Home care is integral to plans for tackling delated discharges from hospital, and in the expansion of intermediate care. The government has introduced national minimum standards for domiciliary care so research providing insights into modes of working for home carers is of importance to policy makers. The Quinn Centre, which studies domiciliary care recently consulted home care staff.
Home carers working in the independent sector in two areas of Hampshire were invited to take part in discussion groups to share experiences and ideas about the values and status of their work. Twenty-six carers took part in five groups during February 2003. The majority were aged over-50, working less than 30 hours a week, with at least two years’ experience in home care.
The carers highlighted the following features of good quality home care:
- Reliability and punctuality.
- Capacity for responsiveness to day-to-day changes in clients’ circumstances.
- Providing worthwhile social interaction in addition to practical support.
- Continuity of care from regular carers, and co-ordination between agencies delivering complex care packages.
The difficulties found trying to achieve these features were also highlighted. The biggest issue with personal care is pressure of time. Typically, the work must be done in a time slot, “the frustrating half an hour”, which barely allows time to complete practical tasks, let alone talk with the service user. Furthermore, (unpaid) time allowed for travelling between calls may be inadequate, especially in rural areas.
Another issue was trying to cope without appearing rushed. Some start early to allow for contingencies, and most expect to end the day running late. Thus, carers work extra time unpaid. Alternatively, travelling time is taken from time allocated for care. In contrast, carers working on specialised intermediate care services experience fewer time pressures, having flexibility with regard to work scheduling, and an explicit assessment and monitoring role. All of which contribute to job satisfaction.
Most carers said that service users ask them to undertake additional tasks, either because they are unclear about limits to the carer’s role or because they choose to ask for a “favour”. Being drawn into doing favours is seen as a consequence of “getting attached” to long- term clients who have limited support. Indeed, up to a point, accommodating service users’ requests is seen as evidence of a caring attitude. Yet, some feel uneasy about being driven to “bend the rules” and others are grateful to refer clients to the regulations to justify a refusal.
Carers value support from accessible managers who get to know them and who:
- Brief them well about new clients.
- Help with maintaining boundaries.
- Re-allocate if carer or service user feels they are incompatible.
- Act if carers report concerns about clients.
- Give emotional support when a client dies.
- Respect limits that carers place on the hours they can work.
The “do as you would be done by” principle is a strong guiding ethic, with caring seen to be largely about common sense. This may explain why opinion was divided among these experienced carers about the merits of attaining NVQs in care. Some were simply unsure how they would gain, although others could see value in reflecting on their practice.
The carers know their service users value them but believe their work goes largely unrecognised by the wider community. Some were optimistic that qualifications may deliver a more professional image and better pay. Others feel that carers should not need to change, but public perceptions should alter so that home care is properly valued.
1 Department of Health, Domiciliary Care: National Minimum Standards, HMSO, 2003