[procaare] HCC:Post Conference discussion -34

[Insight Initiative Team <insight@hdnet.org>]

HCC: Post Conference discussion - 34
- HDN Key Correspondents/Rapporteur Team,Thailand
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Family members as caregiver: Does that include the elderly too?

It is well known that families as carers can be burdened financially, physically,
socially, and in so many ways that they need support from various agencies and through
community mobilization. However, only recently has there been some focus on elderly
caregivers. The research is revealing that many carers are elderly and that they need
programmes targeted to their needs. That they have been neglected for so long in the fight
against AIDS and in care and support programs is a concern, and now it seems that the
major concern is how to effectively rectify this situation.

Joint teams of Thai and US researchers have produced nine reports on the situation of the
elderly and the AIDS epidemic in Thailand. A quantitative report from this team was
presented by Jiraporn Kespichayawattana (f), exploring the impact on older persons caring
for adult children in three regions of Thailand. This was complimented by a qualitative
survey of 24 older caregivers, presented by Paul Godfred, from research in northern
Thailand. Paul is from Help Age, Thailand, and this research was carried out in two
sub-districts in carefully designed and implemented research. The former team, represented
by researchers at Mahidol University in Thailand, and Help Age, are the leading
institutions in this type of research.

Both reports highlight the economic and social burden of parents and families providing
care for their adult children. Paul also discussed the intergenerational conflicts that
arise with what may be described as a gender gap, where young people, usually
grandchildren, are mostly not involved in caring. The primary care giver is most often the
woman, generally over 60 years old, and it is not uncommon that they may be over 70.
Reports were cited suggesting that over 70% of primary caregivers are in this age range.
This may be due to parents of the adult child having died, or away at work, or if the PLHA
is older, which is often the case, the caregiver is actually the parent, rather than
grandparent.

While family members contribute to the care, the older persons appear to take much of the
burden, which results in health consequences to themselves due to the workload that is
imposed upon them. Men it seems can play an important role but generally it is the women
who take control and put in the hours. Paul said that men will help around the house, and
they will take people to where they need to go, such as hospital visits, but he noted that
in the case of a person being admitted to hospital it is the mother, or grandmother, that
will stay with their child, and tend to their needs.

Jiraporn suggested that 60% of their sample, of several hundred respondents, were women
caregivers, the great majority over 50; and in 27% of the cases the man was the primary
caregiver. This does suggest that the burden falls on the women, even when the man was the
caregiver women may contribute a lot of support. However, 27% is not insignificant and
more research on such gender issues may point to ways that more men can share the burden.

Issues like this are being raised but not thoroughly analyzed. It is well known that women
will always shoulder domestic burdens more than men, but when over a quarter of men are
shouldering much of the burden there should be further analysis of why, or how this came
about. Both papers addressed important issues, but could have said more on the role of
elderly carers and their needs. It has been long recognized that very little attention has
been made to AIDS knowledge and attitudes of the elderly. It is generally known that there
are many HIV/AIDS issues that are misunderstood by the elderly, and yet these are the very
people who are the primary caregivers for most of the PLHA.

Time constraints prevented the lessons learned and the core issues being brought to the
fore. Greg Gray's paper from APN+ Thailand was a long, systematic list of what it is to be
a good carer, although it did not especially deal with family issues in care it did cover
all the important qualities and attitudes in dealing with the terminally ill. It was
evident that some suggestions would be beyond the elderly caregiver. This may highlight
another issue, namely, that one person alone cannot provide all needs, and even families
may not fulfill all the needs of the PLHA.

Encouraging informal networks was one important suggestion, and this is cited by the
previous studies as important, which may require a concerted effort by peers or siblings.
This list of suggestions certainly serves to remind us of what a difficult job it can be,
and how special counseling skills would go a long way to meeting the goals of long term,
day in, day out, care giving.

HDN Key Correspondent Team
Rapporteur Team
E-mail: correspondents@hdnet.org

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The Insight Initiative Project is managed by Health & Development Networks (HDN) in
collaboration with the Thailand Red Cross Society, the World Health Organization and the
Royal Thailand Government, with financial support from AusAid and UNAIDS.

For more information about this project (the 'Insight Initiative'), visit the HDN website
at: http://www.hdnet.org

Fifth International Conference on Home and Community Care for Persons Living with HIV/AIDS
Chiang Mai, Thailand - 17-20 December 2001
Website: http://www.hiv2001.com


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