Globally, many children and young people provide support to family members who have poor physical or mental health, are disabled, or misuse drugs and alcohol. These young carers are at higher risk of ...poorer education, employment, health, and social participation outcomes compared to their peers without caring responsibilities. In the UK, awareness of the challenges faced by young carers, and a framework of their legal rights, are relatively well-developed. However, it is unclear how support can most effectively be provided. Taking a qualitative approach we explored experiences and views of young carers (aged 9-25), conducting focus groups or interviews with 133 young carers and 17 parent care recipients. We explored what aspects of services and support are seen as helpful, valued, and acceptable to young people, and what could be improved. A reflexive, thematic analysis was conducted. Valued support came from: young carers groups (including peer support), school-based and mental health support, and support for the care recipient. Helpful aspects of support included someone who listens and understands, and can be trusted not to break confidentiality; involving the young person in information, decision-making and planning (sometimes including regarding the care recipient); and finding and linking to other services. There was a difficult balance for practitioners between being perceived as proactive, persistent or intrusive when offering support to a young carer, but it was important to allow opportunities for young carers, and those they care for, to change their minds about when and whether to access support. Many interactions were perceived as unhelpful or threatening to the family, and there was often not enough of the type of support that was valued. Sharing of positive experiences can be beneficial for both people seeking support and those delivering it; key messages on what is helpful from the perspective of young carers can help support and shape practice approaches.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Many countries worldwide have experienced reductions in provision of formal long-term care services amidst rising need for care. Provision of unpaid care, meanwhile, has grown. This includes care ...provided by young people. Care responsibilities can affect a young people's health, education and employment. We aimed to investigate the impacts on the employment and health of young people aged 16 to 25 of providing care, and the associated individual and public expenditure costs.
We examined employment, earnings and health impacts for individuals, and a range of economic impacts for society, focusing on young people aged 16 to 25 providing unpaid care in England. We applied regression analysis to data from three waves of the UK Household Longitudinal Study (2013/2015, 2014/2016, and 2015/2017) to compare employment and health outcomes among carers and non-carers, and two-part Generalised Linear Models to estimate costs. To address potential selection bias, we then used propensity score matching methods to explore outcomes for a matched sub-sample of young adult carers who started providing care at baseline (2014/16).
Young people aged 16 to 25 who provided care at baseline (2014/16) were less likely to be in employment, had lower earnings from paid employment, and had poorer mental and physical health at follow-up (2015/17) compared to young people of the same age who were not providing care at baseline.. There were substantial costs to the state of young adults providing care from lower tax revenue, welfare benefit payments, and health service use. In aggregate, these costs amounted to £1048 million annually in 2017.
High individual impacts and costs to the state of providing unpaid care, and the potential of such impacts to compound existing inequalities, have many implications for policy and practice in the health, social care, employment and welfare benefits sectors. In particular, the findings reinforce the case for reducing the need for young people to provide unpaid care, for example through better provision of formal care services, and to provide ongoing support for those young people who do provide care. As impacts are seen in a number of domains, support needs to be multidimensional.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Context: There is very little research on the impact of caring on physical health, and the evidence that exists is mixed. There is also lack of evidence on the role of other factors including both ...socio-economic factors and the role played by care services and unmet needs for such services. Aims: This study aims to understand the association between physical health outcomes among unpaid carers in the United Kingdom compared to individuals who have not provided unpaid care, and investigate what is the role that time, and unmet needs for care services play in this relationship. Methods: We used four waves of the UK Household Longitudinal Survey, a large representative sample, covering the period 2015 to 2020. We performed Propensity Score Matching to compare health outcomes of carers against non-carers and Latent Class Analysis to identify different typologies of unpaid carers. Results: We found that the relationship between care provision and physical health is complex, that effects on health may differ between the short and medium run, and that deprivation levels and unmet need for services play an important role. Conclusion: This research contributes original insights into our understanding of the impact of different care trajectories on the health of the carer taking into consideration the characteristics of care-recipients, the effect of unmet needs, and external factors. This is crucial both in relation to their ability to provide support and in terms of their own care needs and is therefore of direct relevance to policy and practice to support unpaid carers.
Globally and locally, ongoing demographic, sociocultural and economic changes have implications for unpaid carers. For those who provide unpaid care, particularly at higher intensities, there is ...substantial evidence of negative effects on employment, health and wellbeing, with associated individual and societal costs. For these reasons, there is increasing policy emphasis on supporting unpaid care in the UK, mirrored, and in some cases exceeded, internationally.
This paper aims to provide an overview of the international evidence on effective support for unpaid carers. This evidence synthesis finds an extensive literature on a wide range of potentially effective interventions to support unpaid carers under the broad categories of indirect support (services for the care-recipient), direct support (such as psychological therapies), work conditions, and combinations of these. However, there are significant gaps in the evidence base with regards to interventions, outcomes and types of caring situation studied, with a dearth of evidence on cost-effectiveness and few evaluations of key recent policy initiatives. Evidence is strongest and most consistent for formal care services for people with care needs (so-called ‘replacement’ or ‘substitution’ care); flexible working conditions; psychological therapy, training and education interventions; and support groups. In many cases it may be that a combination of interventions is most effective. These findings have implications for social care policy and practice which aims to support carers, particularly in the context of the changing landscape of global macro-level processes and recent policy, legislative and funding changes for local authority and voluntary sector providers of support and services for carers in the UK.
