Financial Support for Family Carers
NACEW’s position on family carers
To determine NACEW’s view on financial support for family care giving, three possible policy approaches to family care-giving were considered (the full analysis is in Annex Two). They are:
- mandated family responsibility – the family is obliged to offer in-kind or monetary payment for services
- government payments and supports to family caregivers to provide relief, or to help them cope with the short and longer term costs of care-giving
- increased formal care so as to allow family members to stop or reduce care (adapted from Kane and Penrod, cited in Guberman,1999:63).
NACEW’s conclusion is that the most important support base for family carers is the quality and quantity of formal care services available to clients at home.
Comprehensive quality services will give family carers the confidence to make normal life choices without worrying about the care their loved one is receiving. As we recommended in our report Improving the Quality of Work for Women in the Homecare, Residential and Cleaning Sectors, improving the quality of the formal services provided in the home requires the precariousness of employment to be addressed. Precarious work undermines the self esteem and wellbeing of workers, and is associated with low investment in skills, low morale and high turnover (NACEW, 2006).
Skilled, supervised and supported workers are critical to the provision of competent, safe, reliable and empathetic quality care services. Comprehensive packages of care, based on need, would legitimate family carers’ rights to a normal life. The transition NACEW recommends occur is parallel to the transition that has occurred in relation to pre-schoolers where parents can now feel confident that early childhood services provide quality care and education. The majority of mothers of pre-schoolers, as well as fathers, now choose to undertake some paid work.
The importance of the affection, support and contact with others that family carers provide to ill or disabled loved ones cannot be underestimated and cannot easily be replaced by formal services. In NACEW’s view, this is the core role of family carers. Formal care is a complement to this core family role. British studies have found that the provision of complementary services to people needing care is an incentive for individuals to take on care responsibilities, because they know they will not be faced with the full responsibility (Woolley, 2001).
Assumptions that family members can provide large amounts, and sometimes 24/7, care, are unfair, because they:
- make it difficult for some carers, including young carers, to manage education or work as well as providing care,
- impose a double burden on carers who are in work, studying or have other caring roles, and
- take a toll on older carers who are nominally “retired”.
Anecdotal evidence also suggests that some people advocate for comprehensive care packages more effectively than others. Some are also far more vulnerable to being persuaded into taking on a large informal caring role. Studies on family carers show they are at high risk of social exclusion – in other words, to limited social interaction, impoverishment, being out of job and not accessing services [1].
There are substantial economic costs for these family carers, as they are often trapped in situations of low status and low or no pay, even after their caring responsibilities cease. Moreover, the economic costs are greater for Māori and Pacific populations than Pākeha populations. These problems are likely to get worse as the population ages and women’s labour force participation continues to increase.
NACEW supports greater clarity around the expectations of family roles and formal care services, so that:
- transparent guidelines counterbalance the current incentives for many funders to reduce home-based services where there are strong supports available
- families and individuals who provide care are not unduly burdened
- the responsibility for providing personal care and specialist supports rests with funder or their agent, not with family carers.
There is scope within a framework like this to employ and pay family carers as part of the formal package of care. This occurs already in ACC and is common in countries where budget or direct payment approaches give consumers a greater choice over the specifics of care they receive.
Providing an option to employ family carers to perform substantive caring tasks is fairer and more efficient than having a separate stream of support for family carers. Separate support systems for family carers have a number of problems including:
- the appropriateness of legitimising some full-time caring roles, for example for young people and people over retirement age
- long-term, full-time caring roles, such as those supported through the DPB for carers, conflict with labour market objectives for women, as well as having risks of poor health and social exclusion
- carers who can only earn a low wage [2] are likely to face disincentives to take on employment, which will entrench their labour market disadvantage (Lundsgaard, 2005)
- cultural factors, as well as physical and emotional needs, impact on the provision of family care, and make it difficult to identify the roles that should be paid for
- whether all carers should be paid, or just those not in employment (akin to the wages for housework dilemma).
A new framework for supporting family carers
NACEW supports a framework for family caring that is based on the following principles:
- that the unique contribution of family carers is the provision of emotional and associative care and this needs to be recognised and valued as a priority
- that formal care packages are comprehensive responses to the intensity of a client’s needs, and do not make assumptions about the family supports available
- that a client and their family members can opt for greater family involvement in care arrangements and negotiate the basis of their involvement within the care package provided
- that individual family members who are contracted into explicit service roles have similar protections and rights as other workers.
What does the NACEW position mean for financial support for family carers?
Would people who care for another family member receive financial assistance from the government?
Paid roles for family carers would need to be agreed by the client and the family carer as part of a comprehensive client care plan. Any paid role taken on by family carers would be explicitly included in this plan as a replacement for a service that would otherwise be provided formally.
Family members and friends would not be paid for the normal activities of relatives and friends, such as providing emotional support and helping people stay in touch with their friends.
Under what circumstances should the government provide financial support to such carers - e.g. short-time versus long-term caring situations; where a person has had to reduce or give up their paid employment to assume their caring responsibilities; or whether or not a paid, formal carer is available to support the family?
The payment would be made for explicit roles required within customised client care plans. Family carers could have other paid employment. The only requirement for a family member to receive payment for care work would be that they provide the designated services. The arrangement is most likely to occur when the care need is long-term and predictable, as in the case of a person with tetraplegia, or short-term and intensive, such as the care of someone who is terminally ill.
What would be the objective(s) of providing financial assistance to such carers – e.g. to compensate a carer for lost earnings where they have reduced or given up paid work to provide care; to offset the costs incurred from caring for another person; or as a payment for services provided?
The objectives of providing payments to family carers would be to:
- enhance the choices of people being cared for and the choices of their family carers
- extend the range of options in developing quality care plans through incorporating family carers
- value family carers and compensate them for designated roles beyond the things that family members normally do for their loved ones.
What level of financial support should be provided – e.g. should lost earnings be fully or partly replaced; should costs be fully or partly met; or should a family member be paid at the same level as a paid care worker?
As the family member would be contracted to undertake specific tasks, they would be paid the market rate for the tasks being performed. In other words, payment would equate to that received by workers delivering formal care services.
How would the provision of financial support interact with other entitlements available to such carers – e.g. should employees who have access to job-protected leave also be entitled to financial assistance; what other assistance is available to a carer including social assistance provided by ACC and Work and Income; or what other financial assistance might a carer need in addition to assistance the person being cared for already receives (i.e. the needs of carers separate to those of the person needing care).
NACEW supports the recent legislative provision which gives family carers the right to request flexible work arrangements to manage caring responsibilities. Because care needs can be short or long-term, and are not necessarily predictable, it would be unfair on employers to expect job protection arrangements to cater for every caring situation, particularly long-term arrangements.
Where family carers are involved on a long-term basis, NACEW supports continued improvements to provisions for leave and requesting flexible work hours to give more carers the opportunity to maintain their paid employment at the same time as being involved in care.
Where a family member is contracted to provide care, they would, in effect, be an employee or self-employed and receive training, ACC cover, Kiwisaver entitlements, and pay tax on the same basis as any other paid worker.
NACEW envisages that relief care arrangements and the child disability allowance would still be available.
[1] These indicators are more fully discussed in Saunders 2007.
[2] Of all recipients of the DPB (CSI), 58 per cent had been on this benefit for over twelve months, and 38 per cent for two years or more.
