'Granny dumping' is not a symptom of heartless families, but of the lack of social support for carers

State policy has effectively encouraged family carers in crisis to present to hospital toaccess rapid home-care packages or respite beds, writes Sinead McGarry

Gone are the days when the local public home help services were valued by the State, providing true ‘person-centred’ care before the term was popular'.

Like all professionals, social workers have their pet hates.

One is the use of the label ‘Granny dumping’ to describe the behaviour of families who bring a relative to hospital and when advised the person does not require admission, decline to bring them home. 

Particularly emotive at Christmas, it instantly conjures up images of morally bankrupt families, abandoning their relative to strangers with ease, in the high-risk environment of an acute hospital. 

It is also symptomatic of our tendency to individualise complex social problems, as it is easier to judge than pause to consider the carer's lived experience of providing care and accessing support in Irish society.

Social workers are trained to look beyond labels to understand the unique human stories behind them. No individual problem is an island; social workers are aware that personal difficulties are shaped by the wider social context of our lives including complex family relationships, failing policies, and inadequate health and social care systems. 

Viewed through that lens, the lazy label of ‘Granny dumping’ which places responsibility for an admission on the shoulders of carers suddenly becomes redundant. Instead, a myriad of complex and interconnected reasons emerge.

A career in medical social work gives insight into the key contributory factors which bring carers in crisis to hospitals. Before taking that step, carers have inevitably failed to find support in their local communities, buckled under the weight of a care burden or experience challenging dynamics in the caring relationship.

State policy choices in community services have effectively encouraged family carers in crisis to present to hospital to access rapid home care packages or respite beds. This is primarily due to the fact the State operates a skewed home care funding model, with separate community and hospital funding streams. 

Community services have been consistently underfunded with recent HSE figures showing 7,827 people are awaiting home care supports. Day centres and services are accessible on a postcode lottery basis, with supports vastly different from one county to the next. The privatisation of home care has narrowed the band of accessible support. 

Gone are the days when the local public home help services were valued by the State, providing true ‘person centred’ care before the term was popular, helping with shopping, hospital appointments, light cooking or housework. 

The State now predominantly invests in private agencies which only deliver assistance with personal hygiene and care tasks, bewilderingly ignoring the carer’s need to have someone simply be present with the older person while they shop, cook, attend appointments or take a much needed break.

Erosion of community support peaked in 2020. Day services closed on public health advice, a loss compounded by poor pandemic policy choices which have resulted in prolonged and harmful levels of redeployment of vital staff from social work, physiotherapy, occupational therapy, and speech and language teams, among others. 

At every turn in 2020, carers and older people were advised that community services which support wellbeing were depleted or unavailable.

‘Granny dumping’ is a simplistic interpretation of the ‘bad family’ and ‘poor abandoned patient.’ Picture: Yui Mok/PA Wire

Left languishing on waiting lists, without supports, the person’s needs invariably increase.

Our community model operates on an antiquated expectation that the family will plug the care gap while awaiting service, a nostalgic throwback to the days when women were based in the home. 

Carers are now predominately older spouses or women with multiple additional life responsibilities, expected to juggle work, childcare, and the caring role on a 24/7 basis. 

Services are often reduced or closed over Christmas and bank holidays meaning that dates traditionally associated with joy and leisure for the general public are anticipated with dread by those with caring responsibilities.

 ‘Be Superwoman’ is the message the State delivers, while offering minimal support.

The care burden in this context is crippling. Social workers work with carers who have struggled to manage, are stressed to the point of illness themselves and cannot afford prohibitively expensive private care in the absence of State services. There are also complexities in family life which impact caring. 

‘Granny dumping’ is a simplistic interpretation of the ‘bad family’ and ‘poor abandoned patient.’ Families are often deeply conflicted about providing care for a relative who was abusive, absent or unloving in their relationships. Caring changes family roles and many people find the challenges of the caring role overwhelming and beyond their personal capabilities. These are the kinds of stories social workers hear, over time, in the context of a trusting, non-judgemental relationship.

Knowing the risks of leaving a person in the care of someone who feels unable or unwilling to provide care, social workers look for solutions, guided by the wishes and preferences of the older person themselves.

However, when under the weight of a care burden, crisis hits, under-resourced community teams struggle to respond. Carers and professionals are aware that hospitals are the quickest route to resources, as rapid access to funding is prioritised for hospital patients in an effort to facilitate discharges. Essentially, the care hours a person can’t access in the community are accessible if the person makes the same application as a hospital patient. 

It is often at the point of entry to the hospital, the label of ‘Granny dumping’ is applied to families. It is a label medical social workers challenge over the course of the admission as it can impact the quality of staff attitudes and communication experienced by carers.

It is too simplistic to criticise healthcare staff for using the term, I have only ever heard it spoken through frustration and despair, never through malice. Overworked doctors and nurses battle daily to preserve hospital beds for sick people in an utterly impossible system.

It is soul-destroying for them to admit people on the basis of social and functional need, exposing that person to a risky acute environment unnecessarily, while sick patients desperately await treatment on trolleys and outpatient lists. Medics also know the cost of social admissions  —over 218,000 hospital bed days were lost in 2019 alone while patients fit for discharge awaited vital home support services.

Green shoots of hope have emerged during the pandemic. Social workers reported increased funding and efficiency at community level and hospital admission avoidance schemes have been successfully introduced in some sites. The Government has announced unprecedented levels of investment in community services for 2021, which social workers welcome, while cautioning that this must translate into, ‘boots on the ground’ supports and interventions for carers, rather than additional layers of assessment. The Irish Association of Social Workers (IASW) continues to lobby for a legislative entitlement to home care, akin to that in place for nursing home care.

Aging well is a personal ambition for most people. Different families can offer different levels of care, based on their resources, relationships, and capacities. 

Rather than judging carers for reaching their own personal limits, health professionals should collectively, demand a system where carers and older people can access emergency and longer term supports in their local communities to allow them live safely in their own homes, while preserving hospitals for people who need medical treatment.

Finally, in an IASW national survey, social workers shared concerns about the draining physical and emotional load carried in isolation by carers throughout the pandemic. We have asked the extraordinary of them and it is in this light they should be viewed this Christmas and in the year ahead.

Sinéad McGarry is a social worker