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Going above and beyond the call of duty: excellence in home care services

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approaches to dementia care, carers, dementia awareness, research

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’ (http://www.channel4.com/programmes/dispatches/on-demand/61826-005) – have highlighted the industry-wide problems of visits being cut 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.

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.

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

A version of this article first appeared in Community Care: http://www.communitycare.co.uk/2017/05/11/saw-care-workers-going-beyond-call-duty/

 

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Home care services

Thanks Lucy and Sam. This is a really nice piece. What's good is that it gets under the stereotype that care in the community is provided by people constantly rushing and not really caring about their work. I think you portray it well. I like the idea of reciprocity. In some of our other research, we have been looking at what's important for people with dementia, and the certainly people with dementia want to use their ability to help others or do things for them as much as they possibly can. It's good if we are able to provide the right opportunities or respond to them in the right sort of way.

Best wishes, Tom

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