The number of people caring for older family members or friends in the community is increasing and will continue to increase in the foreseeable future for three reasons: the ageing population (Centre for Ageing Better, 2022), austerity in local authority budgets (Glendinning, 2016) and a rights-based attitude to autonomy and choice for older people regarding where they live. These changes increase the pressure on community nurses. Knowledge of sources of information, advice and support is invaluable for such nurses, who need to signpost informal carers to help them provide help for their older relatives. Without this, the carer and the person they care for would be more dependent on health services.
According to the charity Carers UK (2019), 1 in 8 adults (around 6.5 million people) are carers. The population of carers is not static, as new family members become dependent and older members move into residential care or die. The role does not stop immediately during such transitions, as the carer continues to provide both direct care in the residential setting, as well as oversight of the professional residential care provider. Eventually, they may also have to manage a funeral and winding up of their loved one's estate. Older carers in their seventies look after parents and in-laws in their nineties. Very old people care for even older spouses or partners. In such cases, the carer may have multiple health needs of their own. The person being cared for may resist any offers of professional care and refuse to accept residential care, making life more difficult for the carer.
Social services and the NHS are already under strain and rely on carers to take on responsibility. The nurse plays a vital role in supporting the model and making this easier for carers. Families may choose to provide direct care, if they are able, to reduce the financial cost of paid care and preserve family resources (for example, to prevent the sale of heritable property). Any family members involved with care will bear an opportunity cost in terms of their time, may suffer health consequences and may also bear financial burdens in terms of loss of employment opportunities and incidental expenses that may not be calculated (such as fuel costs traveling to and from the loved one's home). For some carers, private paid care is not affordable and if statutory services are limited, the carer has few options if they are not going to abandon the person in need. The nurse's knowledge and understanding of the financial burdens and alternative sources of support and models of care is essential.
A community nurse should be able to guide a carer of an older person through the maze of getting help from the local authority, the NHS, third sector providers and private providers. An understanding of Attendance Allowance and Carer's Allowance is desirable, but at the very least, the nurse should be familiar with the information available on the Government website (https://www.gov.uk/carers-allowance), or advise the carer to take the aid of their local Age UK, Carer's UK organisation or through the Carer's Trust. These organisations often employ local staff with the sole function of helping people with the difficult paperwork involved. The financing of care is extremely complex, but the nurse should be able to explain why up-to-date advice is needed and where the carer can go locally to get it. Staying up to date with information is crucial, as this information is different in each part of the country and changes almost every year with budget constraints.
It is also crucial that the nurse is aware of the health needs of the carer and is able to advise them on how to maintain their own physical and mental health. The nurse can support the creation of an emergency plan in case the carer becomes unexpectedly unavailable. The carer should be advised on how to access GP support and to make themselves formally known to the GP or local health centre as a carer. Community nurses developing good relationships with colleagues in local authority social care and with other local providers can make a real positive contribution to the lives of family and friends of carers, and those who depend on them.
Jane Andrews' latest book, titled Carers and caring: the one-stop guide: how to care for older relatives and friends - with tips for managing finances and accessing the right support, is now available in book stores and online at https://tinyurl.com/mpc26n7v
Ultimately, community nurses are an essential support for carers of older people in the community, and our understanding of the processes that they need to go through, and the other areas of support are vital to deal with this ever-increasing burden that they willingly, or unwillingly, carry.