Abstract

Background: The Hong Kong Government has implemented a series of new policy initiatives using the “money follows the person” principle to enhance the LTC system. One of these initiatives is to provide cash allowance for informal carers of frail elder to enhance their ability to provide care continuously and to reduce their caregiving burden. Little is known about how these caregivers used the cash allowance and the impacts of this allowance on the care process and carers’ outcomes.

Objectives: We investigated the impacts of this new carer allowance pilot programme, which consisted of a carer allowance of HKD2,000 (approx. = EUR200) per month per frail elder and carer support services provided by social worker, on spending pattern among low-income informal carers of older persons in Hong Kong. We investigated how carers allocated the allowance to support themselves, care recipients, or both, and what characteristics predict their allocation.

Methods: A mixed methods approach was used to collect data for this study. We interviewed 122 carers twice over a two year period. We also conducted focus groups and individual in-depth interviews to collect feedbacks from stakeholders on this program.

Results: Majority (58%) of the carers reported that they had spent most of the allowance on their care recipients. Most common ways of spending were i) buying nutritional foods or supplements for the care recipient, ii) going out with the care recipient, iii) purchasing equipment and consumables for daily living for the care recipient, iv) paying for medical expenses of the care recipient, and v) paying for daily expenses of the carer. Carers who were taking care of elderly with higher ADL (OR = 1.12, 95%CI 1.01 to 1.24, p = 0.028) and without a diagnosis of dementia (OR = 0.35, 95%CI 0.12 to 0.98, p = 0.047) were more likely to use the allowance for their own living expenses. Carers’ caregiving burden and quality of life were not significantly associated with their spending patterns.

Conclusion: Although the major goal of the carer allowance pilot programme was to support the carers and to reduce their caregiving burden, we found that the carers see the allowance as part of their regular monthly income and use the money on their care recipients, disregarding their own needs. The carer allowance reduces the financial burden on carers but did not enhance their ability to cope with caregiver burden. This is particularly observed when the older person’s condition requires higher level of care, a situation in which the carer faces a higher risk of burnout.