There is a growing international trend in favour of professionalising hitherto volunteer-run, family-based short-break services for people with intellectual disability (ID). This movement towards providing professional ‘respite’ is gaining support in Ireland also. Its success will probably depend on whether, or not, it can minimise the real risk of alienating the hundreds of volunteer hosts who currently make up the backbone of the existing service.
Family-based short breaks have been around for over thirty years. The first Irish service, Break Away, has been active since 1981. Today there are up to thirty similar services throughout the Republic of Ireland. These services recruit individuals and families and link them with people with ID. The aim is to provide the person with ID, and their relatives, a break from their everyday routine and from each other. Breaks can last from a couple of hours to a few weeks, depending on individual preference. Initially services relied exclusively on volunteers. These ‘hosts’ were paid a relatively small flat rate of expenses to cover incidental costs and also, some schemes claimed, to recognise the efforts of the host families. Today most services still rely on volunteers. The expenses are a little more realistic, although none of the schemes pay anything near the true cost of hosting.
When short break services were first launched, recruiting was not seen as a problem. This changed in the nineties; recruiting became more difficult and by the new millennium there was considered to be a crisis. At the same time the numbers and needs of potential guests were greater. This increased need was partially a result of a move away from institutional accommodation and hospital-based respite. It was also due to a greater survival rate of children with more complex healthcare needs.
The response to this perceived recruitment crisis, by service providers, is to increase expenses and even to introduce part-time professional hosts. These professional hosts are usually paid a retainer in return for providing a minimum number of overnight breaks per year. It is expected that they will also cater for less able guests and especially guests with complex healthcare needs. The latter tend to occupy waiting lists, if they are referred in the first place. On top of this retainer, professional hosts are usually paid a flat rate of expenses, as happens with the other schemes. It is too early to evaluate the results of such schemes, although some attempts have been made in Britain where these schemes have been multiplying significantly in recent years. It would appear that results have been mixed.
In Ireland, the aim of professionalising the service is to recruit and retain more hosts than the current volunteer model is doing. A second aim is to increase the number of overnights offered. Simple addition should prove whether or not these aims are being achieved, once these schemes have been given time to become established. The goal of reducing waiting lists might be more difficult to achieve. This is because it is likely that more service users will be referred as a consequence of professionalisation, owing to increased expectations on the part of all concerned.
Another challenge for such schemes will be to maintain the quality of hospitality offered to guests, particularly if they attract hosts who are mainly motivated by extrinsic factors and especially increased payments.
There are many economic and psychology studies which support the phenomenon that paying people for work that they previously did for nothing reduces their effort. Some volunteers give fewer hours, while others are not as vigilant about the quality of their work. The findings are especially true for people who are mainly intrinsically motivated or have a large intrinsic component to their motivation. The quality factor is especially important in the health and social services where quality of service is not as easy to measure as it is in industry. There is a risk that increased bed nights might mask poor quality.
Another unexpected outcome of switching to professional services is that people who were inclined to come forward when there was no professional service will no longer volunteer. Why provide a volunteer fire service in your village when there is a professional one in the next town that will do? This response is becoming more common in some modern societies and has been described as a loss of social capital. This hidden cost of professionalising previously voluntary services has been blamed for a reduction of the social relationships that are important to maintain social cohesion. Were this to happen, then providing funds to professional services, at the expense of voluntary services, could prove to be more expensive for society than policy makers reckon.
One way of avoiding this is to also provide funding to voluntary efforts in order to support them to recruit, retain and support volunteers.
While the recruitment crisis of the nineties was blamed on poor monetary rewards to hosts, other factors were at work. One of these was the inadequate resourcing of such services. Not enough social workers were allocated to carry out assessment on potential hosts. Where they were allocated, they often found themselves trying to fit recruiting, assessing and supporting volunteers into a busy caseload. Few schemes had a dedicated fulltime manager to develop such services. Poor resourcing also meant that not enough funding was available for effective advertising campaigns. So, while these factors together with other demographic and societal factors were influencing the supply of volunteer hosts, service providers, in the absence of local research (another victim of inadequate resourcing), were blaming the level of monetary rewards paid to hosts.
This is not to say that increased payments and professional short break providers are not necessary. They are. Indeed, there is a role for fulltime hosts who will welcome people to share their homes on a long-term basis if required. However, we need to be careful to recognise the possible negative social capital consequences of going down the professional road. We need to analyse why our services are struggling to attract enough hosts and use these findings to develop them into the future. Otherwise increased payments and professional options will be seen, misleadingly, as a fix-all solution; a knee jerk reaction. This is especially relevant for services that might be struggling to attract enough volunteers because they don’t have time to spend on recruitment and retention.
On the other hand, we should not rush to assume that there is something wrong with going professional and that policy makers and governments should not support this trend. On the contrary, it should be supported one hundred percent. Indeed it is probably the future of respite in this area and therefore should be given every encouragement to succeed. However, this should not be undertaken at the cost of alienating a significant source of valuable expertise. We should not write off a model of service that has been chronically under-funded just because it didn’t perform like it should have, were it to have been funded appropriately in the first place. Both service delivery models should be equally encouraged in order to maximise the numbers, quality, choice and social capital that is available to our service users.