6. Chapter 6: Conclusions
The contribution made by unpaid carers is well established, as is the recognition that people providing care can need and should have support. In this report we show carers in Scotland today. We have analysed large population datasets and set out who and where carers are. We've highlighted the health and wellbeing challenges that carers may experience particularly for those for whom the caring load is considerably higher. We've also examined international research on effective support for carers to promote carers' health and prevent ill-health.
6.1. Profile of carers
Carers are a diverse group, comprising both men and women, from all ethnicities and age groups from the very young to those in their later years. They are part of all Scotland's communities; urban and rural, deprived through to wealthy. They are in full-time education, paid employment, caring full time, unemployed and retired. Their caring can be for a few hours to full time.
However this analysis has shown that the number of carers and intensity of caring is more common in some groups than others:
- Women comprise the majority of carers, although men comprise 40% and genders are in equal proportions in the oldest age group.
- High intensity carers (over 35 hours) are drawn disproportionally from the most deprived areas.
- Similarly carers are most commonly aged 55-64 and many of them provide over 20 hours care, but it is carers aged 65 and over that are the highest providers of this level of care.
- A higher proportion of young carers are in lone parent families and they have more intense caring responsibilities.
- More young people in the most deprived areas are carers.
6.2. Carers' health and wellbeing
While caring can be an extremely rewarding experience, this review has pointed to considerable evidence which suggests that carers often experience poor mental and physical health arising from their caring giving role. For some this may be compounded by existing inequalities. Those most at risk are carers in more complex and demanding caring situations. Although these carers may represent a minority of the carer population, they nonetheless provide the bulk of unpaid care.
Our analysis has shown that the pattern of caring has changed. While there has been a very small increase in the number of carers, there are more carers providing more intensive care. This has important policy and practice implications, since carers with heavier care burdens are often drawn disproportionally from the caring groups identified above.
For those providing more intensive care, there can be financial and social challenges. While employment may sustain carers in their role, some carers struggle with combining a job and caring and either have to adjust working pattern or stop work altogether. Furthermore carers may face additional financial burdens associated with their caring responsibilities. As care load increases, carers can be at risk of social isolation as it can be difficult to maintain or foster social networks or pursue hobbies.
6.3. Support for carers
The review has highlighted the need to support carers in demanding care situations, particularly those providing higher levels of caring over an extended period since it is they that are most likely to experience psychological distress. Many of these carers do not have support, although those providing greater numbers of hours care seem more likely to receive it. More carers caring for five hours or more reported not feeling supported to continue caring than those caring for fewer hours. Indeed not all carers receive support and not all reported they needed or wanted it.
It is also important also to take a preventative approach which involves support for carers at early stages and when caring is less intensive. Identification of these carers and providing information and advice can be effective in supporting them in their caring role. Information and training is also beneficial throughout the caring period and at key times of change in the cared for person's condition. Carers value short breaks and although ensuring these have positive impact is complex, they have been found to be beneficial. Day care and other support during the day seem to be effective and more likely to be accepted by the carers and cared for person than residential care.
The review also showed that caring can be associated with poor physical health, albeit to a lesser degree than psychological distress, therefore interventions to support carers should also focus on physical health promotion such as providing opportunities for exercise, health eating, and preventative care visits.
While we have focused this review on direct support for carers, it is important to consider this in context of the cared for person. Carers and their relationship with the cared for person (s) are so closely intertwined. What impacts on the cared for person will have a bearing on carers and vice versa. Accordingly high quality care for the cared for person can provide the most effective support to carers.
Above all, any form of support should be timely, person-centred and based around the needs of the carer and their caring situation. This should be informed by carers' socio-economic situation and issues particularly relevant to them as carers.
Email: Steven Gillespie