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3. Families or organisations? Formal and informal systems of support

3. Families or organisations? Formal and informal systems of support. Overview of lecture. 1.   Informal support at home        Primary or informal groups: Families, households, neighbours and friends.        ABS, Broad evidence of need for care – disability- and support patterns.

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3. Families or organisations? Formal and informal systems of support

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  1. 3.Families or organisations? Formal and informal systems of support

  2. Overview of lecture 1.   Informal support at home •        Primary or informal groups: Families, households, neighbours and friends. •        ABS, Broad evidence of need for care – disability- and support patterns. 2.   Feminist perspectives on informal care. •       Carers and the burden of care. • ABS Data on carers •        Proposals to overcome this burden. 3.   Formal support • Professions, semi-professions and others: a thumbnail history. •        Organised forms of intervention: the welfare mix model. 4.   Litwak’s view of complimentary structures and functions. •      The roles and functions of primary groups and formal organisations. •       Matching tasks with function. 5.   ComplimentarityRevisited • Links between formal and informal support – other ways of thinking about support.

  3. 1 Informal support at home Informal Support: often called ‘Primary Groups’ (after Cooley, 1909) Intimate relationships • Family. • Households. • Neighbours. • Friends.

  4. Family • Form taken is socially variable, but some form of family (through kinship, descent, and interdependence) present in all different societies at different historical periods. (cf experimental utopian communities, such as Kibbutz) • Family often defined as ‘mother and her children’ (e.g. Fox, 1967). Knowledge of descent link between mother and children clear, fathers possibly doubtful. • Clear that ‘family’ has been, and continues to be major provider of informal social support. • Family clearly ground for making and playing out of gender differences. • Differential expectations of women (mothers) and men (fathers). Clear evidence of recent change, and of continuity. M. Bittman and J. Pixley (1997) The Double Life of the Family. Allen and Unwin, St Leonards. (See also SOC315 – The Intimate Sphere; GEN320 ‘Family Values’ in the 21st century)

  5. Disability Support ABS, 2006: One in five people in Australia (3,958,300 or 20%) had a reported disability in 2003 http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4430.0Main+Features12003?OpenDocument (ABS, 2006)

  6. ABS Definitions of Disability • Core activities • Core activities are communication, mobility and self care. • Core-activity limitation • Four levels of core-activity limitation are determined based on whether a person needs help, has difficulty, or uses aids or equipment with any of the core activities (communication, mobility or self care). A person's overall level of core-activity limitation is determined by their highest level of limitation in these activities. • The four levels of limitation are: • profound: the person is unable to do, or always needs help with, a core-activity task • severe: the person • sometimes needs help with a core-activity task • has difficulty understanding or being understood by family or friends • can communicate more easily using sign language or other non-spoken forms of communication. • moderate: the person needs no help but has difficulty with a core-activity task • mild: the person needs no help and has no difficulty with any of the core-activity tasks, but • uses aids and equipment • cannot easily walk 200 metres • cannot walk up and down stairs without a handrail • cannot easily bend to pick up an object from the floor • cannot use public transport • can use public transport but needs help or supervision; or • needs no help or supervision but has difficulty using public transport.

  7. 2  Feminist perspectives ‘First wave’ feminist rejection of traditional assumptions about the women and the family, including that: • the sexual division of labour is ‘natural’; • domestic tasks (including care) must be done by women at home; • opportunities for employment and broader social participation of women should be sacrificed as part of the division of social roles based on gender. • Policy implications - Identification of carers as exploited and unrecognised female workers. • (C.f. ‘Ethics of care’ debate: Gilligan, 1984, et al.)

  8. [Married] ‘women acquire a set of domestic duties which include caring for their children, their elderly or sick relatives and, of course, their husbands’. (Hilary Land, 1978: 360) • 1980, Finch and Groves extended gender analysis to community care policy. • ‘In practice community care equals care by the family, and in practice care by the family equals care by women’ (Finch and Groves, 1980: 494) • Finch and Groves (1983) A Labour of Love. Women, Work and Caring, Routledge, London • Research subsequently tended to focus on the (so-called) ‘burden of care’ (e.g. Nissel and Bonnerjea, 1982; Wright, 1986, Lewis and Meredith, 1988, Ungerson, 1987; Moore, 1989; Baldwin, 1985; Glendinning, 1989)

  9. Subsequent research documented: • large number of hours devoted to providing hands-on care; • even greater amount of time that caring for someone took in terms of providing supervision, company and simply being available; • opportunity costs of caring - lost earnings, careers foregone, social isolation and psychological distress involved in devoting so much time, with little financial or practical support. • Elaine Brody (1981). ‘Women in the middle’: -identified stress and strains of (middle aged) women involved in providing care for both parents and children. Brody, E. (1981) ‘Women in the middle and family help to older people’ The Gerontologist 26: 373-81

  10. The invention (emergence)of ‘carers’. • Carer’s movement emerged first in the UK, with an organisation called The National Council for the Single Woman and her Dependants, founded in 1965. (The focus on single women had historical demographic origins: caring for elderly parents was both a reason for not marrying and a legitimate ‘occupation’ for those who had not married). 1981 the Association of Carers (for all carers regardless of gender, marital status or the age or disability of the person they were caring for) was formed 1982 organisation retitled The National Council for Carers and their Elderly Dependants - but by then the term carer was in widespread use. Australia: Clare Stephenson, 1976 ‘Dedication’ NSW COA http://www.carersnsw.asn.au/ http://www.carersaustralia.com.au/

