The Review of the Carer’s Allowance (CA) was undertaken by the Department of Social, Community and Family Affairs (DSCFA) under the proposed civil-service-wide Expenditure Review Programme. The CA review working group included eight civil servants from the (DSCfA), one from the Department of Finance, and one from the Department of Health and Children.
The working group considered the objectives of the CA, how they had been achieved, and its future role. They estimated approximately 40,000 adults in need of full-time care in Ireland, plus almost 9000 children with severe disabilities. At the end of 1997, the costs of CA were £36.5 million, for a total of 10,330 claimants. (Because the majority of recipient carers had previously been in receipt of a social welfare payment before claiming CA, the real net cost of the scheme is considerably lower.)
The report states that there is limited evidence that community care is cheaper than, or reduces the use of institutional care. But it says that ‘while this analysis is perfectly valid at the macro level, at the micro level the opportunity cost to the carer has to be distinguished from the actual cash cost to the state of the informal care provided by the carer and this tends to be the focus of carers themselves. From this perspective, community care can be argued to be the de facto cheaper option.’ Care in the community ‘should not be seen as a substitute for, or alternative to institutional care, but rather as a complementary type of care which addresses different care needs in society.’
Stated government policy is strongly in favour of supporting care in the community. The role of carers is of crucial importance to this policy objective, and this necessitates the provision of adequate support services to support and assist care recipients and their carers.
The CA has three main objectives: to provide income support to full-time carers on low incomes; to maintain people in the community; and to recognise and support the valuable role of carers.
Efficiency and effectiveness of the present CA scheme
There were criticisms that the scheme is currently administered by two sections of the DSCFA. It was considered that ‘the scheme is only effective for carers who are on low incomes, many of whom are already in receipt of social welfare payments. It is less effective in meeting its objectives to support care in the community and to give recognition to the role of carers.’ The working group encountered data problems throughout the course of the review; they suggested that a national survey of carers and caring should be conducted.
Issues and proposals
The major issues which arose, from discussions with interest groups, the health boards and professional groups, related to demands for a needs assessment, a direct payment for caring services, the lack of recognition and the inadequacy of respite and other healthcare services. Improvements to the scheme will be contingent on the necessary resources being made available to finance them, and it is acknowledged that it is necessary to establish priorities among the various possible enhancements identified.
The introduction of a needs assessment, both of the needs of the care recipient and of the carer, was proposed. Devising and administering such assessment would need to involve the DSCFA, the Department of Health and Children and the health boards and would necessitate the allocation of considerable resources.
A ‘continual care payment, a non-means tested payment for carers in recognition of their caring role, should be introduced (similar in nature to the Domiciliary Care Allowance). The CA review estimates the full-year cost of this proposal to be £7.25m, to the benefit of 6000 carers [i.e. £100 per month]. Alternatively, such additional resources might be put into respite care which would be seen to be for the benefit of all carers, not only for those with an actual income need.
Another of the proposals in the review was that an additional annual flat-rate payment might be made to approximately 11,000-12,000 carers, as a contribution towards respite care. [The budget figure given—£1m—implies a maximum grant of £100 per year.]
Issues for other departments
The statutory obligation to provide nursing home subventions contrasts with the discretionary nature of some community care services such as home helps. This has resulted in an imbalance of public expenditure in favour of institutional care, despite government policy objectives favouring care in the community.
The Department of the Environment and Local Government is reviewing their Disabled Person’s Grant Scheme and the Department of Finance is examining the possibility of introducing a targetted tax relief for carers in the home, which would provide some recognition to carers who are not eligible for CA.
Alternative financing arrangements
Various public and private options which might be considered as a means for paying for long-term care include increased general taxation, an increased health contribution levy, an extension of the PRSI system to those who leave work for a period to become carers, and an extension of the PRSI system to enable care recipients to fund some of all of their own care needs. ‘The choice or balance between the various options is properly a matter for political debate and decision.’
Opposing views within interest groups
Although most criticisms of the CA and suggestions for its improvement were widely agreed by all interest groups, there was one major issue on which groups diverged. Those groups representing people with disabilities favoured the payment of CA to the care recipient, to empower them to choose and purchase their own care, while groups representing carers and older people supported the payment of CA to those who carry out the caring duties.