Social Work Research Findings No. 38Family Support and Community Care: A Study of South Asian Older People
Alison Bowes and Naira Dar with the assistance of Archana Srivastava
This study explores the views of older South Asian people about home support needs and services, in the context of a review of existing provision. Interviews with 102 older people and 10 family carers were conducted in Glasgow and Edinburgh. In addition, 14 service providers from the statutory, voluntary and private sectors were interviewed.
- South Asian older people had very little knowledge about social services and welfare benefits. The home help service was used by 7% of respondents and only one received a 'package' of social services.
- Day care provided by community based groups with time limited funding was the main source of support outside the family.
- Service providers saw services for older South Asians as being separate and distinct. Referral to mainstream services by GPs or community-based groups was rare.
- Social work departments acknowledged that mainstream services were not tailored to the needs of South Asian older people. However community care plans in both cities expressed commitment to addressing these needs.
- Failure by social care services to respond to cultural diversity means that South Asian older people are effectively denied access to mainstream social services, in particular, home care, aids for daily living and adaptations to housing.
- The unmet needs of people living in family households tend to be hidden. Eligibility criteria for services need to take account of their support needs and those of their family carers.
The aims of the research were
- to identify South Asian older people's perceptions of their needs for care and support at home;
- to examine the pattern of services available to them locally;
- to explore the fit between people's own perceptions of need and the service provision;
- to identify and explain unmet need;
- to consider the implications of the findings for the planning and implementation of services.
102 short self-assessment interviews with South Asian older people established a broad overview of their experiences of seeking and finding care and support at home, and identified key issues. Follow-up interviews with a sub sample of 30 enabled issues to be explored in more depth. Ten carers of older people were interviewed about their experiences of and views about caring, and their felt needs for support.
A review of existing service provision was carried out through interviews with five statutory providers, seven voluntary sector providers, two national charities, and one private organisation.
South Asians in Scotland
Analysis of census and other statistical data reveals that Scotland's South Asian population is mainly Pakistani, with a large minority of Indian people and a small minority of Bangladeshis. As a whole, South Asians are concentrated in the inner cities, and are less affluent than the general population. They experience lower pay, more unemployment and more self-employment. They are concentrated in owner-occupied housing, some of which is low quality, lacks amenity, and is overcrowded. Households are larger, and include more children and more extended families. There is a relatively small population of older people, and more older men than older women.
Living conditions and use of services
Short interviews with 102 South Asian older people showed that most (60 per cent) lived with their children or in an extended family, 20 per cent lived with their spouse only, and 20 per cent lived alone. A large majority of respondents (94 per cent) said that they had help available in the case of an emergency.
High levels of illness and disability (85 per cent) were reported and 48 per cent found their illness or disability limiting. 84 per cent were living in owner-occupied housing. Eleven people described housing problems, although the interviewer did not raise the question. 48 per cent of respondents reported that they were in need of help, including meal preparation and various aspects of personal care. 51 per cent received GP help and 54 per cent used day centres or lunch clubs. In contrast, use of domiciliary services was very limited.
Needs for help and support
Thirty older people were interviewed in depth. The majority described housing problems. Seven needed adaptations to their houses and eleven were hoping to move. Applications for rehousing for reasons of disability had been unsuccessful, and only one person interviewed had had equipment supplied to aid mobility.
There was clear potential for respondents without families to be extremely isolated, facing poor housing, low income and debilitation, and lacking access to networks of informal support.
Ill health was confirmed as a major restriction on quality of life, limiting activity, producing mental distress, and increasing needs for support. Most interviewees were receiving regular medical treatment with which they were satisfied. There was evidence that in-patient services did not include providing suitable food.
Help with household tasks was a key concern. However, means of access to sources of help in the home were largely unknown. One third of interviewees appeared to have no pension at all. In most cases, other family members looked after their finances, including housing provision. There was little knowledge of welfare benefits.
