News Blog The home care worker: "Sometimes you feel like it's not enough" Our care homes are in crisis, with researchers estimating over 20,000 deaths in care homes resulting from the coronavirus pandemic. By a margin of two to one, our polling shows that people think the Government did not sufficiently prioritise care homes when the pandemic started. But the wider care sector, including those who support people in their homes, has been in a slow-motion crisis for decades. It is among the lowest paid jobs – in 2019 carers in the independent sector barely cleared minimum wage, earning £8.52 an hour on average, or £16,400 over a year. In care homes they earned less, just £8.33 an hour. This sector is under-valued and underpaid because that is still how our society views the life-preserving, vital care work that many women do. This is a threefold issue for women, who make up 8 in 10 care workers, 6 in 10 of those providing unpaid care for adults, and the majority of care users because women live longer and with fewer years of good health. We have been sharing the experiences of social care to explore the reality on the ground for care workers in our country. We spoke with a home care worker, Teresa (not her real name), a Black woman in her 60s who works in outer London and Essex. What is your daily work like? I work on the outskirts of London. As a carer you go in to the service users’ home, provide them with breakfast – usually porridge and a cup of tea - and their morning wash. I ensure they’re suitably dressed for the day. Depending on the age group you’re going in to, some use incontinence pads as their bladders are not very strong, and some of them suffer from loose bowels. Most of those I work with are in their eighties. Some of them still have their mental capacities and have kept up with changes in society, and you can have a good conversation with them, but for others life is more wait, wash, dress, and look out the window or at the television. Either way you’re a big part of their social world. How did you get into this work? I came from working with children, I never thought I would work with an older age group, but I did my training and gave it a try. I work for a private company; we link with the local authority. Often people come out of hospital with a care package, and we have to meet those needs. How has your job changed during coronavirus? It’s made the pensioners very confused. Why am I wearing a mask? Why can’t they go out for walks? Often with dementia setting in as well it’s really hard. They aren’t leaving their home, and they don’t have the day centres to attend now either. How does it feel for you as one of the people still going out and taking that risk? It’s stressful. I feel it’s stressful – the service users ask a lot of questions that I can’t really answer, I can only say to watch the news and listen to what the Prime Minister has to say. He was late coming forward [with plans on lifting the lockdown] and that made them quite angry and also nervous because they didn’t know whether it had stopped or not. You mentioned PPE – do you have access to enough of it? They said wear masks, and they give you a supply – but that may only last for three weeks, and we don’t know if more supply will be coming in. Do we need to ration what we’ve got, or what do we do? You do four visits per day with some of the clients – if you change masks and aprons every visit that does add up. Have you found yourself having to ration masks or gloves? The ladies I work with are good, and drop them off to me when they visit head office by car. Head office initially said only to use masks for a certain percentage of visits, and they were optional for others because there wasn’t enough stock for everyone. I don’t think I interacted with anyone with the virus, and have had deliveries of masks since. But when the next one will be, I’m not sure. What hours do you normally work, and has that changed at the moment? We are the early team, so I start at five thirty or six o’clock, finish by about ten thirty or eleven, take a break, do lunch until one thirty or two, and then go back at teatime around four or five… that’s six days a week. At the moment travel is a bit easier as the roads are clear. But it’s [the work] also more difficult – our service users are feeling quite sad because next-door neighbours who used to pop in no longer can. Do you think carers are valued fairly? I work across different areas of London, and if you work in some you get paid differently. Yes, it should be valued more – often I get asked medical questions, and have to administer medicine. You might have to adjust bandages too. You have a lot of responsibilities when you visit. Do you think you get enough time with each client? I think a few years ago it used to be more time allowed with each client, but as the years have gone by… I think the minimum is 30 minutes, which stops you from having that little social chat. If you could ask Government to change one thing about your job to make it better for you, what would you change? Paperwork – there is a lot involved at the moment. Whatever you do in that person’s home, you must note it at the end so if you’re not able to get back, the next person can go into the diary and read what you’ve done. Some supervisors ask for a lot of detailed information, which takes up a lot of time for the care worker to finish their daily routine plus write notes. Sometimes you feel like it’s not enough. I’d like more time, not less paperwork, if possible. It’s difficult to get everything done in half an hour, especially at first when you don’t know where things are in someone’s home. Fumbling around takes time. I often raise time allocations with head office, and sometimes I might be lucky enough to get extra time [with a client]. How do you think the public perceives the work you do? They don’t look at the sad side of anything, and there is a happy and sad side. The happy side is when the clients are well, the sad side is when their health deteriorates and there’s not a lot you can do to help them. Doctors look after patients, but who looks after the doctors? It’s clear from our conversation that for Teresa, she does the job because she feels it is important that her service users are looked after well. But the hours are long, and hard, and the pandemic has made them more emotionally taxing. Her problems with inadequate and intermittent PPE are sadly not unusual, and Fawcett has joined numerous voices calling for Government to prioritise the safety of carers. The low pay and poor conditions in the sector, and the significant time pressure on visits she describes, are a longer-term problem. Funding for social care has fallen 2% in real terms since 2010, while demand has risen. It is important to remember that the £21bn councils spend on social care makes up 70% of all paid social care in the country. That means that the state which we fund as taxpayers, and the national and local politicians we vote for, are in effect the biggest buyers of social care. It is hard to conclude that they are ethical consumers. As the Chancellor, Rishi Sunak MP, said in a recent select committee appearance, solving this problem all comes back to a lack of consensus in answering the question: “who will pay?” This crisis is an opportunity for change. It has cast a light on the unfairness care workers experience, and we think it has resulted in a shift in public perceptions. Three quarters of the public agree that carers should get a minimum of the real living wage of £9.30 (£10.75 in London), with similar levels of support for better terms and conditions. Our survey also finds that 65% of the public agrees with a 1% rise in income tax to fund for a pay rise for carers. This would bring in approximately £7bn, enough to really alleviate some of the strains on the sector, and on workers like Teresa.