By Samantha Wilkinson and Lucy Perry-Young
The poor quality of home care services is never far from the headlines these days. Recent documentaries, such as the Channel 4 Dispatches ‘Britain’s Pensioner Care Scandal’, have highlighted the industry-wide problems of visits being cuts short, unfair terms and conditions for staff, and variable quality and regulation of services. It all makes for a worrying picture.
But when we started working as home care workers for a research project at the University of Nottingham, this negative portrayal didn’t resonate with the standard of care we saw provided. Yes, we saw some of the same problems, like the effect of zero hour contracts and lack of payment for travel time, but we also found positive and encouraging examples of care.
The research project was about understanding what ‘good’ home care looks like. It involved working for 11 months with a reputable home care provider, where we completed the usual training. Some of the visits we undertook were to help clients get up and ready for the day, others were for companionship and involved chatting or taking clients out to local cafes and shops. We got to know our clients and their relatives and enjoyed spending time with them.
‘Above and beyond’
In the social care sector, it’s common for home care visits to last as little as 15 minutes. The organisation we worked for offered a minimum of one hour, but we still frequently found it very difficult to leave on time and would often spend extra time with our clients when we felt it was unsafe or unkind to leave them at the end of the hour. We wanted to make sure clients were safely washed and dressed before we left them, but they weren’t always ready to do this and perhaps wanted to enjoy their breakfast and a chat first (who can blame them).
Because we were working with people with dementia, it was also often impossible to explain in any meaningful way why leaving on time was an issue, and so it felt unkind to try to do this.
Other care workers at the provider said they regularly spent unpaid time with clients and were not paid for the time travelling between visits. The number of hours they received each week was also unpredictable and understandably this caused some to worry about their finances. We were thankfully paid by the university so this didn’t affect us, but the long hours were a challenge and meant we often skipped meals and missed out on time with family and friends.
Despite these issues, we still saw staff going ‘above and beyond’ the call of duty. We witnessed care workers bringing dolls and pets to visits for clients to interact with. Others used their own money to purchase treats for clients (such as scones and strawberries), and referred to clients as a member of the family. Most care workers also demonstrated a high level of skill and sensitivity in communicating with clients, especially those with dementia. Some also told us how they take their work home with them – as clients occupy their worries and thoughts outside of ‘usual working hours’. Of course, this may be a reflection of the recruitment and training standards in the company we worked for, we know it’s not the case everywhere.
‘Reciprocal relationships’
One key thing we found, and other care workers told us, was that care visits are particularly rewarding when there are signs of a reciprocal relationship between care worker and client. For example, when clients show their appreciation and signs of their personalities, which may otherwise be concealed by their symptoms of dementia. Some of the most enjoyable visits were those where clients remembered things about us, like where we’d been on holiday, and shared stories of their own experiences, as this enabled a more reciprocal conversation.
We are now interested in finding out more about how care workers may find value or reward in care visits when the client is uncommunicative, or cannot articulate their thanks. Our time with the company taught us that care work is a very diverse and highly-skilled job, and it deserves both better recognition and higher pay.
Samantha Wilkinson and Lucy Perry-Young worked as home carers as part of the BOUGH study (Broadening Our Understanding of Good Home Care for people with dementia), which is funded by the NIHR School for Social Care Research (SCCR).
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I give care on a private scale,it is very rewarding as it is on a one to one basis. I have worked for agencies in the past, having very little time to spend with the client and leaving some very muddled as you have to rush to get everything done . It is all about profit and the last thing of importance is the client,it is very sad and often left me worrying about the client and how they were coping . If the rate of pay was better , more time allocated to the client and better vetting of carers it would be much better and happier on both sides. I would have young girls straight from school shadowing me on my round and not having the slightest bit of interest in the job, it was just a way of getting a wage until something else came along, heartbreaking for the clients I had introduce them to knowing they could be off anytime soon. There are some excellent carers but there is also carers who unsupervised give sub standard care and when brought to attention of these so called care agencies is brushed aside ,the shift is being covered so that is all that matters. This is why I went self employed, I can sleep at night knowing I am making a difference to a person’s life and they are happy in the last stage of their lives.
Its really nice to read something positive for a change. I’m sure this goes on a lot everywhere but is never reported.
There will always be reports of bad things going on in Community Care, but I have worked in three counties in England and the majority of Carers are decent people who want to make a difference in vulnerable peoples lives in a positive manner. Good news stories are often hidden from the public because scandal sells better! Our carers deserve professional recognition and the pay that reflects the responsibility of the job.
Hi all,
I am currently a senior care assistant in a care home, i love my job and have over 20 years experience and i have NVQ’s at level 2, 3 and 5 in health and social care. However i recently feel i could be helping more in my community where the help is needed.
I am trying to start up a home support service to which care is tailored to the individuals needs. I don’t want to be in and out within 15 minutes i to want to be there for as long as needed again thinking of 1 hour minimum visit.
I’m just starting to advertise any help or advise would be gratefully received.
There are so many wonderful carers out there that don’t get enough recognition for their hard work, a good carer genuinely cares and is not in it for the money although that would help.
Have you ever though about setting up a not for profit care agency as a social enterprise ?
Hi Catherine,
I started my own agency 8 years ago. We won’t deal with Social Services anymore, not only because they won’t pay enough to allow us to pay a decent wage (or any mileage or travel time to staff) but also because they only sanction care through a nameless ‘panel’ where the first question is how much not why the care. The problem with 1 hour minimum calls is that you run the risk of ‘ripping off’ people where they genuinely don’t need more than 30 or 45 minutes. We don’t do 15 minutes because there really is no care need that can be met in that time but if the care is to be tailored, then, you should only schedule for how long it takes. My advice is to pay as much as possible to your staff (we pay travel time and mileage for petrol). You know it’s a challenging job that is very underpaid- but without good staff, doing work to the standard you will expect, you’ll run the risk of not sleeping at night. BTW for all those that recommend setting up as a social enterprise -who provides the very risky capital to allow you the cost of setting up a new business, which, despite your best efforts might not survive?