Caring for people at home
Jo gets up at her usual early hour, listening out for her client then checking in to make sure he’s comfortable. After helping him to get cleaned up, washed, and dressed she then prepares his medications and makes sure that he’s taken the right pills at the right time and hands the food supplements that his doctor recommended. Her next task is to thoroughly clean his room and clothing, put him in clean clothes and make sure that his oral health continues to be maintained.
Today it’s time to collect his weekly supply of medical drugs, and the emollients and barrier creams that help to keep his skin hygienic. By prior arrangement she goes out and collects his favourite low sugar snacks. Then she starts to prepare today’s lunch, and helps him to swallow his food.
Then she has two hours to herself. Except that today her client has a minor problem but one which requires her immediate attention.
Onwards then, she starts to prepare the next meal. And so it goes, she keeps her older disabled client out of an expensive hospital bed, she keeps him safe and as secure as possible.
The skills and experience she brings to the job are considerable, and are not too dissimilar to those of a nurse – yes I know there is more than one ‘type’ of nurse – yet a typical ‘Jo’ is paid roughly 60% of what a nurse is paid. Also Jo has to pay for job-related insurances and occupational fees and courses out of income.
Altogether, at a conservative estimate, there are over 900,000 people like Jo in England, providing personal, often quite critical and intimate, care to adults and children with long-term care needs in their own homes. Other paid carers obviously include those working solely or mainly in care homes.
But, it is not at all clear what ministers refer to when they give speeches about social care: whether they actually understand that it covers not only care services provided in people’s homes as well as care provided in residential care homes. Or do they actually understand the reality of what many carers do, which often involves help with health needs, such as assistance with medications or feeding, as well as what is frequently narrowly defined as personal care?
Yes, it’s a big sector financially, and one with a tendency to grow as our population ages. But the current arrangement (based on the 1990 NHS and Community Care Act) was itself introduced in the early 90s primarily as a device to curb costs, as well to encourage more private provision in both the NHS and social care. And it makes a spurious and unwarranted distinction between someone’s health needs and social care needs. The current system probably is one of the cheapest ways of covering this awkward, messy area – its annual cost will get you just a mile or two of HS2 built!
On a more personal note: when I was discharged from hospital last year, I came to understand how crucial it was to have an empathic live-in carer. She bridged that gap between a hospital bed and a bed at home. So for me the carers’ sector has been nigh on impossible to overpraise.
What should, must happen now is for the DHSC and its Ministers to pay carers and the care sector what’s needed – don’t hold your breath …
