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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