that helps the care receivers not fear death. The assessment of needs of both the elderly and people suffering from Alzheimer should adopt a person centred approach that sees each individual as unique and should treat each individual with dignity and respect. The person centred theory and Erikson theory of personality development are important in the assessment of Alzheimer. They help us understand that care experiences and exchanges are affected by the timescales of the human life course, and generational exchanges of care. Also, a person experiences so many complexities throughout the life course and the best way to address these complexities is by use of an approach that views individuals needs as unique rather than the caregiver’s efficiencies. A wide range of theoretical and empirical studies has been used to explore the processes of care. How care practices and knowledge are exchanged over time and across space have been discussed. These exchanges occur through legislation, institutional practices, and in form of communication. As a result, care related services and policies, and informal and formal practices of care are influenced. References Adams S, & Porteus, J, 2003, Having Our Say: A Housing Action Kit for Older People, Care and Repair, Nottingham: England. Alzheimers Association, 2013, Alzheimers Disease Facts and Figures: Alzheimers & Dementia: The Journal of the Alzheimer’s Association, 9(2), 208–245. Dent V, 2003, Group Activities with Older Adults. Speech mark Publishing Company: Bicester. Doraiswamy, P, M, Gwyther, L, & Adler, T, 2008, The Alzheimer’s action plan: What you need to know—and what you can do—about memory problems, from prevention to early intervention and care, St. Martin’s Griffin: New York. Ferrell B, & Osterwell, D, 1990, Pain in the Nursing Home, Journal of the American Geriatric Society, 2 (38), 409-414. Harris, D, 1990, Sociology of Ageing, Harper and Rowe: New York. NAPA, 2005, The Good Practice Guide to Therapeutic Activities with older people in care settings, Speech mark Publishing Limited: United Kingdom. Read More