A day out with the domiciliary workers

Domiciliary workers act as agents of independence, enabling older and disabled people to stay at home. But they have to put up with low pay. Anabel Unity Sale joins one worker for a Monday morning shift
Home care is vital if older people are going to gain more independence, particularly as the population ages. But according to a recent report from the Commission for Social Care Inspection,(1)  services need a radical shake-up.

CSCI reserved most of its criticism for council commissioning because of wide variations between areas in the number of
people served and the quality of services. Also, contracts between councils and the service providers often cut the time home
care staff spend with clients, with many visits lasting 30 minutes or less. And it pointed to serious recruitment and retention problems caused by poor pay and conditions.

About 80 per cent of all registered home care is purchased by councils. In 2005, 354,500 people had home care workers and
at least 163,000 staff are employed as care workers, equivalent to the number of people employed in the hotel industry.

Community Care spent a Monday shift with Karen Burns, a home care worker with private domiciliary care provider Enara Community Care, to gain a view of the front line. The London Borough of Islington contracted out most of its home care services in 2000 and Enara is one of seven agencies it uses.

It is a cold November morning as Karen Burns makes her way down a residential street off the old Arsenal football stadium,
north London. She is visiting Tom Collins, aged 78. A stroke four and half years ago left him with extremely limited speech and mobility. Tom lives with Peggy, his wife of 56 years, in a house that radiates warmth. On the mantelpiece in the cosy living room are photographs of the couple’s three children – one of whom lives next door – and their many grandchildren.

Seven mornings a week Karen helps Tom out of bed, washes and dresses him and takes him downstairs. Tom has had care
workers since returning home from hospital in October 2001 because Peggy, 77, is unable to manage. As Tom sits on the side
of his bed, Karen washes him with a flannel and soapy water. Her colleague AnnMarie Brown arrives to help her move Tom, using a stand-up hoist, on to his commode.

The pair dress him as Peggy discusses what it was like for the couple having to adjust to seeing five care workers each day.
“At first it felt awful because we lost our privacy. Now I can’t fault them and Tom understands why they are here.”

At 8.30am Tom is dressed and Karen and AnnMarie move him out of a wheelchair and on to a stairlift. At the bottom Peggy and his home carers help Tom back into his wheelchair and Karen pushes him into the kitchen. AnnMarie goes to her other
appointments while Karen fills in Enara’s paperwork about the morning’s work.

Peggy makes tea while chatting to Karen, who she says feels like one of the family now. “I can’t fault the services, all I can fault is that they don’t get paid enough. It takes a certain type of person to do this job.”

The CSCI’s point about pay is illustrated by Karen’s pay packet. She earns £6 an hour during the week, £7 at weekends and £12 on a bank holiday and works seven days a week. She doesn’t receive sick pay and nor is she paid for holidays, although Enara pays staff an extra 54p per hour in lieu of holiday pay. Islington pays Enara just over £12 per hour for clients’ home care.

“I don’t like to take time off because you really feel it in your wages,” says Karen. But, for Islington, low pay is not a local matter. Gwen Ovshinsky, its director of adult social services, says: “Options for Excellence recognises the issue of a relatively low paid workforce in social care and if the white paper Our Health, Our Care, Our Say is to be delivered then workforce issues need to be addressed nationally.”

After leaving the Collins’s at 9.07am, there is a brisk walk past the rapidly disappearing old Arsenal ground to Rose Thomas’s council flat. She is aged 86 and a widow. She is very pleased to see visitors and greets us happily as she opens her front door.

Rose has been waiting for Karen to help her shower. “I’m scared to get in the bath in case I slip,” she explains.

Rose showers while we wait by the electric fire in the small living room. Six minutes later she returns, announcing she feels
great. “It’s lovely to see Karen so I can have my shower. Once I’ve had it I feel on top of the world.” Rose sits on the sofa while Karen gets her a cup of water so she can take her medication at 9.45am and then makes her some tea. Rose looks at her family photos while Karen writes up her notes in the Enara records.

Karen finds the job satisfying but demanding. She is used to dealing with older people like Rose because she cared for her own grandmother before working in a children’s home and as a dinner lady. At 10.05am Karen says goodbye to Rose.

Another short walk and Karen lets herself into Anne Clarke’s second floor council flat. Anne is 64 and confined to a recliner chair in her living room because she finds standing difficult. “My home carers do everything. I wish I could be more independent,” she says. Karen refills some water flasks on a trolley next to Anne’s chair. In the kitchen she makes six rolls for Anne’s snacks up until Wednesday and puts them in the fridge.

The CSCI report identified a growing gap between users’ wants and needs, amply demonstrated by the fact that at 10.35am a
meals-on-wheel meal of chicken, peas and chips goes into the microwave and Karen serves Anne her meal. Probably not the
time most people would want lunch, but if that is when your home care worker visits then users have little choice.

At 10.45am AnnMarie arrives to help Karen move Anne using an electronic hoist on to a bedpan. Both she and Karen are
studying for an NVQ level two in social care and like Karen, AnnMarie became interested in care work after looking after her
grandmother in Jamaica. When they qualify it will give them an extra £1 an hour in their pay packets.

Karen writes in Anne’s file at 11.10am and they talk about Anne’s annual assessment on Thursday. Soon after using the hoist
to move Anne off her bedpan AnnMarie leaves and Karen follows at 11.30am, telling Ann she will ring her at 3.30pm in case she needs the bedpan again.

12 noon
Karen’s final client lives near the picturesque Highbury Fields. Ann Marsden is 73 and a former social worker, who read history at Oxford University. She has had a number of strokes since she was 50, uses a wheelchair and sees three home carers a day and two at the weekends. It was Ann’s birthday last week and Karen dead heads the flowers on her table as the pair chat. At 12.25pm Karen answers the phone to the nurse and checks with Ann that it is all right for the nurse to come and give her a flu jab tomorrow. Then she writes in Ann’s care plan folder while Ann observes: “I think it’s too much for anyone to work every day.”

Karen makes Ann lunch, usually a ready meal – but not, Ann insists, from meal-on wheels – or a sandwich. Today she puts a
meat stew in the microwave and sticks the kettle on for tea before putting a bib on Ann. At 1pm as Ann is tucking into her
lunch Karen leaves, her shift over.

Contact the author
 Anabel Unity Sale

(1) Time to Care, CSCI, 2006

This article appeared in the 16-22 November issue, under the headline “In Sickness and in Health”

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