Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association
RESEARCH ARTICLE

The invisible contract: shifting care from the hospital to the home

Briony Dow and John McDonald

Australian Health Review 31(2) 193 - 202
Published: 2007

Abstract

The ageing population and associated burgeoning health care costs have resulted in a shift of care from institutional settings to home and communitybased care. As one example, rehabilitation-in-thehome (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.

https://doi.org/10.1071/AH070193

© AHHA 2007

PDF (234 KB) Export Citation Cited By (13)