Community care shifts responsibility for care to the family in general and to women in particular.

Definition of community care

Ø Community care is a broad almost indefinable concept and much has been written about the contentious nature of both ‘community’ and ‘care’. The disability movement criticise to the concept of ‘care’ as it implies passive recipients and powerful providers. Put together, ‘Community Care’ has been used to describe the development of domestic-scale residential establishments as opposed to huge campus institutions; the development of domiciliary care delivered to people’s own homes, and informal care provided by spouses, other family members, friends and neighbours. It can be both informal and professional.

Department of Health 'Caring for People' 1989 'provision of services which people who are affected by problems of ageing, mental illness, mental handicap or physical or sensory disability need to be able to live as independent a life as possible in their own homes or in homely settings in the community.'


Arguments For...

Gender

Gendered assumptions contribute to the social construction in the process of implementing community care. There is a significant relationship between gender and caring in social work and social care. There is a specific focus on a woman’s capacity to undertake care work. Women are seen as a ‘natural’ carer. This sex-role stereotyping has led to women being confined to the roles which are predominantly unpaid. These roles include looking after the family: children, adult relatives and others within the community. They are more likely to be seen as having ‘typical’ feminine qualities of care Married women (daughters/daughters in law) were the family members who provide care for relatives, including moving the cared for person into their own home. It is suggested that male and female behaviours differ in the way that they cope with emotional issues, this relates to their capacity to nurture. Links to gender identity – women could feel threatened that a man could take over their natural role. However, men within care roles are increasing. It is still females who practice the majority of personal care and men managerial roles. Common male carers are those looking after their wives etc.

Distinguishing informal/formal care

Informal care is mostly unpaid and within private homes – ‘duty care’. The state saves money by transferring the role to family members. There are benefits, direct payments etc…but barriers which prevent this including lengthy forms and the use of jargon. It is also unknown how many informal carers there are and will be more than records show. As for formal paid carers this is reordered. However there is a high percentage of women in informal care in many countries, as studies show:

Percentage of adult population whose daily activities include caring for sick, disabled or frail adults without pay by sex 1996:
France: 27% women, 14% men
Germany: 33% of women, 19% of men
Ireland: 44% of women, 19% of men
Italy: 41% of women, 18% of men
Netherlands 45% of women, 34% of men
UK: 43% Of women, 26% of men

It could be argued that if insufficient resources are put into community care, families often have no choice but to intervene. Dalley (1996, in Ideology of Caring) discusses when professional services are insufficient, extended networks e.g. Neighbours, friends, or more commonly the person/small group closest to the person intervene with additional support to ‘make-up’ this deficit. Twigg and Atkin (1994, in Carers Perceived) also discuss how feelings of responsibility can lead family members to monitor the situation, stepping up their involvement as the need arises and ‘adjusting actions to meet any shortfalls’ (p9).
Twigg and Atkin (1994) discuss the fiscal crises caused in part by the ageing population and GNP being spread more thinly ‘per head’. In light of this, informal care could be viewed as a valuable resource that may save the government a lot of money.

Twigg and Atkin (1994) identify 4 models of carers:
Carers as resources – informal care considered as a free resource. Carers interests not considered, emphasis on meeting dependent person’s needs in most cost efficient way.
Carers as co-workers – focus on the need of depended person. Carers interest/well-being considered, but mainly on instrumental basis
Carers as co-clients – ‘carers are regarded as clients, as people in need of help in their own right’. Services are organised to help relive their situation.
The superseded model - removes the title and even role of carer, family/relatives can become more neutral in role with less obligation and responsibility

The way in which carers are recognised and their needs considered may affect the extent to which the statement is true. Twigg and Atkin suggest that people with social care training tend to engage the co-workers concept where as managers tend to look at a cost-based resource model.

Dalley (1996) discusses the expectation for women to care for dependent family members, following from the common pattern around childcare. The role of the mother may be extended in relation to other relationships and contexts.
Notion of ‘caring for’ and caring about’ being entwined. ‘Those who care about are always expected to care for and vise versa’ (p17). Dalley argues that it is more acceptable for men to care about but not necessarily for, as long as they take responsibility e.g. provide setting for care, financial support.

Statistics do exist to indicate that men are involved in some aspects of caring roles (office for population censuses and survey data). These are usually lighter and less time consuming responsibilities (Arber and Ginn, 1995).


