In the first wave of the COVID-19 pandemic, people took to the streets to applaud key workers such as home care workers. It was a real ‘moment’ of feeling seen. Despite this rare glimpse of visibility for the huge social care workforce, which has more employees than the NHS, common perceptions persist, dismissing care work as women’s work; unskilled work; work unworthy of decent employment conditions.
Yet social care is not only worthy of recognition, it desperately needs it for the care needs of our society to be met both now and in the future. Read more about why social care reform matters to everybody, not just care workers.
Homecare work is highly skilled
“The phrase “basic care” dramatically understates the work of this group. Helping an elderly person to eat and swallow, bathing someone with dignity and without hurting them, communicating with someone with early onset dementia; doing these things with intelligent kindness, dignity, care and respect requires skill. Doing so alone in the home of a stranger, when the district nurse has left no notes, and you are only being paid to be there for 30 minutes, requires considerable maturity and resilience” (Cavendish, 2013, p.7)
“When (care workers are) asked about their work the response is generally prefaced with ‘Well I just.....’ they then go on to describe a complex mix of psychological insight, knowledge, practical creativity and skill.” (Richard Banks, submission to Cavendish Review)” (Cavendish, 2013, p.21)
“All too often during the course of this review, I’ve heard the words ‘I’m just a Care Worker’. How unfair it sounds. Care Workers often have to deal with complex feeding methods, use hoists for moving clients, dress wounds, administer medication, and provide vital emotional and domestic support for Care Recipients. It’s not a job for the faint-hearted and it’s certainly not ‘just a job’” (Kingsmill, 2014, p.3)
“Caregiving also supports people at the end of life by maintaining discreet routines and promoting personal dignity” (Hayes, 2017, p.2)
Homecare work was recently added to the UK government’s list of shortage occupations for the Skilled Worker Visa, meaning that homecare workers from abroad are able to apply for a working visa to come to the UK on the basis of their occupation (GOV.UK, 2023). Whilst this is an inappropriate response by the government to the recruitment crisis in social care, it is good to see the skill involved in home care officially recognised.
High quality, person-centred care requires a certain kind of individual
"Care work is a noble profession that many people would be unable or unwilling to do well. Good care workers are a lifeline to those for whom they care and a huge asset to the care system" (Koehler, 2014, p.22)
"Many home care workers are exactly the kind of people you would want looking after you in a crisis. They are genuinely caring and dedicated" (Koehler, 2014, p.1)
“Participants emphasised the commitment and dedication shown by the majority of those working in adult social care – they are not ‘the problem’” (Moriarty, Manthorpe and Harris, 2018, p.1)
“I listened to senior care assistant Siobhan talking about how lucky she is to work with “naturals”: people whose vocation is to care. Hearing her describe how the team helped a woman with severe learning disabilities who has no verbal communication learn to make her own coffee – after noticing the way her eyes followed them around the kitchen from her wheelchair – I knew I was watching a natural at work” (Cavendish, 2013, p.11)
“I met Arceli, a young woman who came to this country to look after elderly people and who, 8 years on, is now training as a nurse but still working at the care home every weekend. She positively glowed when talking about old people and when I asked how she copes with the strain of it all she at first looked a little blank, then answered: “it’s easy if you love what you do” (Cavendish, 2013, p.11)
Given that it takes a certain kind of personality to be able to deliver good care, the fact that home care work is a low-paid, entry level job compromises the quality of care available to people, by attracting individuals who are not natural carers into the workforce.
Good home care workers truly care about their clients, and the standard of their work
“One of the most striking observations from our focus groups was that the workers we spoke to were attached to their work because, in keeping with the name of the job, they care about their work and the people they care for” (Cominetti, 2023, p.10)
One home care worker comments: “They’re not just your service users, they become friends. If they’ve got no family, you become their support system. Going out of a client’s house, knowing you’ve made that slightest bit of difference puts a smile on your face. I absolutely love them to bits” (Cominetti, 2023, p.10)
“Most of my work is long term care and building relationships and all the tiny things, like where the soap is, in someone’s home, need to be learned so I can support them – I like working with people like this.”... “If you know what they like – how they have the curtains drawn, their favourite breakfast cereal and if you really know your clients and build relationships, that’s what I really enjoy”... “You make a difference. You might be the only person they see in a day” (Cavendish, 2013, p.27)
“Some in social care talked passionately about being advocates for the people they look after. While there were plenty of frustrations raised about other things, not a single one of these workers said anything negative about the people they look after” (Cavendish, 2013, p.27)
“Dedicated, sometimes fierce, advocates for the people they look after, many in this group are also frustrated at what they feel is a lack of recognition from managers, employers and/or commissioners” (Cavendish, 2013, p.83)
It is time home care workers were afforded the same level of appreciation and respect for their efforts as is expressed to those working in the NHS. At the moment, social care is too often only associated with negatives: bed blocking in hospitals, scandals where care has gone wrong, the 'ugly sister' of the NHS.
Good home care workers are the people who are always there in between occasional appointments with the GP, the hospital, the OT. When things need explaining, we explain; where advocacy is necessary, we advocate; when someone is upset; we reassure; when someone is at the end of their life, we carefully choose what words to end a visit on.
The author of this report powerfully sums up the need for greater recognition when it comes to care workers:
“I could never do the jobs these women do, let alone do it with the glow they bring to their work. I have come away from this project thinking that our society is incredibly lucky to have so many people with a dedication to caring. But I also fear that if we continue to take them for granted, if we do not fix dysfunctional systems of commissioning and regulation, we may find as we grow old that they are not there to look after us” (Cavendish, 2013, p.11)