To ask why people think so little of care home staff?

[AMAcarer]

NC for this one

I'm a Senior Care Assistant in a Nursing home, I also previously worked in domiciliary care and support work. I'm extremely experienced, kind and compassionate, I know I excel in my role and I mentor my team to high standards BUT I'm at breaking point.

I could write paragraph after paragraph about how we are treated often by residents' family members, and how their expectations just simply don't match up to reality, and they never ever will unless by some miracle my 40 bed unit has at least 2-1 staffing ratios! So many of my colleagues are in tears during their shifts, being told their best isn't good enough (and many other nasty jibes) by family members or friends of residents.

Now, I know many have bad experiences with Care and Nursing homes, they don't always get it right. People are living longer including those with severe disabilities and impairments, than we didn't see reach these ages in the past. We are so short staffed, and cannot attract new staff due to the poor pay for the demanding role we do.

If Care staff are so utterly useless then why are we trusted with some of the most vulnerable people to look after? Why can residents' loved ones not see the bigger picture we face in the home? Why do they not trust what we communicate to them in terms of what their loved one needs? Why are we not deemed as being skilled workers or valued the same as others in health and social care?

What can be done to make us valued, and respected and our role recognised?

I know many people DO understand and we have many kind visitors to the home, but the overwhelming majority just seem to berate us at any given opportunity. We can't go on like this,

Nor do I. And I didn't say that.

Are you suggesting all care workers are the same because of your singular experience? That's extremely narrow minded if so.

OP I think sadly its a mixture of things, mostly based on ignorance and general snobbery. As it's low paid people assume its low skilled, which its not. Just because you don't normally require formal qualifications its hard manual and also emotional labour; definitely not something everyone can do. As it's female dominant that's another reason for people to minimise the work, and as a lot of care workers are immigrants that's another reason. It's tricky because of course people's parents are important to them and they want the best care possible, this doesn't always correlate to reality though. With the resources and the scope of what a care home can do they aren't going to get 1 to 1 care many seem to expect and want.

I worked in a care home when I was younger and honestly some family members are absolutely vile.

You can join the NHS as a HCSW (HCA in old money) without formal qualifications and experience though, that's more similar to a carer than a social worker or a nurse. The idea of a properly staffed care home is that you have continual nurse presence in high enough numbers to provide support, much like you do on a ward. This isnt always the case though and with the staffing issues most carers just have unmanagable workloads. Both carers and HCSWs are ridiculously underpaid for the work they do.

Hi OP I think the majority of us would struggle with your job but instead of appreciating carers some people turn this into disrespect ie they do not like that which they don’t understand.
Sending you 💐 I think all carers deserve much more recognition and more pay.

Scotland are talking about introducing a National Care Service to pull together all the various functions currently spread between councils and NHS. If it works it will be great but as with everything it needs funded properly.

I think caring is sometimes (wrongly) seen as an easy job because it is poorly paid. Lots of care homes and agencies have vacancies and potentially people not suited to it could be encouraged to apply.

My dad had carers at home for a few weeks and some were lovely and others were not great. Once we found he had fallen, unable to get up, and in soiled (incontinence) pants at a time the carers had logged they were present at the house
We weren't even sure they had visited at all.

However, once he was in a care home, the care was faultless and I had the utmost respect for those who those who looked after and attended him in his final weeks and at his death. And I really appreciated the huge responsibility and work for not very much money.

You said yourself that nursing homes are understaffed and underfunded. The families are probably frustrated about that but it is easier to blame a person than the system.

Also some people are just awful- to support staff, nurses, waiters etc.

I don't - I think most of them do a wonderful job, for a pittance.

My dad was in a care home when Covid hit - they didn't get the support and PPE that hospitals did.

They had patients discharged into there that were Covid positive. It ripped through the home.

They looked after my dad wonderfully until he died. Of Covid.

I think they should be respected and better paid - they are just as essential as NHS staff.

Home Care can be more erratic, but that's more about underfunding and time restraints.