Other members of the household were the main source of practical and personal support: two thirds of all the older people interviewed said they were cared for by their families. The interviews with older people had indicated quite widespread use of day care services. However, the particular carers interviewed were not receiving the respite which they might have received had their relatives attended a centre.
Carers interviewed expressed needs for access to services, including adaptations to the house, community groups, benefits and housing advice and help in the house. Some carers chose not to seek help. Others were reluctant to do so, taking the view that potential helpers would have neither the language skills nor the necessary respect for older South Asian people which would make their services acceptable.
Community care plans in both cities indicated a commitment to addressing the needs of minority ethnic groups. However, deficiencies in statutory service provision were widely acknowledged. Some service providers believed that local government reorganisation had undermined service development for older people from minority ethnic groups.
Existing services took the form of specialist day care in the voluntary sector, the result of grassroots and statutory sector initiatives. Short term funding and unqualified staff limited the scope of these services.
Voluntary sector providers had clear perceptions of South Asian people's preferences, which reflected the older people's own views. Voluntary providers appeared to be more flexible, responsive, and able to participate in inter-agency working in ways which mainstream providers found problematic.
National charities promoting service development through short term initiatives appeared to have the advantage of overview, flexibility and working with a range of providers.
There is some evidence to suggest that the private sector is beginning to respond to demand for home care amongst South Asian older people.
Implications for policy and practice
Current service provision
Local community care plans included commitments to improving services for this client group. However, the findings indicate that there continues to be a tendency for services to minorities to be marginalised, thus limiting the potential for success. The voluntary sector providers were offering an invaluable service but one which was patchy and lacking secure resources. More secure funding and stronger links with mainstream services would increase the effectiveness of existing provision.
Access to mainstream services
South Asian older people had limited access to mainstream services, and this was mainly due to lack of knowledge and to the nature of the mainstream services themselves.
Word of mouth is an important vehicle in spreading information about services. Information strategies could involve the community-based groups, GP services and housing departments in educating and informing South Asian people about services and welfare benefits.
Mainstream services in general tend to offer rather inflexible forms of provision, and to have difficulty accommodating to individual needs, where these do not easily fit existing models. Flexibility, multi-disciplinary working and creativity in service provision can benefit all users, not only those from minority ethnic groups. The findings suggest that involving those voluntary sector groups which have a closer understanding of needs in partnership with mainstream providers could facilitate the development of more responsive services.
Recognition of need
Respondents were using GP services and specialist day care extensively. However, there was evidence of unmet need. This was not strongly linked with chronological age, or with family help, in that younger people and people with family support still had needs for services at home. There were particular needs for support for carers, practical help in the home and advice on housing and welfare benefits.
The recognition of need by statutory services requires effective community consultation. Communication with minority communities needs to be developed, to ensure that it is wide, effective, and representative. This will give service providers a better understanding of need and how to respond to it.
Developing support at home
Principles of best practice in the provision of community care for older people from minority ethnic groups have been identified, and there is much good practice in the Scottish context. Experience of good practice is an important basis for future service development.
Statutory providers did not appear able to respond to the needs of this client group, particularly in relation to appropriate language use and culturally based preferences. Eligibility criteria also restrict people's access to the support they need, if they do not easily fit the service-defined categories.
Stronger links between different service providers are needed to improve responsiveness to need. Older people experienced their needs for help and support as interconnected: housing need and health care need were thus intertwined with needs for social care.
Carer support was a particular issue, and the needs of older carers needed recognition. Though some carers preferred not to seek support, there was demand from others for services.
About the research
This research was designed as a parallel study to 'Support at Home', research carried out at the Social Work Research Centre at Stirling University by Charlotte MacDonald (see Findings 35). That study focused on perceptions of need and the availability of support for people aged 75+ in the population as a whole. Both studies were funded by the Scottish Executive. A comparative analysis of findings from the two studies is also available (Findings 36).
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