Maternal Gatekeeping: Mothers’ Beliefs and behaviours that inhibit greater father involvement in family work (from a study carried out by Sarah Allen and Alan Hawkins, Journal of Marriage and the Family 61, Feb 1999):

Ø Maternal gatekeeping is conceptualised within the framework of the social construction of gender and is defined as having three dimensions: mothers’ reluctance to relinquish responsibility over family matters by settings rigid standards, external validations of a mothering identity, and differentiated conceptions of family roles. The study concludes that 21 % of the mothers interviewed were classified as gatekeepers. Gatekeepers did 5 more hours of family work per week and had less equal divisions of labour than women classified as collaborators.

Ø Maternal gatekeeping is a collection of beliefs and behaviours that ultimately inhibit a collaborative effort between men and women in family work by limiting men’s opportunities for learning and growing through caring for home and children. It is clear from its frequent appearance in scholarly research that maternal gatekeeping can be one important source of men’s underinvolvement in domestic labour and may inhibit mutually satisfactory arrangements for sharing family work.

Ø In the 19th century ideological construct of the doctrine of separate gender spheres, the ideas of women as nurturers of home and children and men as breadwinners came to represent an ideal in which women, by being central to the home and family, were given the opportunity to wield some domestic power and privilege over men. Thus, a wall was built around a maternal garden of home and family, complete with a latched gate to ensure the specialisation of gender.

Ø Mothers may feel that they need to manage or oversee their husbands’ participation in housework and child care because fathers can’t do it ‘right’ without supervision from someone more competent.

Ø If fathers join mothers in this endeavor bur by becoming collaborative partners in housework and child care, some mothers may fear loss of self-respect or self-identity as a woman, perhaps because doing family work is a way to validate a mothering identity externally and is a source of self-esteem and satisfaction


Maternal Gatekeeping: Mothers’ Beliefs and behaviours that inhibit greater father involvement in family work (from a study carried out by Sarah Allen and Alan Hawkins, Journal of Marriage and the Family 61, Feb 1999):

Ø Maternal gatekeeping is conceptualised within the framework of the social construction of gender and is defined as having three dimensions: mothers’ reluctance to relinquish responsibility over family matters by settings rigid standards, external validations of a mothering identity, and differentiated conceptions of family roles. The study concludes that 21 % of the mothers interviewed were classified as gatekeepers. Gatekeepers did 5 more hours of family work per week and had less equal divisions of labour than women classified as collaborators.

Ø Maternal gatekeeping is a collection of beliefs and behaviours that ultimately inhibit a collaborative effort between men and women in family work by limiting men’s opportunities for learning and growing through caring for home and children. It is clear from its frequent appearance in scholarly research that maternal gatekeeping can be one important source of men’s underinvolvement in domestic labour and may inhibit mutually satisfactory arrangements for sharing family work.

Ø In the 19th century ideological construct of the doctrine of separate gender spheres, the ideas of women as nurturers of home and children and men as breadwinners came to represent an ideal in which women, by being central to the home and family, were given the opportunity to wield some domestic power and privilege over men. Thus, a wall was built around a maternal garden of home and family, complete with a latched gate to ensure the specialisation of gender.

Ø Mothers may feel that they need to manage or oversee their husbands’ participation in housework and child care because fathers can’t do it ‘right’ without supervision from someone more competent.

Ø If fathers join mothers in this endeavor bur by becoming collaborative partners in housework and child care, some mothers may fear loss of self-respect or self-identity as a woman, perhaps because doing family work is a way to validate a mothering identity externally and is a source of self-esteem and satisfaction


Statistics supporting the argument that women do most of the work, from Lena Dominelli (Anti-Oppressive Social Work Theory and Practice, 2002)

Ø Wichterich (2000) has calculated that 70 per cent of the world’s work is performed by women who are not paid for it, a reality that excludes them from wage-based benefits. The United Nations Development Programme has valued their contribution at $US11 billion compared to $US7.3 billion as the total of manufactured goods produced. Yet, 70 per cent of the world’s poor are women, 35 per cent of whom are sole parents.
Ø Despite these well know statistics, the modernising agenda in Britain excludes those who form the working poor or those unable to work and their needs have been ignored by the government (Jordan, 2000).
Ø Dominelli reflects on the familialist ideology constructed around women’s role as a nurturer within the family, seen not as a human being with individual needs but as a carer with responsibilities. Her status is then dependent.

Some Facts and Figures!