I visit a lot of care homes through work (LD not elderly care) - some are absolutely fantastic, amazing staff and you see it with the relationships they have with the residents. If we recommend something - it'll be done and done well.

Then I visit ones where the culture's just got fucked up - usually because of management meaning massive staff turnover and the staff who care quit, leaving it in a doom spiral - they don't want suggestions to improve quality of life, they want to tick a box that this report's been done, shove it in a file and want to get as far down the medication route as they can get to keep things ticking over easily.

Community carers - have to do too many fucking calls in too short a time (staffing - again) and where I cover - the travel distances can be huge. So they do what they can to get through their calls list - and it leads to ridiculous things like morning calls at 11am, followed by a lunch visit from someone else at 11:30 and then teatime visit not until 7pm because someone's covering two shifts and was running late...

Money. Root of all evil.

A grandparent was in a care home for 8 years. Over that time we saw 6 different sets of management in the home and four different area managers. They went into special measures twice in that time too.

We also saw a huge spectrum of carers from the truly dedicated and incredible to work experience kids visibly horrified by being there and carers who should never be allowed to work in care. Our experience on the whole is that the staff were 80 percent angels and amazing. The management however...

One staff member ignored him repeatedly tling her he needed his urine bottle after she'd taken it away and returned without a new one so, struggling and still having capacity a bit at that time partly he weed into an empty cup so as not to make a mess. He was so distressed when we got there same morning and disclosed that she'd berated him and sworn at him and called him all the disgusting names for doing it (he hadn't told staff members because he was so ashamed and kept it in until we got there) when really he had saved her a bigger job cleaning it up and changing him and bedding etc! He was so distressed we had to buy sets of cups for him to physically give to the manager to apologise. (even though both we and the manager said it didn't matter. The manager reported it and sacked the carer after an investigation and it was logged with an official body apparently.)

We had hospital appointments changed by "his daughter in law" (he doesn't have one!) regularly despite me being the one who took him to appointments so they were missed or we turned up to them and they'd been cancelled. Never knew for sure but fully suspected a particular staff member for doing it because he was difficult towards the end due to dementia. Same staff member rang me at 2am to tell me once that had almost fallen. He hadn't and they'd caught him..... But she was ringing to tell me he'd almost fallen....?

One manager we had to call safe guarding about after a period of some serious issues including neglect. An investigation in the same week found she was falsifying records (sending runners to update paperwork if important people were in so there were no gaps, getting people to sign to say stuff was done when it was found that those people didn't work there at times) knew medication was not being given, not passing on important (or even run of the mill messages) to staff from family members, made no mention to the staff of one lady who needed thickening agents in her drink and pureed food so this person was either choking or just not eating/drinking, heard slagging a family off by an inspector in the middle of the day room, ignoring reports that bells were ringing for half an hour plus by us and other families for toilet requirements and so and do forth. Staff we had known for years at that point were telling us she was treating them so poorly too and regularly had them in tears or others walking out. After the full investigation we were told that she is no now longer allowed to work in a care position.

We labeled ALL his belongings including remotes, hearing aids (even had them looped together by a glasses holder thing), glasses with names on, clothes and shoes with 6 ft letters repeatedly done in sharpie as well as sewn in labels, we even labeled his rosary, bible, TV, alarm clock/radio, ornament of a cross, clock, slippers, hats gloves and scarves, coat, bedding ... Everything he had we labeled and we cleaned out his room ourselves every 4 months to look for missing things, check the condition and amount of his Clothing (ie did he need new undies, socks, tshirts etc) everything still went walkies repeatedly or got lost. Most never found again. He frequently had tshirts never seen again. Even his hoody that we had made for him with his name printed on (an extra layer for him and a family joke printed onto it) only lasted a month.

He was prone to urine infections and had to drink a lot but couldn't pour his own drinks so after repeated requests to staff members and management to constantly pour him a drink if looking in we even put signs around his room for it to remind them. It made the job ten times harder when he had an infection as he'd try to walk even though he couldn't and so fall, try get out of bed, strip wherever he was as he didn't want clothes on, get violent and twist thumbs etc back of his hand was held and keep demanding they get him out of bed to go to the toilet ad he'd forgotten his bottle so it was in their interest to keep him well hydrated too. We supplied drinks in literal litre loads to give a stock pile but he was still often dehydrated and had serious infections, usually needing night time a and e admissions.

