The Care Home Worker’s Tale

I work in a care home for the former residents of our old asylums. Men and women who do not speak, but spend their days staring at their hands and screaming, men and women who wear nappies, or colostomy bags, who perform fast and rigid rocking motions, or persist in standing up, sitting down, violently flailing their arms, even when you try to feed them and even when you sit them on the toilet. The food and shit flies everywhere.

 Several times we must clean a man after he has done this, whilst he still performs the violent flinging motion. He wiped his shitty hands across me and head butted me so hard I wanted to head butt him back. But it’s not his fault, and that’s a mantra that most support workers live by – they are decent, unsung and praiseworthy people. All day long they deal with such situations and put up with the insults from both the left and the right.

 ‘We need immigrants because the Brits won’t do this work’ says Labour, despite more than half of the staff being English. ‘Work hard and you will prosper’ say the Tories, but anybody who washes human excrement off after a 14-hour shift for a wage that will never put them on the property ladder knows this isn’t true.

 I am called a ‘support worker’. A conveniently vague term, which obscures what it is actually like to work with the severely disabled. ‘Support’ gives the impression that you just have to help people a bit here and there, when in reality you have (often literally) to immerse yourself in their most basic bodily functions.

 Once upon a time the inmates were looked after by the state, often by well-trained or highly experienced helpers, now anybody can get the job by just turning up at the local Labour Exchange. The home I now work in is no exception.

 As soon as I accepted the job I was sent on a three-day first aid and how to use a hoist course. I hadn’t met my managers, I’d had no other training, and my contract was sent by post. A few days later I received directions to a property that the company had just bought off the council, and arrived to get some idea of what the work would be like from a woman who I was taking it from. It was an awkward meeting – she was employed by the council, who paid her between £9 and £11 per hour. I had taken her job because I’d signed up to say I’d do the same work for £7.50.

Nonetheless, she was personally concerned about the level of care the men would receive when she went. Like most support workers her first concern was that the men were cared for by me as well as she cared for them herself.

 ‘Who else will be working with me?’ I asked.

‘Nobody’, she said, ‘you’re on your own’.

She then asked me if I was trained to hand out medication. I said I was not and she looked confused.

‘Well I don’t know how your company operates’ she shrugged.

The next day I began my shift – 24 hours with a sleepover.

 I put into action what little I’d learned from her – get everybody up, dressed and showered. Make breakfast, clean rooms, wash clothes, cook dinner, sort finances out, arrange appointments, showers, evening medication, then bed, all whilst trying to keep two of the men in separate rooms because they hated each other to the point of fighting.

 ‘Front line delivery of care’ the industry calls it. Or ‘actually helping people’ as its more commonly known, and I found myself enjoying the day, though I was followed around and repetitively questioned by one of the male residents until I hid in the toilet for five minutes.

 I was free to cook what I wanted for dinner though I wasn’t allowed to sit with the men and eat it like the council employees had been. The private care company had not only slashed wages and staff, they had done away with the mere human triviality of sharing a meal together, and the men were left confused as to why I was eating sandwiches whilst they tucked into the shepherd’s pie I’d made from scratch.

‘Didn’t I want any?’ they asked.

Still, at least dinner was a success, unlike my next task – the evening medication.

I looked over the pill boxes which had been highlighted for 8pm. Diazepam, and with no training and no supervision whatsoever, I handed them all out.

The first I knew of my dreadful mistake was a phone call from head office at the end of my shift demanding to know why I had missed out tablets and not filled in the MARS sheet. The tone was accusing, and I was informed I would be removed from the home forthwith. This was only the third conversation I’d had with my employers, and I was overwhelmed at the responsibility placed on me, and upset that I’d done something that could have potentially harmed one of the men.

 I lost my temper, ‘Good God I’ve never met you, you’ve never met me, I don’t even know what a MARS sheet is!’ I cried.

‘I’m just a person off the street, I’m working alone and can’t do these things!’

This was met with silence, and later, an apology as I was ‘supposed to be meds trained’ apparently. I was re-assigned to another home wondering how often such dangerous mistakes were made.

 While the number of qualified care staff is decreasing, the money is just not good enough, the army of support workers on minimum wage is growing. A support worker may now be anything from an ‘outreach home visitor’, meaning taking a resident shopping or for outside trips, to a full-time carer. They may be working with physical disability, mental disability, youth offenders or the elderly.

 I discovered quickly that the most pressing issue within the private care industry is staffing. Although I’m working with a small team of co-workers in the new home, there are not nearly enough staff to cover the entire rota, just as there were not enough staff in any of the other properties either. Every morning starts with phone calls begging and poaching carers from other properties for the day. To make it even more difficult, this was also a newly acquired property; everybody had started their employment when I did.

