Supporting the health and occupational participation of Australia's carers

Australia has more than 2.7 million family carers and about a quarter are primary carers, the majority of whom are women, aged 55–64 years (Australian Bureau of Statistics, 2012). Primary carers usually provide crucial assistance in instrumental activities of daily living, navigate services or provide individualised support to the person needing care. The assistance provided by carers may be temporary, episodic on ongoing. In some capacity, occupational therapists work with carers in virtually every area of traditional practice in Australia: mental health; paediatrics; aged care; acute care; palliative care; community practice; disability and rehabilitation. What do we know about caring and the impact of caring, and are occupational therapists doing enough for carers in daily practice in Australia? Occupational therapists have deep knowledge about how clients might experience different conditions, capacities and capabilities. As a consequence, occupational therapists will also predict the impact on a family carer with some accuracy. If the care recipient requires temporary or ongoing support, equipment, technology or environmental changes, transport, medical procedures or surveillance to be kept safe and well, then the carer often performs these tasks as required. There are different types and levels of care including night and day care, direct (in the presence of the person needing care) and indirect care (done on behalf of the person, usually in their absence). All types of care requires time, skill and persistence from a carer charged with these responsibilities. Occupational therapists have other specialised knowledge in relation to caring. We know that there is a balance between the care needed by a person and the care provided, including amount, frequency and intensity of care provided. Too little care and support may leave a person unable to participate in daily occupations and too much care and support may leave a person unable to use or develop the skills that they have or want. We know that technology and equipment in the home must suit the care recipient and care provider's unique needs and circumstances. We know that carers experience health consequences. For example, Australian mothers of a child with a disability experience higher levels of stress and higher rates of anxiety and depression than other mothers (Bourke-Taylor, Howie, Law, 2010; Bourke-Taylor, Howie, Law & Pallant, 2012). We know that carers of family members who are experiencing serious neurological conditions report compromised quality of life themselves and strain related to navigating services for their care recipient (Peters, Jenkinson, Doll, Playford & Fitzpatrick, 2013). We know that caring for a family member with a mental health condition can impact the health of carers as well (Happell, Wilson, Platania-Phung & Stanton, 2016). In Australia, occupational therapists are aware of the compounding issues associated with service unavailability and reliance on technology and other supports, as faced by rural carers (Gardner, Bundy, Dew, 2016). The capacity of carers to provide care, the impact of the responsibility on the care provider, including their capacity to work, be healthy and participate in society will vary according to circumstances. Care can be very complex, including that of a preventative or protective nature associated with episodic physical and mental health or chronic medical conditions. Recognising that vigilance and care activities that prevent more extensive care needs at a later point are valuable and crucial, as well as having a cost saving function for the community, is important. Occupational therapists have committed to research and to attend to the needs of carers (O'Sullivan, 2007). What can occupational therapists do at a clinical, community and organisational level to better support carers? The Federal government launched Australia's first National Carers Strategy in 2010, which was followed by an action plan (2011–2014) that sought to implement change to improve the lives of carers (Australian Government, 2012). The action plan targeted six areas related to carers: recognition and respect; information and access; economic security; services for carers; education and training of people within the health and disability sectors to recognise carer needs; and ways to promote carer health and wellbeing. In late 2015, the Carer Gateway (see https://www.carergateway.gov.au/) was launched as a part of the actions. This navigation portal offers a lot for carers—validation of the role of carer, suggestions for support in the event that the carer may need counselling or home modification to ease carer duties in the home or elsewhere. Occupational therapist might routinely bring the site to the attention of a carer through conversation, a resource sheet or by demonstration. Similarly, organisations might advertise the site to carers, along with information about Medicare services (Enhanced Primary Care Program or Mental Health Treatment Plan) available through general practitioners. Mental Health Australia recently coined the term ‘carer champion’, referring to a professional who takes on the specific role of liaising with, or being responsible for working with carers (Mind Australia and Helping Minds, 2016). In line with the concept of carer champions, occupational therapists know about caring and can do more to support carers. As a profession, we can contribute to better health outcomes and carer's occupational participation. Using a ground roots approach, occupational therapists can support carers to achieve occupational balance as individually desired through including carer needs in every interaction with clients, and wider organisation procedures that recognise and value the role and health of carers.

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