Glendinning, C.

Summary: The policy of personalisation in English adult social care prioritises choice and control by service users over the support they receive. Carers also have rights to assessments and support, but these rights have developed separately, so interdependencies between carers and service users may be overlooked. Moreover, it may be difficult to reconcile these divergent policies in routine practice.

As a major provider of services to older people, Age UK is interested in what research tells us is known to work. In this book we've asked experts to write jargon-free summaries of the latest evidence they have of the most effective practice. We hope it will inform and further the debate about how services can enhance the lives of older people today. In his foreword Lord Filkin says, 'The key question is how to make these years as healthy, happy and meaningful as possible and improve the quality of later life whenever we can.

This chapter provides an overview of different models of financial support for informal carers (that is, the kin and close friends) of older people. These models reflect the institutional and cultural traditions of the broader societies and welfare states of which they are a part. The chapter first argues that the issue of paying informal carers needs to be understood from several different policy perspectives. It then outlines four models of providing financial support for informal care, illustrated with examples from specific countries.

Risk is a central defining feature and area of concern in adult social care provision, but what do we actually know about how service users, carers and practitioners define and manage risk? This question is increasingly important as current policy advocates greater service user choice and control through a range of self-directed support mechanisms, and statutory duties and professional boundaries are challenged.

Extending choice and control for social care service users is a central feature of current English policies. However, these have comparatively little to say about choice in relation to the informal carers of relatives, friends or older people who are disabled or sick. To explore the realities of choice as experienced by carers, the present paper reviews research published in English since 1985 about three situations in which carers are likely to face choices: receiving social services; the entry of an older person to long-term care; and combining paid work and care.

This paper examines four specific themes relating to older carers' experience: care-giving in the context of particular roles and relationships embedded in biographical histories; care in the context of dementia; care involving skilled or complex health care-tasks; and care of an intimate/personal nature. In each case, we look at the nature of support provided by health care professionals. Analysis of the data suggests several conclusions. Older carers are carrying out a range of tasks including complex health care tasks, many of which were once part of a nurse's remit and role.

Providing substantial amounts (particularly over 20 hours a week) of care to a disabled or elderly relative or friend is associated with reduced labour market participation, poverty and adverse psychological and physical health. Many countries have introduced “cash for care” measures. Sometimes their primary objective is to provide financial support for the older or disabled person to help meet the additional costs of needing care. In other instances “cash for care” aims at offering consumer-style choice to older and disabled people.