Several staff members are angels. One was off when he actually passed and approached me and hugged me in the middle of a shop to say how sorry she was and cried. Another male worker knew exactly how to handle him and had a bond with him so he would do whatever the man needed him to without arguing as he playfully jollied him along, he was incredible. One incredible worker implemented so many changes during her time that stuff just improved ten fold for the residents... It was so heartening to see.

His doctor was also rather... Unhelpful... And wouldn't turn out to the home when requested 80 percent of the time too, even when a and e requested it, but that's a whole other story.

Late Father was in a care home for four years paying £8k per month. Home went into Inadequate and most of the carers were temp staff. Yes they could pay more but it would be charged to residents and £8k for 4 years is enough. Some one was making a lot of money out of him…

Oh goodness - I'm so sorry you feel like this op.

My mum was in a care home for the last 3 years of her life. My sister and I never witnessed anything other than professionalism and kindness from the very overworked staff. And we spent a lot of time there - one of us visited pretty much every day, staying for a couple of hours. We used to marvel at the long shifts the staff worked and the demands placed on them. We valued their expertise and understanding of dementia (something that, until mum developed it, we had no experience of). They helped us understand what mum was experiencing and the changes she was going through. They seemed genuinely interested when we told them stories of what mum was like before she developed dementia. We'd go in and find they'd put the cricket on the radio for her as we'd told them how much she liked it and they thought the familiar sound would soothe her.

The day mum died my sister, not realising anything had changed, was about to leave and a staff member gently suggested she stayed. Sure enough a couple of hours later mum died. Two staff members came to mum's funeral and it was lovely to have them there. We are so so grateful to them for the care they gave to our lovely mum.

I'm really sorry op that you feel so undervalued when you do such an invaluable job

Re gifting money to care home staff, the wonderful staff who cared for my mum were allowed to accept a donation to their staff fund.

I have had a few relatives go through the care system. 2 in a care home who have since passed away and one currently at home on end of life care. I can't really fault any of it.
I looked at one care home and the person taking me round said she was just a carer! I said no! Not just! You do a great job.
I think the issue is that many families see how much they are paying or their relative is paying and therefore expect so much more. and this is fair enough. In our area it's about 1000 a week. But often what the relatives don't see is that there are not enough staff and the staff that are there are paid not much more than minimum wage.
I'm still in touch with the carers from the home of one relative. For the 3 years she was there they were like extended family to her.

Please please report this care home to CQC 🙏

One of the things that concerns me is that, with more proactive and targeted care, my husband's progress could be accelerated. He needs people to really encourage him to leave his room, to engage in activities, to take the first steps in regaining the life skills that he stopped using during his serious mental illness and hospitalisation. Yet, the carers simply do not have the time to do this. My husband is only 64 and should be working towards supported living provision, but he is making no progress.

He has heart disease as well, and really needs a low fat diet (despite the fact that he lost a lot of weight through not eating). Yet the menu seems to be a light breakfast, sandwich and soup for lunch and fish and chips, pie and mash etc for tea. The menu is designed to be cost effective rather than nutritious.

The point that I am making is that just delivering basic care is not enough to help individuals live the lives they want to live, and should be living.

My eldest son was also in residential care for three years and is now in supported living. The expectations we had, and the aims that were discussed when he went into care (at the age of 18) were that he would have a team around him, he would be supported to engage in therapeutic and community activities and this would lead to supported employment and a wider informal network of care. At 24, he remains unemployed, largely un-occupied and very lonely.

I realise that this is not the fault of the carers. It is rather the lack of integrated working with other services. I also realise that care for younger people with chronic MH and learning disabilities/autism may be different from care for the very elderly because in the case of my husband and son, there are expectations of positive progression.

