title: The invisible contract: shifting care from the hospital to the home.
abstract: The ageing population and associated burgeoning health care costs have resulted in a shift of care from institutional settings to home and community-based care. As one example, rehabilitation-in-the-home (RITH) programs are becoming increasingly prevalent. These programs either substitute or supplement in-hospital treatment by providing multidisciplinary rehabilitation and support services in the client's own home. This paper investigates the impact of RITH programs on informal carers. Semi-structured interviews carried out with caregivers and staff revealed a complex and contradictory interpretation of informal caring. Analysis of carers' interviews revealed: an assumption by themselves and others (including RITH staff) that they would provide care; the intimate, arduous and relentless work of caring; lack of consultation about discharge; lack of recognition and reimbursement; and low levels of program support for them as carers. Carers are integral to the successful rehabilitation of the client, but they occupy a marginal status within the program. An invisible contract consigns to them substantial care-work that was previously provided by the hospital. Informal carers in RITH programs can be seen as disenfranchised care contractors. This has implications for policy makers, program managers and researchers.
authors.affiliation: Preventive and Public Health Division, National Ageing Research Institute, PO Box 31, Parkville, Melbourne, VIC 3052, Australia. b.dow@nari.unimelb.edu.au
authors.forename: Briony
authors.initials: B
authors.lastname: Dow
authors.forename: John
authors.initials: J
authors.lastname: McDonald
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D032982:Contracts; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000458:organization & administration; D010351:Patient Discharge; D014739:Victoria