
%0 Journal Article
%A Dow, Briony 
%A McDonald, John 
%T The invisible contract: shifting care from the hospital to the home
%J Australian Health Review
%D 2007/04/01
%V 31
%N 2
%P 193-202
%K 
%R https://doi.org/10.1071/AH070193
%U https://www.publish.csiro.au/paper/AH070193 
%X 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. 
