1. ‘To those who have, more is given’; Network type and service use in England’ Paul Higgs 1, Xanthippe M. Tzimoula 1, Fiona Poland 2, Georgina M. Charlesworth 1 1 University College London, Centre for Behavioural & Social Sciences in Medicine 2 University of East Anglia, School of Allied Health Professions Acknowledgements The Befriending and Costs of Caring (BECCA) project (ISRCTN08130075) was funded by the Health Technology Assessment (HTA) Programme (project no 99/34/07) granted to Charlesworth (University College London), Mugford, Poland, Harvey, Price, Reynolds and Shepstone (University of East Anglia). Befriender expenses were funded by Norfolk and Suffolk Social Services, the King’s Lynn and West Norfolk Branch of the Alzheimer’s Society and an AdHoc grant from the Department of Health to North East London Mental Health Trust. The views and opinions expressed in this paper are those of the authors and do not necessarily reflect those of the Department of Health. XT is currently funded by the ESRC (RES-000-22-2020 grantholders:Charlesworth, Higgs and Poland). Abstract The interaction between formal (service use) and informal (family/friends) care for people with dementia (PwD) was examined in a sample of 236 carers of PwD recruited in the UK counties of Norfolk & Suffolk and the London Borough of Havering. Results supported the ‘crowding in’ hypothesis, as carers well-supported supported by their social network, were enabled to make more use of formal services. Introduction People with dementia have considerable care needs (Philp et al., 1995) and family carers often provide care for long period of time. Greater knowledge of the interaction between formal and informal care is needed (Nordberg et al., 2005). Social networks may influence the use of health and social care services (Keating et al., 2003). The introduction of services may lead to a withdrawal (‘crowding out’) of family support or an accumulation of help from formal sector and family supporters (‘crowding in’). This is a secondary analysis of data from a longitudinal study of family carers of people with dementia in the UK, which examined the relationship between network type and service use. ‘Services’ here include day care services and respite care for the person with dementia. Service Use was assessed by 5 dichotomous (yes/no) questions : – ‘Has PwD stayed in residential or nursing home facilities?’ (Respite care) – ‘Does PwD use day care/ day hospital services?’ (Daycare) – ‘Is there anyone who comes to help PwD with personal care?’ (Personal care) – ‘During the last 6 months of caring, have you used any services for carers?’ (Carer services) – ‘Use of any social clubs/ day centres yourself / jointly with PwD?’ (Joint social events). Results Carer Network type at Baseline is presented in Table 1. Table 1. Carer Network type 13 (5.7%) were classified as having an ‘Inconclusive’ network type (Missing data for 6 carers). 118 (50.4%) carers used day care services and 56 (24.1%) carers used respite care services. Findings suggested a relation between use of day care service and network type (Χ 2 (4)=13.54, p=.009) (Table 2) and between respite care and network type (Χ 2 (4)=10.90, p=.028) (Table 3). Carers in a locally integrated network were more likely to make use of day care services (28.7%) for the person with dementia. Carers in a private restricted network were less likely to make use of day care services (28.7%). Table 2. Day care service use by carers in Network types Carers in a locally integrated network were more likely (28.8%) to use respite care service, while carers in the private restricted network were the least (21.3%) likely to use respite care for the person with dementia. Table 3. Respite care service use by carers in Network types Use of Respite care service No use of Respite care service Family dependent14 (26.9%)26 (16.0%) Locally integrated15 (28.8%)33 (20.4%) Local self-contained12 (23.1%)34 (21.0%) Wider community-focused1 (1.9%)26 (16.0%) Private restricted10 (19.2%)43 (26.5%) Results supported the ‘crowding in’ hypothesis. Conclusions Findings suggest that carers in more socially restricted networks, and maybe more in need of support, are less likely to use services that could benefit them. On the other hand, carers in well-integrated social network types, make more use of services for the person with dementia. It is recommended that assessment of social networks should be more widely incorporated into Carers Assessments to help identify individual support needs and service use planning. References Keating, N., Otfinowski, P., Wenger, C., Fast, J. & Winblad, B. (2003). Understanding the capacity of informal networks of frail seniors: a case for care networks. Ageing and Society, 23: 115 -127. Nordberg, G., von Strauss, E., Kareholt, I., Johansson, L., & Wimo, A. (2005) The amount of informal and formal care among non-demented and demented elderly persons – results from a Swedish population-based study. International Journal of Geriatric Psychiatry, 20, 862-871. Philp, I, McKee, K., J., Armstrong, G., K., Ballinger, B.R., Gilhooly, M.,L.,M., Gordon, D.,S., Mutch, W., J., Whittick, J., E. (1997?) Institutionalization risk amongst people with dementia supported by family carers in a Scottish city. Aging & Mental Health, 1(4), 339-345. Wenger, G.C. (1997) Social networks and the prediction of elderly people at risk. Aging & Mental Health, 1 vol.4, pp. 311-320. Methods Participants were 236 carers Recruitment took place through: Primary care Voluntary organisations e.g. Alzheimer’s Society Self-referral e.g. after presentations / media publicity Other Health or Social Services in the UK counties of Norfolk and Suffolk, and the London Borough of Havering. Eligibility criteria were: to provide care for at least 20 or more hours per week for a relative with progressive dementia living at home. Measures included: Network type (PANT; Practitioner Assessment of Network Typology; Wenger, 1997) 8 questions assessing – Frequency of contact with, and geographical proximity to family – Frequency of contact with friends & neighbours – Membership of clubs or religious groups Five network types can be identified: Family dependent, Locally integrated, Local self-contained, Wider community focused and Private Restricted. Baseline(N=230) n(%) Family dependent41(17.8) Locally integrated48(20.9) Local self-contained46(20.0) Wider community-focused28(12.2) Private restricted54(23.5) Use of Day care services No use of Day care services Family dependent22 (20.4%)19 (17.6%) Locally integrated31 (28.7%)16 (14.8%) Local self-contained25 (23.1%)21 (19.4%) Wider community-focused7 (6.5%)21 (19.4%) Private restricted23 (21.3%)31 (28.7%)