  11. Carers: ABS definitionsABS (2005) 4102.0 - Australian Social Trends • Informal assistance (or care) comprises unpaid help or supervision by family, friends or neighbours and also paid help provided by family or friends living in the same household. It contrasts to formal assistance which comprises paid or unpaid help or supervision provided through an organisation (government or private, including both not for profit and commercial); and other paid help or supervision provided by persons other than family, friends or neighbours. Carer refers to a person aged 15 years or over who provides ongoing informal help or supervision to persons with disabilities or long term health conditions, or to persons aged 60 years and over. The help provided must have lasted or be expected to last for at least 6 months. Carers who assist someone in another household are identified on the basis that they provide help with 'everyday sorts of activities' without further specification. Carers who assist someone in the same household are identified on the basis that they provide assistance with one or more of these activities: communication, health care, housework, meal preparation, mobility, paperwork, property maintenance, self care and transport. Primary carer refers to a person aged 15 years or over who provides the majority of the ongoing informal assistance to a person with a disability who has a limitation in one of the core activity areas of self care, communication or mobility. Person cared for… refers to the main recipient of care (some carers assisted more than one person).

  12. Carers 2003(ABS- Australian Social Trends, 2004 : 4102.0)

  13. CARER RATE(a) - 2003

  14. ABS, 2003:Disability, Ageing and Carers.

  15. Carers(a) by labour force status and sex – 2003 (ABS- Australian Social Trends, 2004: 4102.0)

  16. 3. Formal support • Informal support: Occurs outside of formal organisational framework. (May nonetheless have legal rights and responsibilities.) • Formal support: formally constituted organisational entities, underpinned by legal and contractual responsibilities. How is it provided? • Organisations. Formal organisations. • Working definition: Deliberately constituted social groups with a defined legal structure and purpose. • Workforce: Professions, semi-professions and other staff. • -Professionals: scope of responsibility defined by law. • -Semi-professionals: More limited scope of responsibility. • -Others: unskilled or those with unrecognised skills. (eg careworker, care attendant, AIN, childcare worker)

  17. The welfare mix model: Sources of Welfare (Evers, 1991; Esping-Anderson, 1999) State Households/Family Market

  18. State Households/Family Market

  19. State Formal Informal Households Market

  20. 1970s: Rediscovery of informal welfare, community(eg Abrams, 1978, Neighbourhood Care and Social Policy) • Despite postwar rise and expansion of the welfare state and predictions of ‘death of the family’ • Acknowledgement that the heart of care remains informal support, based on family carers and recipients of support, together with neigbours, friends and ‘community’. • Home and households become major site of social programs. • Raises new question: what is the relation between formal and informal support?

  21. 4  Litwak: Complimentary structures and functions of formal and informal support The roles and functions of primary groups and formal organisations. • Functionalist perspective (eg Parsons). • Different social institutions and groups have specific roles and ‘functions’. • Normative expectations enable these functions to be adjusted to each other, and for the whole to achieve an equilibrium.

  22. Matching tasks with function. Support functions vary between informal groups and formal sources of support. InformalFormal Spontaneous Deliberate, planned, routine Affectionate Effective Unskilled – experience Professional – formal expertise Generally long-term Generally time-limited Multi-facetted Specific intervention (instrumental) Litwak argues that ‘Groups will most effectively handle those tasks that are consistent with their structure’ (1985: 36) Therefore sees complementarity between informal groups and formal organisations and professionals.

  23. 5. Complimentarity extended Links between formal and informal support – other ways of thinking about support. • Support has traditionally been seen as dichotomous alternatives - either informal or formal. NOT both together. • Yet reality seldom ‘pure’. Always some penetration of home by state, market and civil society through regulation, monitoring. • A key characteristic of post-industrial societies (postmodernism) is that the old hierarchies and certainties have become fluid (Bauman: ‘liquid modernity’).Distinctions between formal and informal support are increasingly blurred. Emergence of ‘hybrid’ patterns of support – the professionalised home?

  24. Explanations for patterns of informal/formal service use • Displacement hypothesis.  Conservative argument that the family is the natural order. Providing formal assistance seen as displacing family, making recipients dependent. • Complementarity hypothesis - portrays formal services and families as having complementary functions. E.g. Litwak (1985) USA, Kendig (1986) Australia (see also Whitaker, 1986), contrast the organisational characteristics of formal services, as bureaucratic organisations, with those of informal social groupings, such as families. • The ‘hierarchical compensation model’ Marjorie Cantor (1979, 1989; see also Cantor and Little, 1985) to explain and predict the use of services and the contribution made by informal caregivers.

  25. Hierarchical compensation • Model emphasises the social psychology of help seeking behaviour rather than the structural characteristics of social groups. • Preference to rely on informal care provided by close family members or confidants whenever possible. • Help is preferred from spouses, then daughters, sons and other family members (in that order of preference) over that provided by formal organisations. • Model predicts that help is likely to be sought from formal services only when these informal caregivers prove inadequate or need supplementation.

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