In health and aged care policy, there is a huge push to encourage home care. Given the often bleak history of institutional care, it’s easy to see the appeal of these policies. But they may have some unintended consequences, cautions Lesley Salem, a nurse practitioner. She has filed this report for Croakey:
“It is very fashionable to encourage care of sick patients in the community right now. Health reform efforts are pushing to keep people out of hospitals as much as possible – whether by not admitting them in the first place, or by discharging them as quickly as possible.
As an Aboriginal nurse practitioner who specialises in the care of patients with chronic conditions, I’ve been contributing to such practices myself.
I know, from both my own experience and the research literature, that many patients will do better if cared for at home.
But through my own work, I’ve become increasingly aware that these policies promoting home-care are often taking an unrecognised toll upon another group – the carers at home.
As carers, by and large, tend to be female, this is also an under-recognised gender issue. It seems as if some of our health policies may have the
unintended effect of contributing to economic and social disadvantage for women.
Ever time we send someone home early from hospital, there is a good chance we are taking another woman out of the workforce. We socially isolate her, relegate her to the lowest economic bracket, and limit her educational opportunities.
The rising tide of chronic diseases means that many patients are going to be unwell for long periods. Carers are often confined to that role, not for
weeks as might once have been the case when acute illness was more common, but for months and years.
Through my work I am very aware that this is a particular issue for Aboriginal women, who are already disadvantaged on so many levels.
If health reform is going to result in even more people being cared for at home, we have to make sure that their carers receive much better support
than is currently available. Their needs also have to be factored into health planning.”