Four months on from his mother's death, PAUL DONOVAN takes a look
at how hard-working carers are held back from providing decent care by
exploitative and profit-driven employers
It's four months now since mum died, so there has been some time to reflect,
particularly about her care.
The thought occurred recently upon meeting one of her former carers.
Sue (not her real name) told how she had really liked mum, her sense of
humour and concern for the carers. Sue was disappointed not to learn about mum's
death at the time from the care company. She said she would have liked to come
to the funeral.
Sue looked exhausted. Working for the care company for the past 14 months had
clearly taken its toll.
On a zero-hours contract, she told of the difficulties of her hours being at
the total whim of the managers. She could get a day packed with back-to-back
calls or be given a couple of hours of work in the morning then a gap of four
hours before again getting stacked-up calls into the evening.
She told how she often wanted to stay longer to get the job done properly,
but there was huge pressure to get in and out as quickly as possible.
I know the keenness of the care companies to pack in as many calls as they
can. In one conversation, a manager said how they liked to hire people with cars
because they could get around that much quicker. Otherwise the individual had to
walk from call to call or cadge a lift.
The final care company that we had for mum was on the whole pretty good - it
provided the care and had a decent oversight process.
But it still employed its workers on zero-hours contracts that no doubt
burned many of them out, as seemed to be the case with Sue.
A previous company had also done a reasonable job for mum for a few years. It
had initially provided just a morning call, which eventually extended up to
three calls a day.
Training there was a concern, though. One carer admitted she'd been a PA a
couple of weeks before and had been out a few times with experienced carers
before being let out on her own. It was very much learning on the job.
In the end with this company it became a case of the workload and complexity
of the care being too much.
The time-keeping methods also seemed haphazard. Most recognised care
companies have a system whereby the carers ring back to the office upon arrival
in the client's house. They then ring again upon completion of the call. This
means there is an accurate record of the time spent. The call has to come from
the client's phone, thereby signifying they were in attendance and not sitting
in the local park with a mobile.
There has been much talk recently about the length of home visits, with a
fixation on 15-minute calls as not being sufficient for care needs.
This can of course be the case but there are other times when the call could
be less than 15 minutes. If it is literally a toilet call, where the carers are
coming at a specific time to see if the person wants the toilet and they don't,
then the call can be less than 15 minutes. Indeed, if you are paying for the
call out you want the visit to last as little time as possible in those
circumstances.
It was over the issue of lapsed timings and the growing care burden that our
family finally parted with the first care company. It had some excellent
dedicated staff but the needs were growing, as we later needed more specialised
equipment such as hoists.
One thing that company did have real concern for was the bottom line. There
were disputes over payments and the final notice period.
It is one of the more disconcerting elements of the world of the private care
industry - trying to judge whether there is genuine compassion being shown
toward your loved one or whether it is all really about getting paid at the end
of the day.
Generally, mum's experience with care in the home worked out fairly well,
though the burden increased all the time as she became more helpless. Had she
come out of hospital rather than dying there, the next stop would have been a
care home.
Our family had experience of care homes too. The last three-and-a-half years
of dad's life were spent in care homes. He had dementia, which got steadily
worse over the last five years of his life.
In the end it was impossible for mum to cope as the main carer at home.
Dad spent just over a month in his first care home, then he went on to two
others spending around 18 months in each. He moved home as the need for more
specialised care for the dementia condition increased.
These homes were generally good, though again the concern had to be how the
staff were treated and the desire to obtain maximum return from the clients.
One minor but instructive example concerned haircuts. Dad had little hair but
seemed at one point to be having haircuts every couple of weeks.
In one memorable exchange I suggested that dad had less hair than he'd ever
had and yet was having more haircuts than ever. I could see what was happening.
The home was receiving the £700-plus a week for care but obviously sought out
other income streams. Haircuts, nails and other things fitted these extras.
They were of course justified on the basis of the dignity of the person. A
valid argument, but also one that can be easily deployed to increase
revenue.
There are a number of lessons to be drawn from our family's experiences of
care both at home and in nursing homes.
The first is the need for the vulnerable person to have someone acting as an
advocate in their corner.
Someone to stand up for that person with the care company, home, social
services and hospital.
I largely did this for my mum and dad but it was always worrying when you saw
an elderly person with seemingly no friends or family in the hospital ward. Who
would fight their corner?
At home who would question the carers coming in or ask the home about the
apparent drowsiness every time you came in to see them?
The other area is the whole treatment of care workers.
These people do vital skilled work that should be valued by society. They
should be treated as such, not as some sort of modern-day slave on zero-hours
contracts.
It is not right that carers should be on the minimum wage and casual
contracts. They should be salaried, with decent living wages and other
conditions of employment like holidays and sick pay.
This change in the employment relationship would change the whole care sector
overnight. The present approach of bringing in people, training them up,
exploiting them to burn-out point and then no doubt getting rid of them is no
way to run care in Britain today.
Staff need to be treated properly and the whole sector needs regulation. Then
maybe there could be a move toward a care sector that is fit for purpose in
terms of dealing with our elderly population in the 21st century.
Morning Star