The residents in this job are much more profoundly disabled than my first home, and require significantly more care. Some of them have spent the greater part of their lives in institutions and as a result of whatever unspeakable conditions they may once have been subjected to, they do not speak and spend their days staring at their hands or screaming. One woman is also paraplegic, having suffered a severe stroke as a baby, so a certain amount of knowledge of physical care is also needed.

 There should be nine workers, but there are only four of us and so the vacant spots that fill every rota must be filled from a random conveyor-belt of agency staff, (bizarrely they cost the company more) while those of us who are off duty can expect a whiny voice from head office on the phone trying to persuade us (with lavish amounts of emotional pleading but no extra money) to ‘just cover the next shift’ or ‘just’ work on their days off. The trouble is, they know this approach works, the entire business model appears to lean heavily on the willingness of support workers to bear the burden of staffing shortfalls. The staff – primarily women, find it difficult to walk out at the end of their shift when they are not certain if the next shift is adequately covered, even when they have young children at home, and the reason they don’t want to do this because they are genuinely concerned about the people they look after.

 The media is fond of creating exposé hidden camera shockers of support workers, typically showing grainy footage of burly abusive women slapping helpless old women and stealing from their purses, but the vast majority of people in this kind of work do it because they are often among the most decent of human beings. It’s not uncommon to find some workers are quietly religious or suffered a tragedy in life that compelled them to wish to help others. Many are also mouse poor, they know suffering when they see it.

 It was difficult for me to believe that I was still in a minimum wage job in the new home, and initially, I found the personal care difficult. It’s not uncommon to get hurt, as well as getting smeared with excrement.There are not only severely mentally disabled in the house – one woman is also a paraplegic and two have difficulty in swallowing which means that their food has to be blended and their drinks thickened, but thanks to the company’s unwillingness to hire enough staff, at least once a week there is a new face on the team, sometimes every day, and time is lost having to endlessly showing the newcomers how to do the job without killing the residents.

 The house had two managers when it was run by the council, but now there is only one (she is paid about 50 pence extra for the privilege of doing the work of two people) and it was this dearth of managers which to led to me being on shift once, with only two agency workers from Nigeria, neither having worked at the house before.

This made me the most senior member of the staff for the day, even though I still wasn’t trained to give out medicines, and had only been there a few weeks. The paraplegic woman was screaming violently, and we could not calm her. When I took the colostomy bag off, the stoma looked red and swollen. I cleaned it and phoned NHS direct – which has become our ‘go-to’ for medical advice, as none of us know any better. Was the stoma infected? Was she just constipated? Could I put anything on it?’ I didn’t know! The agency staff looked as demoralised as I did, and after we put the woman to bed, the three of us stayed an extra hour figuring out their drugs which I’m still not trained to deal with.

The residents are the real victims of the privatisation of such small residential homes. Helpless, they cannot complain about their distress when each morning and evening, they find themselves washed, fed and medicated by yet another stranger, never being able to predict what level of care they will get, or if they will receive care at all.

Worse after living for years in institutions, they find their time in a real home run by the local council with permanent staff was only a brief interlude, their days of being looked after by the same people, building a relationship with them, have suddenly ended, the familiar faces they may have known for years replaced by swarms of semi-anonymous ‘support workers’.

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 I am not sure what the corporate plan is but I can make a guess. When a company offers to run a council’s residential homes, I suspect that part of the deal is often the purchase of the real estate. Private care homes were never a viable business model anyway, many of the smaller ones are facing closure. Will the profit for companies come from the sale of thousands of these small, private houses with their residents absorbed into big blocks of flats. There is a big block going up next to the home I work in. Cheaper, faster turnover, low paid staff; the economies of scale. In other words, back to the madhouse.

12 Comments on The Care Home Worker’s Tale

  1. You say “Some of them have spent the greater part of their lives in institutions and as a result of whatever unspeakable conditions they may once have been subjected to”. I began my psychiatric career working in a large northern psychiatric hospital and worked in two others later on. In none of them did I encounter conditions that I thought were “unspeakable” although I have since encountered such conditions in the private healthcare sector albeit only on a couple of occasions. The plain truth is that the chronically mentally ill have never had a good deal, always at the back of the queue when it comes down to funding and of little or no interest to career minded medics. A colleague pointed out to me a couple of years ago that the average life expectancy of a patient with chronic schizophrenia is now less than it was in the days of the old institutions. Why? Because such people are less well cared for now than they were thirty years ago.

    For you, given your awful experiences, I have only sympathy. You write in a way that leaves me thinking that you have career choices; if you have I suggest you exercise them. What you describe is, in my experience, commonplace and will continue to be until we realise that the state, for all of its faults, is far safer and more compassionate when it comes to caring for vulnerable people than business will ever be.

  2. No happy/good prospects for the chronically mental ill.

    The political will, when it comes to compassion, which I suppose has to do with doing good, is squarely, and almost wholly, with persons of colour and persons of non-Christian provenance.

