Sunday, 23 March 2014

Carer's health

More people are cared for by loved ones, family members and spouses than in formal mental health clinics, hospitals and NGOs. Partly this is because it is part of a loving family to care; a reciprocal arrangement of spouses  in sickness and in health); and if you are unwell who do you want near you and who can you trust. It is also economic rationalism to place people, no matter how sick, in the community and rely on loved ones to provide care.
This care is not without cost which carer's allowances clearly does not cover. It means an economic loss for the carer. The carer often has a 24 hour job with no or few breaks. The mental health for the carer needs to be considered. The demands of the job and, often demandingness of the patient, can be extreme and things for which the carer has little or no training. Burnout is common. Carers also have little room to set limits and boundaries that professionals can more easily do and  the lack of privacy for both patient and carer can become claustrophobic.
It can be rewarding of course, to spend tie with a loved one, be there for recovery and spend precious moments together especially in terminal illness. When the carer is supported by other family members, extended family and community, the model is a good one.
Carers however can be physically and verbally attacked or even killed in their role. Women take up the majority roles of carers, along with their domestic chores and the social roles of women in general.  This expands an already unfair social, economic and emotional distance between men and women in society. After the care situation ends it can be difficult for the carer to re-enter the workforce because they have not been engaged in paid work that looks good on a resume.
Carers are often left out of medical information and the treatment alliance between patient and professional health care provider. Mostly this is to give the patient some privacy and confidentiality. Not all carers are well meaning or capable of providing good care and abuse is a problem to consider. I think it is wise to divide up the appointment time between a private discussion and then ask the carer to join in, often able to give in depth discussion about the problems and observations on progress. It also give the professionals the opportunity to see how the carer is faring and if they need help.
Not all carers are fulltime. Not all patients are fully dependent and promoting as much independence as possible is a good approach.
There are often good self help groups for carers. There is usually respite available so a carer can take a break. Resources are low however and people in rural and remote areas often miss out.
Spare a thought for the carer's role.

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