Yet, from a relative's point of view, the weaknesses in the systems place so much more onus on family (in this case, just me) to try to fill in the gaps. There are times when I have very negative feelings about the organisation providing the care, because it promises so much and so little is delivered.

2 experiences with elderly parents both now deceased.

Mother was a handful, early stage dementia and lifelong member of the awkward squad. She was blind for the last years having always been partially sighted. My Dad had to give up being her carer because she had an infection and lost sense of taste and desire to eat. The nursing home gave excellent care, identified she qualified for all sorts of free care and seamlessly provided this. Occasionally, things didn’t go to plan. Hospital appointment arrangements for example, but it was always a number of variables in play. I could not really fault her nursing level care and the general care and kindness she received.

My Dad, who passed away this week, had carers coming in 4 times a day. They were all lovely, and all showed compassion as well as being good at practical things. Dad was taken very quickly by a recurrence of skin cancer that involved development of a more serious skull invasive tumour. He was a good patient having been a carer himself. Only the recipient of care for a very short time in the scheme of things but I really couldn’t fault carers. Apart from anything else, their job involves doing things for people most of us would find hard to do for anyone not our loved one.

Respect 💕👍🏼

You do an amazing job OP. I did agency care work for a while and was mainly visiting clients on my own in their homes. The lack of support from our office was shocking, and when I tried to report neglect by other staff members they named me to them and told me that I must have got it wrong. It was horrendous.
It was so difficult to leave very vulnerable people knowing they would be alone for hours before someone else came in to see them also. This is really difficult work and is highly undervalued in our society. Thank you to anyone who does it with care and compassion.

It's not unreasonable to expect that, but considering the resources available to the staff in many care homes, it is unrealistic unfortunately.

The last place I worked in care was a 'specialised' dementia unit with 20 residents, with needs ranging from fully mobile but needing the assistance of one person to complete personal care through to fully bed bound and needing everything done for them, around 10 residents needed the use of equipment that needed two care staff to move around.

There were medication rounds to complete (time consuming when you are needing to talk/persuade people to take their medication or have to hide it in food or drinks (as directed by GP/other professionals) and observe until it's gone) and not make people feel like they're just having pills shoved under their nose and then done, and a specified amount of time between certain medications - and the need to ensure pain relief is delivered correctly and on time.

Four people on average needing feeding all meals and drinks and everything but lunch (main meal) was prepared and given out by care staff.

At least one person on EOL at any one time.

Phone ringing.

Relatives wanting to be in/out or talk to you.

Dr & nurses visits to assist with.

And there were 4 care staff. Four of us for 20 people with complex needs. The CQC didn't have an issue with the resident/staff ratio, nor the local council. And on average we'd run at least one shift a week short staffed.

At night there were 2 care staff, because despite it being well known (and something I was trained to understand!!!) that people with dementia have disturbed sleeping patterns, apparently no more staff were needed because 'everyone is asleep'.

It's just not physically possible to give even a basic level of care in a timely manner to 20 people between 4 people, let alone 2, especially when one is on a meds round and two are needed to transfer half the residents.

So no, it's not unreasonable to expect a basic level of care, but it's unrealistic to expect it when resources (that are generally controlled by people interested in profit) are not there.

And while care staff are scapegoated and blamed for poor care rather than a system that is there for profit, nothing will change, nor did it in the years I worked in care.

I loved the actual job, but I came across a phrase (on here I think) that perfectly described my 'burn out' - moral injury - I was under constant stress and anxiety because it didn't matter how much I cared, or what I wanted to do, or how much I knew what needed doing, I physically couldn't do it all and I felt horrendously guilty about that.

I left for hospitality because although you may not get treated any better, I'm not at risk of a safeguarding for being physically unable to be in 3 places at once. And I get paid marginally more and can afford to pay bills and have my heating on now and again.

And that's before you get to covid and what went on there and some of my colleagues having to deal with abuse in the street and in shops from family members - "So this is why my mum has got covid!!!" Along with a few choice words and threats at a member of the staff getting food from a shop.
Unbelievable.