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Community studies Lecture 10: Community care
What is community care?
A process whereby services are provided
‘within the community’ rather than in institutional settings.
Like many issues related to ‘community’ it
is a process that is much associated with
post WW2 western society.
The shift towards community care has been
a marked process within most European
countries, including Ireland and the UK.
Much of the literature that is available to us
is from the latter.
Meanings of community care
 can refer to informal networks (eg kin,
neighbourhood-based) within localities
 can refer to the delivery of services
within the community to disadvantaged
groups or those in need of assistance,
such as the aged, disadvantaged young
people, those with learning difficulties
&c
 in Ireland, refers to a particular organisational structure within the Health
Boards
Meanings may overlap, but are not always
the same. Can make a clear understanding
of community care difficult.
According to Bornat et al community care
is
a distinctive range of professional practice, it is also some people’s everyday experience of life, the inspiration of a
movement away from institutional care
and towards supported life in the community, a euphemism for women’s labour in
the home, and the focus for intense debate
and controversy
it is a slippery concept – in favour with both
the left and right of politics
informal networks
Bulmer: the social basis of community care
Local social relationships – even personal
relationships - as basis for community care
Concept of network may be more useful
(and less misleading) than that of ‘community’
The 1982 UK Barclay Report into Social
Work saw community as ‘local networks of
formal and informal relationships together
with their capacity to mobilise individual
and collective responses to adversity’.
Most social care in Britain (and in Ireland)
is provided not by statutory or voluntary
agencies but by individual citizens who are
often linked into informal caring networks
– the key group is kin (family networks)
It is often thought that these relationships
extend out into communities or neighbourhoods:
a context such as a locale acts as a focus
for relationships which themselves produce care, notably kinship, friendship,
moral community, communities of interest ad economic interdependence
Social care workers might then be seen as
‘upholders of networks’ – perhaps seen as
‘natural helping networks’ that complement
more formalised social services.
Provision of social support through building upon networks: strategies
1. personal networks – utilising and perhaps expanding on a client’s existing
networks of kin, friends, workmates &c
2. volunteer linking strategy – link client
with existing supports within the community
3. mutual aid networks – development of
communities of interest
4. neighbourhood helping networks –
developing links between people in
neighbourhoods, perhaps with clergy &c
5. community empowerment networks –
development of local community action
groups: obviously political
Example a strategy for overtly linking formal and informal networks: a project that
made use of hairdressers in rural Australia
as a means of delivering health advice and
referrals to older males in the community.
They were very resistant to ‘advice’ from
professionals such as social workers, medical personnel or social workers – but were
used to receiving and processing information while at the barber’s.
Other examples?
Societal change & community care
In the past: ‘traditional’ models of local
care were generally based on collective responses to highly negative situations (poverty, social exclusion) – ‘unpleasant conditions rendered less appalling by intense
neighbouring’ - people were ‘in the same
boat’
BUT ‘once the social context changes and
conditions of social closure, insecurity and
isolation and choicelessness cease to apply,
neighbouring becomes a carefully restricted
matter
NOW: Limitations of informal community
care as ‘the development of reciprocitybased relationships has become increasingly problematic as a result of social change’
– such as:
 greater disposable income for many
people
 entry of increasing numbers of women
into the paid labour market
a changed world, to a modern context of
more impersonal and privatised local life
which leaves many people isolated, their
neighbourhood care needs unmet, despite
the provision of certain statutory services’ –
they may also be experiments in the creation of neighbourliness?
Community or neighbourhood care can
mean either a localising of formal systems,
or a strengthening of informal systems:
but different processes and challenges are at
play in each case. But the main player is
always the statutory sector with its overall
welfare policy.
According to Abrams et al ‘there is little
prospect of non-kin-based neighbourhood
networks naturally or informally playing a
major part in the provision of social care.
We need therefore to look to formally organised methods of stimulating and providing neighbourhood care.
Delivery of services
 increased geographical mobility.
In the UK enthusiasm for community care
was linked with an emphasis on more use
of volunteers in the delivery of social services, and a devolution (to some extent) of
provision of services to the more local level
(localisation). Similar trends exist in Ireland
Nowadays, for most people: (quote from
Abrams et al):
Example: eg Ballymote CC council: care
for the aged
 greater availability of state-provided
care
 increased privatisation of family living
most neighbours are not constrained and
do not choose to make their friends
among their neighbours. Those who do
tend to be seeking to highly specific solutions to highly specific problems which
they cannot solve elsewhere and which
make them ‘expensive’ people to befriend
from the point of view of their neighbours
Community care in this sense is unlikely to
develop spontaneously amongst non-related
residents [interesting contrast the caring
practices within gay communities in relation to AIDS].
But there have been attempts made by voluntary and statutory agencies to replicate
informal structures and networks of
community care, and to link into such
networks as already exist.
Community care approaches can then be
seen, in the positive sense , as ‘responses to
This council is in existence for the past 25
years. Its activities include the Care of the
Aged, installation of Aid Alarms (33 in all
installed), outings for the aged and many
more activities for the less well off in the
Parish.
Curry in Irish Social Services discusses
the evolution of community care within the
Irish health services
He refers to the history of a strong institutional model. He points out that the shift
towards community care was at least partly
for economic reasons (perhaps associated
with decline in religious vocations)
Community care, according to the NESC
(1987) involves:
 an active role for the state in providing a
framework of services to families,
communities and voluntary organisa-
tions to allow them to provide various
forms of care
 health services to be provided by a multidisciplinary team involving doctors,
social workers &c to mitigate fragmentation of services. Associated with devolution of services to more localised level
The community care approach has been encouraged in various pieces of Irish social
legislation and policy documents: eg the
report of the Commission of Enquiry on
Mental Handicap in 1965 which favoured
the provision of services through religious
orders and voluntary bodies
It can be seen to strongly reflect the concept
of subsidiarity/Catholic social teaching, as
well as some of the other ideas about community care coming from the UK & US.
