Financial Support for Family Carers
The policy context for supporting family care-giving [1]
International approaches
Internationally, the high level objectives of government policies on care-giving are similar and cover: the wellbeing of clients; supporting family and other relationships, and fiscal prudence. Specific country policies, however, tend to reflect assumptions around family and unpaid family work, as much as they reflect research on what works best.
Lundsgaard’s (2005:12) investigation into the long-term care of older persons, which explored five main country contexts for family care in OECD countries (New Zealand was not included in the study), showed the importance of cultural norms as well as financial incentives in different approaches to care. He identified:
- countries where long-term care primarily occurs informally within families even though nursing homes and other residential care is predominately publicly funded (Korea, Spain);
- countries where there are high levels of public funding used for formal services provided in homes as well as for institutions (Netherlands, Norway and Sweden);
- countries where a significant share of the funding for long-term care is used to fund family care through either granting allowances to care recipients who can then choose their carer (Austria, Germany and Luxembourg), or through allowances to family carers (Australia, Ireland, United Kingdom);
- in Japan, there is substantial family care, with no financial support. Formal care alternatives are growing as a result of mandatory long-term insurance;
- in the United States and Canada, an increase in consumer directed care has introduced limited arrangements where relatives can be paid.
Formal care services and family care in New Zealand
New Zealand’s current policies are closest in approach to the Australia/Ireland/ United Kingdom model of providing support directly to carers. Policies include relief care for family carers (which other family members from another household can be paid to provide at a reduced rate), an income and asset tested benefit (DPB for carers), and a non-means tested child disability allowance paid to families. Many countries provide more for family carers than New Zealand does. Small, non-means tested allowances are paid to family carers in Australia and Ireland, for example.
The proportion of GDP spent on publicly-funded care services in New Zealand appears to be low; in a 2000 comparison on public expenditure on long-term care for older people, New Zealand had the second lowest (next to Spain) share of GDP spent on long-term care for the elderly. The expenditure was relatively low even when adjusted for different population profiles (OECD, 2005).
In 2005-06, NACEW estimated that there were around 40 - 50,000 formal carers in New Zealand with around 18,000 - 20,000 providing care for clients at home, and the rest working in residential institutions (NACEW, 2007).
Care services in the home are accessed in several ways: ACC provides services for people disabled by accidents; Disability Supports are provided to people with long-term needs through Ministry of Health Disability Supports (if aged under 65) and District Health Boards (aged over 65), usually following a formalised needs assessment process; and care services are provided when leaving acute care in hospital. While all processes refer to the need to take into account informal family carers, there is no explicit guidance on what this should mean in practice for formal care provision. There are only limited provisions within formal care packages to pay family carers. ACC, for example, sometimes employs family members to provide care.
Many people in need of care at home are not receiving comprehensive packages of formal services. This means a sizeable care load is being carried by family carers. Davey and Keeling’s (2004) study of workers with eldercare responsibilities in two New Zealand City Councils found that while the vast majority of working carers were providing less than 10 hours’ care a week, some were combining employment with more than 20 hours of unpaid care.
There are cases where almost all the care is provided by family carers and this is reflected in the DPB for carers, and relief care, being largely focused on the needs of full-time family carers.
Goodhead and McDonald (2007:25) argue that New Zealand views about where responsibility rests for those needing care “have turned full circle from societal expectations that family should be totally responsible for the care of dependent members, through a period of state support with the provision of institutional care, back to an expectation that the family will take increasing responsibility for family members.
[1] In broad terms, family care-giving refers to the unpaid care of children (including disabled children), and the care of other working age adults and older adults, arising from frailty, illness or disability. Typically family carers are relatives or partners, but sometimes are friends, or other close associates.
This discussion excludes the predictable care requirements of children for pre-school, after school and out of school care, along with the predictable needs of mothers and other parents for leave; that is, the bulk of unpaid care of children carried out by parents. Family care includes routine and non-routine and emergency care. Routine care is ongoing and anticipated, whereas emergency care arises with an event that cannot be predicted with any certainty and is likely to be sporadic and intensive. It can be long-term, as is the care of a disabled child or an older person who is chronically ill, or it can be short-term care.
