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.