I read that informal care saves the government £87 billion a year. In addition to this research by carers UK in 2002 found that carers contribute around 1 billion per year by supporting the community through starting self-help groups, campaigning for carers centres and raising money.
2001 census found that there are 3,400,000 female carers (58%) compared with 2,460,000 male carers (42%)
11.3% of the population are female carers and 8% are male carers.
This pattern, however, is found to be reversed in later life where men are reported to give a greater time commitment to caring. Female carers are well reported, but the importance of men as informal carers in old age is much less commented upon.

Gender and Community Care. Women, Men and Caring

Women seen as innate carers.

In the 1940s/50s direct care work was held in low regard and therefore thought suitable for women, predominantly working class and Black and ethnic minority women. Care work is particularly suited to women because it is consistent with their traditional roles in the home.
Caring seen as unnatural if done by men, as it goes against the notion of the ‘rational’ man.
Women are locked into caring. Expectations that they will be available to care. Men who provide care do it for change in familial circumstances,
In the Equal Opportunities Commission, 1981 states that married women and cohabiting women who stayed at home were at one stage not allowed to claim the invalid care allowance available to men and single women performing the same role. Reinforces the economic dependence of women.
Reluctance to accept that men do care. Men ‘fill in’ as carers when unemployed. Women’s overall level of labour market participation does not appear to be affected by caring o the same extent as mens. Women are expected to be at home, and not seeking work.
Class and age differences.
Co-resident care is provided more frequently by working-class men and women than by middle class. Middle aged unmarried women and men have a much higher chance of becoming carers than any other group. Men as a group are much less likely to be expected to provide informal care, young single men and older never-married men are just as likely to involved as their female peers.
Different housing patterns, age structures and cultural traditions all influence statistics. Sons in Asia, for example, take a lead role in caring for their mothers. Challenges the Western notion that men are known to provide care for their partners but very rarely provide care for other relatives or friends.
There may be under-representation of caring by men because the notion of ‘caring’ has feminine connotations. It is seen as ‘woman’s work’ and challenges masculinity.
Early studies show that men are rarely involved in personal care, and feel uncomfortable with certain tasks associated with caring. Men and women, it seems, take on different roles within caring.

Jack, R (1998)
Value of care provided by informal carers estimated in 1988 to be between 15 and 24 billion, but goverment funds for NHS and Community Care Act 1993 came to 539 million.
Community care is increasingly unmasked as care by the family and by women.
National Institute for Social Work 1993 found 3 xs as many carers were women than men.
Feminist writers have advocated residential care as a means by which opression of women in the socially constructed role of natural carer may be alleviated (Dalley 1993)


Arguments Against...

It could be argued that if insufficient resources are put into community care, families often have no choice but to intervene. Dalley (1996, in Ideology of Caring) discusses when professional services are insufficient, extended networks e.g. Neighbours, friends, or more commonly the person/small group closest to the person intervene with additional support to ‘make-up’ this deficit. Twigg and Atkin (1994, in Carers Perceived) also discuss how feelings of responsibility can lead family members to monitor the situation, stepping up their involvement as the need arises and ‘adjusting actions to meet any shortfalls’ (p9).
Twigg and Atkin (1994) discuss the fiscal crises caused in part by the ageing population and GNP being spread more thinly ‘per head’. In light of this, informal care could be viewed as a valuable resource that may save the government a lot of money.

Twigg and Atkin (1994) identify 4 models of carers:
Carers as resources – informal care considered as a free resource. Carers interests not considered, emphasis on meeting dependent person’s needs in most cost efficient way.
Carers as co-workers – focus on the need of depended person. Carers interest/well-being considered, but mainly on instrumental basis
Carers as co-clients – ‘carers are regarded as clients, as people in need of help in their own right’. Services are organised to help relive their situation.
The superseded model - removes the title and even role of carer, family/relatives can become more neutral in role with less obligation and responsibility

The way in which carers are recognised and their needs considered may affect the extent to which the statement is true. Twigg and Atkin suggest that people with social care training tend to engage the co-workers concept where as managers tend to look at a cost-based resource model.

Dalley (1996) discusses the expectation for women to care for dependent family members, following from the common pattern around childcare. The role of the mother may be extended in relation to other relationships and contexts.
Notion of ‘caring for’ and caring about’ being entwined. ‘Those who care about are always expected to care for and vise versa’ (p17). Dalley argues that it is more acceptable for men to care about but not necessarily for, as long as they take responsibility e.g. provide setting for care, financial support.