  3. The story above is indicative of so much of the modern working experience for the many. The fact that it deals with the elderly and demented adds to the human suffering in the tale, but the ethos that got us here is troublingly commonplace. Modern management thrives on promoting the inept, cutting training, undervaluing the skilled and experienced and replacing them with the willing, but unpaid and under-trained when they leave. Employees are ‘full time equivalents’, or FTEs, not people. The name change from Personnel to Human Resources,(or Human Resources Business Partner to give the full title)was not just new words, it marked a change from Personnel acting as honest broker between employees and employer, to HRBP acting as the thought police, and the wage control bureau, and the agents preventing the promotion of the honest diligent and hardworking (doing a ‘good job’ is never enough). The verbal attack and threats for failing to fill in a MARS sheet, and the “whiny voice from head office on the phone trying to persuade us (with lavish amounts of emotional pleading but no extra money)”, are such archetypes of modern management, the first stems from a mangerialist horror that someone senior might get blamed for the wrong medication being administered (even though it wasn’t) with no ‘audit trail’ to devolve blame downwards, and the second from an unwillingness to pay staff any more money (when there are bonuses and promotion for managers who keep the wage bill low), and a knowledge that whilst the management don’t care about workers or patients, the workers of course do. If it isn’t a care home, the emotional blackmail will be a colleague who has ‘a lot on’, if it is the MoD it will be soldiers or sailors who are ‘risking their lives’, if a lecturer it will be the students..etc. Whatever the reason pressure will be applied to people who do care for more than just money, by people who care for nothing but money. I hope that we can remove this corporatism from our society, it comes from neither the left or the right, or maybe it contains the worst of each, enormous greed, combined with a desire to completely control the individual.

  4. Walk away Mary. Your employer is exploiting the fact that you care and you are propping up a cruel and dysfunctional system. We’re all sorry for your residents but other people are being paid handsomely to ensure they get care – you aren’t.

  5. The “community” always claims to care about those less fortunate. In reality, many of those described above need constant 24 hr care, which, at minimum wage rates, would cost over £80,000 p.a. plus further cost for accommodation, food, heating, electricity etc., say about £100,000 p.a.in all.

    Inevitably, those less fortunate will not have any income of their own, so the burden falls on the rest of us through Central and Local Government. For the care of these people, the funding runs to £600-700 p.w. which comes out at £30,-35,000 p.a. or a fraction of what is required. Rolls-Royce care for Ford money just doesn’t work.

    Care Homes are going out of business across the country because there is simply no way any suficient level of care can be provided for the sums that the “community” is prepared to provide out of people’s taxes.

    Add to that the fact that people are living much longer than fifty years ago. Ninety is now a normal achievement and a hundred not unusual. This means that the daughters on whom the burden of looking after the elderly usually fell, are themselves in their sixties and seventies and are physically and emotionally too tired to cope.

    Finally, the oldest of the post-1945 baby boom are now 72 years old. Most are probably in good health and independent. But in ten years they’ll be eighty-two and needing more by way of Care and Health services. So the government, seeing this increase in demand on the horizon, has naturally made funds available to provide for it…….in your dreams.

    What is a crisis now is a catastrophe in the making.

    • The solution is the one the government hates the most, to accept the state cannot care for people and that families need to take care of their own. I’ve already forseen the coming disaster and have started talking to parents and in-laws about the potential to live with myself and my wife and how to arrange this financially.

    • Another aspect of this is that because of “privatization” enthusiastically enforced by Thatcher and carried on by others since, billions of pounds of wealth has been stripped out of Britain and transferred overseas, often into foreign pension funds. What standard of living is now extant in Britain is largely carried by debt.
      You are right, what is now a crisis will shortly become a disaster and then a catastrophe, and not just for the old either.

  6. It is truly tragic that this happens while billions is sent away on foreign aid, or in providing benefits to people who’ve barely been here 5 minutes.

  7. John B: yes, a great correction is needed. Every right-thinking man and woman should support the growing protest against the £13 billion given away in foreign aid every year.

  8. The writer of the article is engaged in a heroic work of corporal mercy. Such works are also intrinsically works of spiritual mercy. The commercial and also the governmental model cannot really encompass them. These agencies’ presumption that they can even help the body ultimately amounts to ignoring that you cannot serve both God and mammon. The world’s cost-benefit analysis will always come up short. I remember the exemplary care given by the old, pre-Vatican II, nursing orders. The nuns of those days took care of the body and also tried to ensure their patients were spiritually prepared for heaven. The orders provided the training needed and the mutual strengthening of their members required to sustain the work. They went beyond what would be considered normally possible because they were serving Christ and they bent every strength of skill, organization, and worldly goods to accomplishing the task. (And of course there were orders and individuals who fell short in this task.)

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