The NESC noted in 1987 that community
care was seen universally as a desirable objective, yet: ‘its implications have not been
specified in terms of services required, nor
has there been a commitment to make the
necessary resources available’. Not surprisingly provision of services can vary widely
across the different Health Boards
Some outcomes
Community care services (such as provision
of home help services) have made it possible for some elderly people to remain at
home rather than entering residential care
In relation to child care: the Kennedy Report of 1970 recommended that residential
care be option of last resort. Since then
there has been a large shift from residential
to foster care, and a change in the nature of
residential care towards group homes.
Similar moves in terms of those with learning difficulties and disabled people: though
provision of services, eg domiciliary care,
day care, training centres &c has not taken
place as rapidly or as extensively as has
been recommended.
Health Boards
Within the Health Boards community care
refers to a range of services delivered to
community care areas (NWHB has 2 – divided in Donegal)
community care has 3 sub-programs:
 community protection includes preventative health and monitoring
 community health includes GP services, other health services (eg dental),
home nursing
 community welfare includes support to
voluntary groups, child care, home help
service
Main expenditure is on the GP service
(40% of expenditure)
eg Community Care services in the Tullamore Sector (Midlands Health Board)
1. services for the elderly
2. child care services
3. services for the disabled
4. services for Travellers
5. public health nursing services
6. community & home support services
7. medical services
8. GMS scheme
9. community welfare services
10. environmental health services
11. dental services
12. ophthalmic & aural services
13. speech & language therapy services
14. occupational therapy services
15. Cloghan House
16. Aontacht Phobail Teoranta
17. health promotion
18. registration of births, deaths & marriages
19. support of voluntary organisations
20. child guidance clinics
21. services for children and families
suffering non-accidental injury /
child abuse
22. mother & child scheme
23. administration
24. community psychological services
Community care issues
What does ‘community’ mean for people?
The term (or the ideology of) ‘community’
often implies ‘neighbourliness, friendliness
and concern for others’- in contrast to selfishness, snobbery and competitiveness.
This then helps to shape how people thing
of community-based services
But people’s ‘private’ accounts of community often reveal snobbery, prying &c at the
level of personal experience
Furthermore, ‘the community’ can be experienced in very different ways by men
and women (work, home)
Community can be seen as a site of confinement: the shift of leisure facilities to
out-of-community locations: eg cinemas,
hospitals, shopping centres. This disadvantages those with mobility problems or
without access to private and/or public
transport
Community is also experienced as a defence of property against some outside
threat: eg as in Community Alert schemes
There are also different approaches to
community, eg: the ‘helping’ approach of
middle-class women; the struggles of working-class residents; the activities of ‘community-based professionals’
We can ask: has ‘the community’ in official
discourse become relegated to the disadvantaged and the workers that provide various
sorts of services. In other words, would it
make sense to talk of ‘the community’ and
‘community development’ in relation to
Foxrock or Clontarf?
Questions of community care
To what extent is the notion of community
dependent on sameness and exclusion?
For example, in community histories studied by Bornat, mentally or physically disabled people seldom appear, and their voices
are rarely heard
In particular, the ‘invisible thread’ that often ties the terms ‘community’ and ‘care’ is
women: ‘it is mainly, though not entirely,
women who form the focus for the dynamics of care and support. The care of children
and of dependent older people have traditionally been seen as ‘women’s concerns’
As Quin et al say in relation to Ireland: demographic and social changes ‘raise issues
for a policy of community-based care
which is built on the assumption of availability and willingness on the part of one
section of society to forego gainful employment in order to provide largely unsupported care’.
Carers
Carers are of low social status, as are those
that they care for: ‘if carers are way down
the ladder, then those that they care for are
at the bottom, popularly seen as exacting
tyrants, as indifferent to their helpers’ feelings as pampered pet poodles (Cooney in
Williams, 89)
For carers it is hard to combine caring and
paid work. They may be forced by lack of
support system into part-time, low paid
work.
Involvement in ‘community care’ may,
ironically, also have the consequence of
cutting carers off from participation in the
community.
For many, community care is still shaped
by institutional care: eg in the UK it was
found that many parents of children with
learning difficulties would use more respite
care, or would see their children moving
away from the family home, if they had
more confidence in the quality of residential care
Feminist perspectives on caring
Since the late 1970s feminist researchers
have been engaged in a sustained critique of
policies of community care, speaking out
against the orthodoxy that communities
should be the major source of care for people with long-term needs for support
There has been an ideology that sees
‘community’ and ‘care’ as naturally linked
– BUT - community care is in reality resourced by the unpaid work of women, who
assume responsibility for care of children,
parents, other kin and male partners
Low-waged and part-time work limits
women’s abilities to pay others to care,
while acting as a carer further limits their
own employability
Other feminist critics have pointed out that
the perspectives of those who receive
community care are usually neglected
Other factors
Gender alone cannot explain community
care, it also important to be aware of differences of class, disability, locality, ethnicity
&c - eg restrictions on family reunification
policies for immigrants
Many white working-class women and ethnic minority women have found their care
arrangements structured by employment
opportunities and immigration restrictions
in ways that restrict their opportunity to receive and give care within their families
We also need to be aware of many forms of
paid care: eg domestic service, care work in
hospitals
There is also a need to recognise the role(s)
of men in community care
It is also important not to draw a firm line
between carers and the cared for: many
people are in both categories at the same
time.
Finally: the focus should then be on caring
rather than carers
Perry Share
December 2000