Statistics do exist to indicate that men are involved in some aspects of caring roles (office for population censuses and survey data). These are usually lighter and less time consuming responsibilities (Arber and Ginn, 1995).


Maternal Gatekeeping: Mothers’ Beliefs and behaviours that inhibit greater father involvement in family work (from a study carried out by Sarah Allen and Alan Hawkins, Journal of Marriage and the Family 61, Feb 1999):

Ø Maternal gatekeeping is conceptualised within the framework of the social construction of gender and is defined as having three dimensions: mothers’ reluctance to relinquish responsibility over family matters by settings rigid standards, external validations of a mothering identity, and differentiated conceptions of family roles. The study concludes that 21 % of the mothers interviewed were classified as gatekeepers. Gatekeepers did 5 more hours of family work per week and had less equal divisions of labour than women classified as collaborators.

Ø Maternal gatekeeping is a collection of beliefs and behaviours that ultimately inhibit a collaborative effort between men and women in family work by limiting men’s opportunities for learning and growing through caring for home and children. It is clear from its frequent appearance in scholarly research that maternal gatekeeping can be one important source of men’s underinvolvement in domestic labour and may inhibit mutually satisfactory arrangements for sharing family work.

Ø In the 19th century ideological construct of the doctrine of separate gender spheres, the ideas of women as nurturers of home and children and men as breadwinners came to represent an ideal in which women, by being central to the home and family, were given the opportunity to wield some domestic power and privilege over men. Thus, a wall was built around a maternal garden of home and family, complete with a latched gate to ensure the specialisation of gender.

Ø Mothers may feel that they need to manage or oversee their husbands’ participation in housework and child care because fathers can’t do it ‘right’ without supervision from someone more competent.

Ø If fathers join mothers in this endeavor bur by becoming collaborative partners in housework and child care, some mothers may fear loss of self-respect or self-identity as a woman, perhaps because doing family work is a way to validate a mothering identity externally and is a source of self-esteem and satisfaction

State provision is minimal as it is assumed younger women will provide care.
Women are expected to retire earlier than men but there is no retirement age for women's unpaid labour.

Jack, R (1998)
Townsends' criticisms of residential care were contrasted with his vision of reciprocal family care accross 3 generations but this idealised view is now dated.
The effort of caring for severely handicapped elderly relatives can result in family tensions and breakdown.
Community Care involves housing, leisure, transport, education etc - by no means just family
We are in a time where the institution of the family is least able to provide care
Sally Redfern - there is a need for the provision of good quality nursing 24 hour in both institutional settings and in peoples homes.

Law Lecture Notes
Carers and disabled Childrens Act 2000 - a carer is entitled to an assessment
National Assistance Act 1948 - facilities for rehabilitation, employment and recreation
Health Services and Public Health Act 1968 provides support services for frail older people - domiciliary services lessen the demand on family
Chronically Sick and Disabled Persons Act 1970 provides domiciliary services, home adaptions and assistance for education.
Department of Health def of community care (above) doesnt mention family.
DoH (1990) Community Care in the next decade and beyond: policy guidance says service provision should include support in own home, move to sheltered housing, move to house of relatives or friends, residential care, nursing home care, long stay care in hospital... only one of these mentions family
p3.28 'preferences of carers should be taken into account and their willingness to continue caring should not be assumed'
Housing Grants, Construction and Regeneration Act 1996 - housing authorities have a duty to approve of applicants for disabled facility grants for carrying out home adaptions.
Health and Social Care Act 2001 s57-58 extends direct payments to users and carers which they can spend on services of their choice - increased independence.

And I wasn't sure where to put this...

Formalising community care under a state umbrella disempowers and undermines a community’s natural capacity to take care of itself:

Ø David Brandon, social work lecturer and Zen monk states: ‘Patients and clients are encouraged to depend more on professional who are seen as being experts – as knowing best. Social workers may see themselves as having an investments in their clients’ lives. I recall one young social work students saying that the only serious personal relationships she made in her life were with her clients. We see social work, medicine and nursing at the absolute centre of the social universe whereas, more truly, professional helping is always peripheral to the main caring energy. Worse still, voluntary caring can be seen as inferior or merely supplementary to professional helping. The number of times I have heard a neighbour say of a client ‘I should like to have helped but I’m not qualified’. When you measure the gigantic forces of caring for one another existing within the community, professionalised helping emerges as a grain of sand on a large beach. Social work in particular has failed to see the vital role of friends, relatives and neighbours. Helping should place more general stress on assisting the community.

