One of the public services most under pressure today is care. Here we look in depth at the problems facing the care sector and how they can be solved. And we hear from care workers on the frontline doing a job they love for so little financial reward. The support of UNISON is vital for this group of workers.
Dave Prentis, UNISON general secretary
Kicking off this special feature looking at the state of social care in the UK, Janey Starling talks to care workers and finds out what it's like on the frontline
Maria Jackman is a community care assistant for an agency in Essex. She spends long days – from 7am to 10pm – travelling between different homes to help people with personal care, medication, housework, food, dressing, and to offer social interaction.
She tells U what a working day looks like for her. “Generally speaking, I’ll get 20 calls a day, and I have around 30 minutes to complete each of those calls. Every call is different. It depends what you’re expected to do, but 30 minutes isn’t always enough. If you’re doing personal care, medication, food and nutrition, you’ll need another 15 minutes.
“It gets difficult when you have someone on medication that has to be taken half an hour before food, and you’ve only got half an hour from start to finish. It’s very easy to end up going over, and that just runs over into the next job. If your first visit of the day runs over, everything runs over. And there’s no paid overtime.”
Home carers provide a critical service to the communities they work in. Carers fill the gaps that families often can’t and help people to function independently in their everyday lives. But they’re hardly valued by society. Usually working on zero-hours contracts with no sick or holiday pay, and with travel time between jobs unpaid, the working conditions are merciless.
“Visits could be 10 miles apart, and you could get stuck in rush hour traffic,” says Maria. “It’s stressful enough when you’re late for a call, but it’s even worse when you’re going to someone with Parkinson’s whose medication needs to be taken at the same time each day. If their medication isn’t given on time, their condition worsens.”
Maria previously worked in a residential care home, but left after two months because of how distressing it was.
“For the amount of money that a resident is charged, they are being wholly fleeced. How can anyone justify £1,500 a week for three meals a day, laundry, and tea and coffee – that’s it. In the home I worked at, residents had very little interaction with carers, and I was told that I didn’t have enough time to engage with residents. So they were sat like robots and zombies around the TV. And if they’re not mobile enough to go to their own room, they just sit watching what someone else wants to watch. It’s phenomenally scandalous.”
“I remember there was a little old lady who understood where she was and knew it wasn’t home, and it threw her confidence totally. She was in this big building where she’s not allowed to come and go as she chooses, in a locked-down unit, with all these strangers saying to her ‘let’s give you breakfast, let’s get you washed, let’s get you dressed’. In a care home you can’t get dressed in your own time because you’ll miss breakfast. I would be told by my manager that I didn’t have time to talk to her. I just felt really bad for people like that.”
But in spite of the stressful conditions, Maria says that she wouldn’t change her job for anything else in the world.
“I enjoy all of it, and I’d like to think I’m making a difference. I’d like to think that I can make a person smile, even just for a couple of minutes. They’ll remember that. That particular person has nobody else coming to see them except their carer, and I want them to have a positive experience of it, not a negative. The thing that frustrates me, though, is that people refer to us as a fantastic service, they say we’re all angels. Well, pay us then.”
Stephen Hughes, a care training facilitator for a large residential care home in Merseyside, holds a similar view to Maria.
“Care assistants are the building blocks of a company, and they deserve more respect than they currently get,” he says. “They have the finger on the pulse in care homes and they know what’s needed, and what needs to be fixed. CEOs only see the homes every six months or so, and companies want to fill up all of the rooms to get the money, but they don’t take into consideration how it impacts the residents or staff.”
Like many care workers, Stephen is drawn to the work itself for the impact it can have on an individual’s life. “It’s all about the interaction with residents, the positive impact that you can have on their day. I worked Christmas Day and Boxing Day, and we had all the residents together with such a family feeling. It was an absolute delight.
“In a care home, you’re supporting people in the twilight of their life. It’s not a question of life being over, but ensuring that you’re enriching their lives. It’s all about treating people with respect and dignity. Some people only look at a person as a number of years – but what about their life up until now? If someone is 86, what have they experienced and achieved in those 86 years?”
The step between home care and residential care is live-in care. Dawn Astley is a live-in carer in Ipswich, who currently works from 8am-8pm with an elderly woman. For 12 hours, she’s constantly busy.
“In the morning I get up, prepare things for the personal care worker to come in, and together we roll the patient who is bedbound, change her clothes and wash her. As a live-in carer, I have to rinse all her clothes before putting them in the washing machine. So that means five washes a day, with my hands in cold water rinsing things. I also have to feed the person and get drinks into her three times a day. In the afternoon, she gets up for two hours, and another carer comes in to assist me so I can have a break.
“Then, I hoist her into bed and go through the same process as the morning: washing, dressing, changing her clothing, emptying her leg bag, measuring it up and fixing the tap to the night bag. Then I go to bed. It all starts again at 8am the following morning.”
Like many live-in carers, Dawn works alone and does not get paid for the hours she stays in the client’s home, which can be a lonely and even vulnerable experience. “I never know what’s going to happen. If I’m alone with someone, and if the person’s got some kind of dementia, they might get angry, they might attack me. I’m working in someone’s house, and it’s just that person and me.”
She also describes how precarious her employment conditions are. “The agency phones you up, and you do the job. There’s no contract involved, really. Some weeks I don’t have any work, some weeks I do. I never know what I’m going to get, unless I do live-in for a fortnight. Two weeks ago I didn’t have any work, and next week I don’t have any work either. For live-ins, you get around £500 a week. That sounds good, but in reality it works out at around £3 or £4 an hour.”
Dawn also does home care. Despite the uncertain working conditions and lower pay, since moving to work for a private agency she does feels that her home care clients are getting a better service. “With a private agency, I get longer time with patients than I did when with the local authority. The shortest time here is two hours with someone. Working with the county, I only had about 15 minutes minimum, at the most half an hour. You’re basically in and out, and you can never build a relationship with someone. This time you can.
“I love the job I do, and I love helping people. If it wasn’t for me, these people wouldn’t have anybody”.
Asked what needs to change, Dawn is quick to answer: “It’s a private industry and it really shouldn’t be. I’d like a national body. I’d like the service to be free for people – for everyone.” We agree.
The names in this article have been changed to protect the identities of the care workers.