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Natural support; choice versus obligation

There has been an ongoing push for people to use natural support more and paid support less, but is all natural support the same and is natural support always the best option for people?

Natural support is the support people get from the unpaid relationships in their lives, their relationships with friends, family/whānau and people in their community. There has been a big focus on people using natural support as an alternative to paid support. Rather than having people’s support needs met only by paid staff, more, or all, can be met by the unpaid people in a person’s life.  This has been largely a positive shift and takes us further away from the dark days of large institutions, where it was assumed only paid staff, especially medical professionals, could provide support to disabled people.

There are different reasons for people to give someone else natural support. Some people give this support simply because they choose and want to. When people do this there is a two-way relationship with the person giving natural support getting something back that they value (such as friendship, natural support themselves and/or feeling good about helping someone). This type of natural support benefits both people involved and should be actively encouraged.

In some cases, however, the choice to provide natural support can be overshadowed by a sense of obligation. This can sometimes be the case for family/whānau, especially if there is a perceived, or actual, lack of good alternative sources of support. During the paid family carer court cases, which took place between 2001 and 2012, the “social obligation” aspect of natural support was in the spotlight. The Government argued that a social contract (an expectation from society) obliged family members to provide natural support to other adult family members. The Government emphasised that its paid supports were only available as a back-up to this natural support.

The Government also argued in the court cases that paying family carers might corrupt the natural support relationship. The trouble is if money can corrupt a natural support relationship, I suspect a sense of obligation can too. Many resources on natural support emphasise that natural support is built on a reciprocal relationship – which is the great advantage. Instead of people supporting someone because they are paid to, they are supporting them because they want to and get something back in return. Yet if social obligation plays a major role, the reciprocal (give and take) nature of the relationship comes under threat.

A strong sense of social obligation can reduce, or even eliminate, choice in a natural support relationship. People end-up providing natural support because they feel they have to, rather than want to.  These relationships can sometimes go down paths that do not result in great, or sustainable, situations for everyone involved.  Parents past retirement age, who are developing support needs themselves, can still be providing natural support to their adult children. Adults can continue to live with family/whānau members well into adulthood, when alternatives could see them live independently in the community.

The way to reduce the impact of social obligations on natural support relationships is to provide a range of good support choices to people and their families/whānau. Sometimes family/whānau members feel they have to keep their adult family/whānau members home because the only other option is residential services.  Many people feel residential services do not provide the same quality of support as a family/whānau can.  Providing a range of good options is important – as it means families/whānau and most importantly disabled people have a real choice.

We need to improve people’s access to natural support in their communities, but it has to be natural support that is based on reciprocity and two-way relationships, not social obligation.

Sam Murray
National Policy Coordinator

3 Responses to “Natural support; choice versus obligation”

  1. Roger Loveless says:

    This is one area where the idea of economic analysis may seem inappropriate to many. But is it? A perceived obligation to provide support in a family situation when the needs are higher than for others may take someone out of the work force where their contribution then becomes lost. At our forums on our transport research yesterday David spoke of us being prepared “to get our hands dirty”. For transport infrastructure upgrades one of the benefits would be allowing persons with disabilities greater independence, thus freeing up support requirements whether from a paid career or family member. The challenge is to value the “natural support” contribution when it is over and above what would generally be accepted as reasonable.

  2. Great article. Personally the Only support I get is the mobility card to enable me to utilise wonderful wide car parks which lessen the impact on my body from craning the neck, shoulders, when backing into the car parks, and shorter walking distances, yay. Regarding physical help with shopping, house wok etc, I get no other support, natural or paid.

  3. Rosemary McDonald says:

    Hmmm…”Natural Support”…The Human Rights Review Tribunal Decision for Atkinson and Others v Miserly of Health….

    will tell us all we really need to know about “natural support”, the concept of, the limits of and the reasonable expectation of.

    How about the Misery of Health adopt the ACC model for paying family carers, with an expectation in certain cases of family members providing a reasonable level of unpaid care? It’s not that hard.
    The sky did not fall and ACC certainly has NOT gone bankrupt.

    And “choice”? Hah! The Tribunal batted THAT one right back at the Ministry…in paragraph 111.

    “[111] The defence argued that the policy decision not to pay parents and spouses to care for family members can be supported on the grounds that a disabled person is in fact, free to choose a resident family member to provide their personal cares. The Tribunal can only speculate as to how many families have in fact felt not able to choose the option of care by resident family members for the reason that it was not financially viable. ”

    If anyone is interested I wrote about the Tribunal decision here…

    Lest we forget.

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