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The stigma of support

Caring for someone at home is good, but who wants to be cared for at home, asks Michael Fine.

Some recent experiences with older family members have reminded me of the attitudes that many older people continue to have towards the services we proudly like to call aged and community care.

Those of us who work in the community care field are proud of what we do and happy to help those who need it. We know the benefits that appropriate support provided to people in their own home can bring. But in contrast to the popular view, many of the supposed beneficiaries try hard to avoid relying on support provided by strangers altogether, for as long as possible.

They are not trying to milk the system for as much help as they can get. On the contrary. While remaining at home is a sign of independence, relying on help from community services is still seen as demeaning by many, as a sign that somehow the end is near. It is something to be avoided.

The view that there is a stigma of some kind about accepting support at home is often strongest for older, first time users, although it is by no means confined to them. It is particularly a problem for those seeking to return home from hospital, as the return home is envisaged as some sort of restoration - a new lease of life promising complete independence.

After all, if you need help, why can’t you stay in the hospital? At home, so the reasoning seems to go, you can get by on their own. And there’s always a partner, or a family member, perhaps a daughter or daughter-in-law around to give a bit of a helping hand, isn’t there? Who wants help from strangers anyway?

There’s often more to it than that. In many cases, experience years ago can be recited to confirm a strongly held opinion – welfare services are intrusive and demeaning. And they never do things right, anyway. Often there are other reasons for refusing assistance.

The home is simply not neat enough to receive visitors – so why let in people who are going to point this out? Old habits of collecting anything that might be useful one day may mean that there is simply not enough room. It’s never been a problem before, so why let anyone else know about it now? Fear of the costs; the financial consequences of receiving help, discourage the use of services, too.

This reluctance to use services is, in the end, remarkably helpful for the whole system. It helps keep demand low and ensures that somehow, the system can keep on going without enough staff or resources to assist all of those who need help. It also reinforces the poor pay and conditions and the modest level of entry qualifications required by community care staff.

When no one is complaining about staff shortages or problems getting services, it is OK for funders to continue the existing approach to service funding.

Which brings us to the reforms planned for the Australian health care system and the 2010 Commonwealth budget. There is a Commonwealth takeover of health care services, new GP clinics, and even funds for training nurses and upgrading the qualifications of those already in the system.

But did you notice how little attention was given to expanding community care services or improving the pay or qualifications of those who work in them? Might that be part of the same problem?

If no one really wants to receive community care, why should government, or anyone else for that matter, spend more on it?

Associate Professor Michael Fine is head of the Department of Sociology and deputy director, Centre for Research on Social Inclusion, Macquarie University.

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