Thursday, 7 November 2013

Experiencing care

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 Mum's 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 couple of years had clearly taken its toll. On a zero hour contract, she told of the difficulties of being at the total whim of the managers in the office regarding hours. So 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 often she wanted to stay longer to get the job done properly but there was the pressure to get in an out as quickly as possible.

I know the keeness of the care companies to pack in as many calls as they can. In one conversation, a manager said how they liked to get 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 were on the whole pretty good, they provided the care and had a decent oversight process. But they still employed their workers on zero hour 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. They had initially done just a morning call, which eventually extended up to three calls a day.

Training there though was a concern. 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 calls, with a fixation on 15 minute calls as not being sufficient for care needs. This can ofcourse 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, you want the visit to last as little time as possible in those circumstances.

It was over lapsed timings and the growing care burden that our family finally parted with the first care company. They had some excellent dedicated staff but the needs were growing, with hoists later required etc.

One thing though that this operation 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 3.5 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 onto 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 example of maximum return concerned hair cuts. Dad had little hair but seemed at one point to be having haircuts every couple of weeks. In one memorable exchange, I suggested 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 were receiving the £700 a week plus for care but obviously sought out other income streams. Haircuts, nails and other things fitted these extras. They were ofcourse 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 families 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 seeing 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 into 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 the UK 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.

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