Carers continuing to care after residential care placement.

One of the most difficult times for family carers is when the person they care for moves into a residential care home. Although they are relieved to some extent of the day-today tasks of caring, they lose the company of their loved one, which can be especially difficult for spouse carers. It is not always easy to obtain residential placement near to the carer's home, so carers may have to travel some distance to see the person they care for, which they often do on a daily basis. Furthermore, they lose control of the care provided, including the perceived quality of that care. They may also lose services, such as home care, or benefits, such as carer payments, that they were receiving on behalf of the person they were caring for or due to their caring responsibilities. These issues are often poorly recognized and managed in a service system that focuses more on the instrumental rather than emotional and social aspects of care for older people. It is often thought that residential care placement signifies the end of the caring role. However, qualitative research in this area highlights that family care is not relinquished when the cared for person goes into residential care and this is clearly demonstrated in the review of the qualitative literature by Afram and colleagues in this issue. Schofield (1996) conceptualized the term " care-guardianship " to recognize that carers maintain an important role in caring for the person with dementia after residential placement and that this role should be acknowledged and valued. Viewing caring in a task oriented fashion fails to acknowledge the role of the relationship and the grief associated with residential placement. She stated that, " after a bereavement through death, friends take the initiative in offering support; but when a family member moves into [residential care], there is a popular assumption that the initial reaction is relief, rather than intense sadness and pain " (Schofield, 1996; p.176). Often services that might provide support for carers, such as case management and carer support groups, withdraw upon entry to residential care; precisely when the need for emotional support is at its greatest. This withdrawal of care reflects the often fragmented nature of aged care services, where home based services have separate funding, policy, programs, and providers to residential aged care services. Many governments are aware of the divide in service programs, however, attempts to …