Home care case studies

Case study 1:

Home care assistant, Redcar and Cleveland social
services

“I have worked as a home care assistant for 10
years. I work for 31 hours per week and I am paid £5.68 per
hour.

My duties include visiting clients in their own homes with
physical or mental disability or elderly. I am expected to use
initiative and act in emergencies. I have to carry out caring and
personal tasks that used to be the responsibility of the district
nurse, but could be expected to be undertaken by a member of the
family. I have to report any changes to the client especially
behaviour, needs or circumstances. I have to encourage the use of
special equipment including artificial limbs if authorised by my
line manager. This can include fitting such appliances. If I
thought it necessary I would contact the emergency services or the
doctor. I administer medication in accordance with the
department’s code and the family permission. I undertake
domestic tasks to ensure a quality of life for the client which the
client cannot do for themselves. I am responsible to the home care
manager. In order to do the job I have to have police and
department of health clearance.

In respect of my health and safety I do not know what infectious
diseases clients might have such as MRSA, Aids or Hepatitis, and I
have been given no specific immunisation to protect me in my
job.

Personal care of the clients is part of my role. This can
include bathing clients, dealing with catheter bags, colostomy
bags, medical sheaths, helping nurses giving enemas, help clients
with physio, apply ointments, deal with incontinency and
commodes.

I am required to ensure that clients are fed their breakfasts,
lunches, teas and suppers. I will also assist with clients in
dressing and undressing themselves.

I also have to deal with clients with Alzheimers and dementia.
This can often result in violence and abuse from the client. I have
experienced verbal, sexual and physical abuse – all
for £5.68 an hour.

In caring for the clients I am also required to collect
pensions, ensure food requirements are adequate, pay their bills
and do shopping for them. If they have family pets I can also be
asked to attend to these for feeding and toileting. I also have to
communicate and deal with clients’ families and friends and
other agencies involved in their care.

I can be required to deal with the terminally ill, and I have
been present and assisted when clients have been dying or died.

I am a keyholder for clients’ homes.

In order to do my job I have to have communication, literacy,
numeracy and interpersonal skills. I have to complete all required
recording arrangements including written information on each
visit.

In recent years I have seen my job change considerably, and the
personal care side is much more intense than it used to be. Because
of the responsibility level and the rate of pay it has been very
difficult to recruit new staff to the service. Provision is
currently provided on the basis of 60 per cent private sector and
40 per cent local authority. The private sector is primarily
dealing with the housework side of the job, and the local authority
staff are dealing with the more intense personal service side.

Health and safety for the home carers is a particular issue.
Each client is not assessed individually, but a generic risk
assessment is undertaken which does not meet all the individual
circumstances of the client or the safety of the carer, who often
or mostly is working alone in a vulnerable situation. There is no
protective clothing issued either.

In addition the job is made harder by a bullying management
style that puts pressure on staff to cover for vacancies, maternity
leave and sickness absence. All this adds to the stress of an
already stressful job. The responsibility level is way above the
rate of pay. Despite having been job evaluated over two years ago
my pay has not been increased.“

Case study 2 – Former home care assistant Durham social
services

“I worked for years as a homecarer. I was paid
£5.69 per hour.

Because I have two young children I can only work evenings so
that my husband can look after the children when I am not
there.

In order to do the home care job I had to travel in the Durham
area, and as I do not drive this required me riding on my bike. It
was not unusual for me to go to a client’s house and work for half
an hour, then have to go home to wait for half an hour before going
to the next client for a 45 minute visit then back home again.  I
rarely left the house to work a full shift. My last call would be
at 10.30 pm. On an occasion I met another home carer so that we
could put a client to bed at 10.30 pm, and she had been working
from 7am that day.

As I could not work mornings the social services department
would not give me a contract to guarantee me specific hours, most
home carers contracts are for a guaranteed minimum of 12 hours.
This meant that every week my hours would be different.

One week I earned only £17 because the work was not
there.

I left the employment of Durham County to work for Tesco
supermarket as a shelf stacker. I work 5pm to 10 pm 3 or 4 nights
per week and I am paid £5 per hour, so I know exactly what I
am working and what pay I will receive. The company is good to work
for and they have given me training and an overall, and my work
colleagues are nice too. I also have the option of working more if
I wish. Given the uncertainty about my work and earnings and the
level of responsibility that I had I considered that for an extra
69p per hour it was not worth it. Some clients could be very
demanding, and some families had high expectations of what the home
care service should be delivering.

While working as a home carer I enjoyed working with the clients
and I received very good training.

The reasons that I left the home care job was that there was no
guaranteed hours, no set times to work, the pay did not match the
level of responsibility, and how I worked varied from week to
week.“