Internationally, many care-recipients and unpaid carers are not receiving the services they need to live full and independent lives, representing substantial social injustice. We explored unmet need ...and inequalities in receipt of long-term care services in England. Methods comprised in-depth interviews and secondary analysis of UK Household Longitudinal Study dyad data from 2017/2019. We found widespread unmet need for services overall and inequalities by sex, ethnicity, income, and area deprivation. Aspects of long-term care policy, service delivery, people’s material resources, and constrained and unconstrained choice all played a role.
Under-provision of long-term care services for people with support needs may have consequences for both them and their unpaid carers. Using in-depth interviews with 23 co-resident carers living in ...England, our study aimed to explore the impacts of unmet need on unpaid carers and how such impacts occur. Unmet need for services – services not being received or gaps between provision and need – had multidimensional impacts on carers. Key mechanisms were constrained opportunities through limited time or emotional resources, and constrained choices about whether and how to provide care, as well as over multiple other aspects of their lives.
Young adults who provide unpaid care for older relatives have poorer outcomes than their peers in education, employment, health and wellbeing. Services that can potentially have a positive impact on ...their lives include services provided to the person they care for. However, survey research in England has indicated that receipt of such services is not necessarily linked to fewer negative consequences for young adult carers. We conducted in-depth interviews with fourteen young adult carers who had responded to the original survey. We explored their experiences with services for the care recipient and what factors limit or enhance the usefulness of those services. We found three interrelated themes. First, difficulties accessing services can add to stress, and make problems harder to address when services are implemented; second, lack of continuity of services, and practitioners, undermines relationships and future trust in services, whereas consistent relationships are beneficial. Third, young adult carers described the benefits that resulted from their being involved in discussions and decisions about services, and the problems when this does not happen. The wellbeing of the young adult carer and the person receiving care are shown to be inextricably interrelated; we draw out implications for efforts to improve services.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Exposure to cold temperatures is known to be associated with deterioration of physical and mental health as well as poorer well-being in many countries. The Winter Fuel Payment, an unconditional ...direct cash transfer of value between £250-£300, was designed to help older people in England cover heating costs during the winter months, to counteract the particular vulnerability of older people to the effects of cold weather.
We evaluated the impact of the Winter Fuel Payment scheme on subsequent prevalence of care needs such as being unable to eat or shower independently, quality of life and the likelihood of having cold-related housing conditions. We also explored the potential effects of the Winter Fuel Payment across different sub-samples (poorer/richer individuals, those living in newer/older properties, and in the North/South of England) to explore whether its benefits (if any) are spread equally across the eligible population.
We used a regression discontinuity design approach with age as running variable to analyse seven waves of a nationally representative sample, the English Longitudinal Study of Ageing, covering the period 2002/2003 to 2016/2017, and consisting of 24,651 observations.
The Winter Fuel Payment had no overall effect on the outcomes of interest (care needs, quality of life, and cold-related housing problems). However, the Payment increased quality of life for poorer individuals, for those living in Northern regions of England, and for those living in newer dwellings. The likelihood of living in a property with at least one cold-related housing problem also decreased for those living in newer properties.
Findings from this research provide important insights into the effectiveness of a winter cash transfer among the older population in England, and they are potentially relevant for other nations looking for strategies to deal with cold seasons and poorly insulated homes. In particular, this evaluation contributes to the ‘universality versus targeting’ policy debate and has implications for the development of energy-efficient policies.
•The Winter Fuel Payment had no overall effect on the outcomes of interest.•However, the Payment increased quality of life for poorer individuals.•It also improved quality of life and housing quality for those living in newer dwellings.•Findings not only feed the ‘universality versus targeting’ debate.•But also, the discussion around the development of energy efficiency policies.
Introduction
COVID‐19 has impacted people with dementia and their family carers, yet little is known about effects on overall quality of life.
Methods
In a UK cohort study, pre‐ and post‐pandemic ...data were collected from 114 carers and 93 recently diagnosed people with dementia. Latent growth curve modeling examined change in quality of life.
Results
Carers reported significant decline in quality of life, although no change was demonstrated by people with dementia. In multivariable analyses, higher levels of cognitive impairment, deprivation, study site, and lower number of memory clinic contacts were associated with greater decline in carer quality of life.
Discussion
Maintaining life quality for people with dementia during the pandemic appears to have come at the expense of their family carers. This inequity has fallen hardest on those caring for people with more severe dementia, in deprived areas, and with least support from memory services. These effects may be prevented or reversed by post‐diagnostic care.
Most older people wish to live in their own homes as they age and to have a choice over their housing and care situation. Housing has the potential to play a key role in promoting independence, ...delaying and/or preventing the onset of care needs and in influencing the level and type of care provision required. However, many older people live in homes that are not suitable for their comfort and needs. Our study focuses on older people living in non-specialist housing in England and aims to i) explore how housing characteristics cluster; and ii) investigate their association with an early onset of care needs. We used four waves of a large representative longitudinal sample of people aged 50 or over, covering the period 2012 to 2020. We performed Latent Class Analysis and a Cox regression survival model to provide answers to our research questions. We found that people living in poor housing conditions or living in social rented housing are more likely to experience early onset of care needs, which may lead to a higher demand for, and utilisation of, long-term care services. We believe that gaining a better understanding of the relationship between housing-related conditions and care needs is paramount from the preventative and service provision point of view, and is of relevance to policymakers, practitioners, and current and future adult long-term care users.
•The 3 typologies of housing were identified may require different strategies to raise standards.•Those living in poor housing are more likely to experience early onset of care needs.•People privately renting or in social housing are more likely to have an early onset of care needs.•The combination of housing conditions may have an effect on when care needs start to develop.•Improving housing quality offers an opportunity to prevent the development of care needs.
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