To Pay or Not to Pay: Examining Underlying Principles in the Debate on Financial Support for Family Caregivers

Abstract

De nombreux pays offrent un soutien financier ou monétaire direct aux membres de la famille ou aux amis dispensateurs de soins familiaux. Les débats sur les avantages et les désavantages de cette politique abondent dans la documentation. D'après l'hypothèse voulant que les valeurs sous-tendent les politiques publiques, l'article examine quatre paradoxes politiques relevés dans la documentation et illustre, à l'aide de certains exemples provenant d'une analyse politique internationale, les objectifs et les valeurs sur lesquels repose l'élaboration de nombre des politiques. Il s'agit de la responsabilité des soins, des objectifs économiques ou sociaux, de l'équité de genre, et de l'autonomie des bénéficiaires de soins. Les auteurs mettent en garde les décideurs au sujet des effets pervers d'une politique de soutien financier et proposent des programmes et des services destinés à appuyer les dispensateurs de soins. La politique futur au Canada doit permettre des choix appropriés tout au long de la vie et faire en sorte que ni le dispensateur de soins, ni le bénéficiaire des soins, n'éprouveront de difficultés financières à court ou à long terme en raison de leur choix. ABSTRACTIn many countries one approach to supporting family-and-friend caregivers is direct financial or monetary support. Debates about the benefits and consequences of such policies pervade the literature. Building on the premise that values underlie public policy, the paper examines four policy paradoxes in the literature and uses selected examples from an international policy analysis to illustrate the underlying objectives and values upon which many of the policies were developed. These include the responsibility to care, economic or social objectives, gender equity, and the autonomy of care receivers. The authors conclude that policy makers need to be cautious about the unintended effects of financial support policy and develop a menu of policies and services to support caregivers. Future policy development in Canada must enable legitimate choice across the life course and ensure that neither the caregiver nor the care receiver will experience short-or long-term financial consequences of his or her choice.

Can we move beyond burden and burnout to support the health and wellness of family caregivers to persons with dementia? Evidence from British Columbia, Canada

“…Researchers and practitioners in the field are currently implementing practices to better support caregivers, and many of these initiatives are being evaluated (Keefe et al. 2007, Keefe & Rajnovich 2007, Nelis et al. 2008, Giesbrecht et al.…”

“…Although the reasons for this are unknown, there appears to be a growing sense that the problems associated with caregiving are sufficiently well understood to start addressing them, as well as a desire to recognise the positive aspects of care-giving (Armstrong & Kits 2001, Brodaty et al 2003, Nelis et al 2008. Researchers and practitioners in the field are currently implementing practices to better support caregivers, and many of these initiatives are being evaluated , Keefe & Rajnovich 2007, Nelis et al 2008, Giesbrecht et al 2010.…”

The gender logic and effects of instrument mixes: implementing eldercare policy in Canada

“…In these three provinces, family members can receive payment if regional health authorities determine that no other care worker is available or able to meet the unique needs of the care recipient due to cultural, linguistic or geographical reasons or because of the nature of the care that needs to be provided. In general, however, the program's exclusion of payment to family members reflects and reinforces the idea of family caregiving as a 'labour of love' or a natural extension of kinship responsibilities (Evers, 1994;Keefe & Rajnovich, 2007), distinct from the care that can be obtained in the private sphere.…”

“…From a life-course perspective, however, this policy may lead women to reduce work to provide care, thereby jeopardizing their future, long-term financial security. As Keefe and Rajnovich (2007) explain, '[a] policy paradox emanating from financial support policies for caregivers is that the very policy designed to support all caregivers, many of whom are women, may have the undesirable life course effect of poverty, limited pensions, and dependency.' Finally, the allowance reflects a residualist model of social policy since it targets care provision to low-income care recipients.…”

Older People's Family Contacts and Long‐term Care Expenditure in OECD Countries: A Comparative Approach Using Qualitative Comparative Analysis

“…In table 4, on QCA analysis, Canada is linked with several combinations of primary implicants with Norway and Germany, given above threshold scores for marriage rates (M) and those who have lived in same area since birth (AR). Canada has begun to examine policy vehicles for sustaining the quality of care in family and community settings, including career breaks for caring activity (Keefe and Rajnovich 2007; Keefe et al. 2007).…”