· Feminist critique, from Critical Practice in Social Work:

Ø In the liberal tradition, people are seen in the abstract as moral agents and bearers of universal rights. In this view, rights are not affected by one’s specific obligations to the particular, real individuals with whom one happens to have actual, ongoing relationships. Some feminists argue that women think differently, choosing instead to give priority to their real primary relationships over abstract theoretical obligations. They hold that our understanding of moral responsibility has been unbalanced by universalist models of human relationships that are excessively abstract and impersonal, products of male thought.
Ø Feminism puts irrevocably on the welfare agenda that users of formal services are, among other things, individually known persons to whom professionals as well as their own kin are bound by partly subjective ties of partnership in actual human relationships. The relations of welfare, therefore, are not accurately described or properly prescribed by the abstract role obligations favoured in the traditional discourse of the human service professions

Government support for carers
A carers UK study found that only 32% of carers had had a carer’s assessment.
The carer’s allowance, however, is only £48.45 per week, this is for 35 hours of care provision.
Many carers’ sites have been set up which express the hardship of carers in order to push the government into taking action.
1 in 5 carers have to give up work to care, while 1 in 3 are living in poverty and are struggling to pay food and utility bills. Carers are calling for:
A social security payment that reflects their role, improved pensions, necessary benefits, and more flexible employment opportunities.
It seems that informal caring is something that many people want to do, they want to care for loved ones and it is comforting for those receiving the care to be in familiar surroundings with family. Community care, it has been argued, has led to greater patient satisfaction, and also a greater life expectancy.
However, it seems that the vast majority of carers are discontented and unhappy with their situation. If the government are going to ‘shift’ informal care to the family then there needs to be greater support structures in place. Carers save the government £87 billion, yet receive little acknowledgment or support for the sacrifices they have made.
Foster carers, for example, receive between £120 and £205 per week. Foster carers, however, are seen as different because they have chosen to undertake this work, while informal care givers are expected to care for loved ones no matter what, so no financial incentive is offered.

The Gender Divide
Male carers: A study of the inter-relations between caring, male identity and age.

The lack of British phenomelogical studies of male informal carers means that we know relatively little about Male carers’ experiences of caring in this country.
Feminist researchers have begun to look at men as active participants in the informal caring economy. The General Household Survey (1985) showed the 40% of all spousal carers being male. (Evandrou, 1990)
Caring is more of a taboo for male carers.
Recent research shows that men are very good at caring in a practical sense, but not very good on an emotional level.
Women tend to take on caring roles naturally, as if it were an integral aspect of their everyday identity, whilst men it has been argued, will only accept a role if there is no one else who can take on the responsibility or there is a crisis in caring provision.
Exception is men who are married to an ill spouse. In this instance male carers identify their caring responsibilities as a duty that they perform because of marriage vows they made.
‘The Gender Deal’ Pat Carlen (1998) refers to an implicit agreement between men and women based upon gender norms and values. Twin ideals of a wage-earning male, and informal care-giving female.
However the recent destruction of heavy industry, loss of jobs traditionally undertaken by men the increasing employment of women in the economy and better educational opportunities for women, the increasing divorce rate and decreasing marriage rate suggest that the gender deal is less likely to prevail in modern society. Perhaps this might lead to a reassessment of caring as a ‘woman’s’ activity.
For many older male carers, however, the gender deal provides a psychological restriction where caring is concerned.
Male carers see caring as an activity, not as part of their identity. They do not ‘see’ themselves as carers. Identities are formed through paid employment, men see themselves as ‘workers’ first.
If many men do not perceive themselves as carers then it is difficult to calculate the number of male carers in Britain. Many carers may not want to acknowledge themselves as carers, because they see this role as compromising their masculine identity.

21% of population are over 60, there are more older people than children (2001 census). In 1951 there were 0.2 million people over 85, in 2001 there were 1.1 million.
Older men are more likely to recieve and request caring support for basic living needs.
R. Jack (1998)
Community Care can be just as institutionalised as residential. The community consists of a variety of institutions imcluding the family and variety of caring services. There is an independent network of institutions both independent and complimentary.
There is a blind assumption of the existence of a community.