home care work

Whether home care work ever amounted just to a spot of dusting, and making a cup of tea for the elderly householder, is a moot point. But there is no doubt that the job has changed out of all recognition in recent years. And the strain is starting to tell.

According to a new survey by Unison, the public services union, 73% of today's home care workers frequently help their clients with medication, 56% at least occasionally do dressings and as many as 83% have assisted with catheters. In 1995, in a previous survey, 43% said most or nearly all of their work was still domestic, as opposed to personal care. Today, that figure is only 5%.

Just over half today's workers say they suffer back pain, commonly as a result of lifting clients, and eight in 10 think the role has become both more demanding and more stressful. Yet pay rates are typically less than £5.50 an hour, even in the local authority sector, and can be little more than the £3.70 statutory minimum. As Malcolm Wing, Unison's head of local government, says: "Pay levels have fallen behind those in local catering, cleaning and retail jobs and equivalent jobs elsewhere in the public sector. So it is hardly surprising that staff are voting with their feet and going to work in less demanding jobs for better pay."

This is not mere union propaganda. Bill McClimont, who chairs the UK Home Care Association, representing independent sector employers, says the recruitment picture is "patchy, but pretty dire as a whole". Where the home care workers of the future are going to come from is an increasingly alarming question.

An estimated 200,000 people are employed in home or domiciliary care in England alone - roughly the same as the car industry. About two-thirds are in the independent sector, with either for-profit providers or voluntary groups, which now delivers more than half all state-funded care. As recently as 1993, it was responsible for just 2%.

Although demand for home care is growing, with an ageing population and policy imperatives to help people stay out of long-term care, services are increasingly focused on the more dependent. As a result, the amount of state-funded care in England rose 3% in 1999 while the number of households receiving it fell 5%. This has been the general trend for the past decade and figures for last year, due later this month, are unlikely to buck it.

Philip Mickleborough, of care market analysts Laing & Buisson, confirms the dramatic change in the nature of the home carer's function. "I would agree it has become more demanding - and much more responsible," he says. "If you're Hoovering for somebody and you do it badly, then they have a dirty carpet. If you're helping them with their medication and that goes wrong, then the consequences can obviously be more severe.

"The important thing to bear in mind is that people who do this are working without supervision. They are on their own and there is no one there to consult or get guidance from."

While Mickleborough agrees that the job as it is today may well not appeal to those who did it when its essential nature was domestic - "home help" - he points out that others may be attracted for that very reason. "Helping someone to get dressed, perhaps lifting them into bed or taking them to the lavatory, is all very different," he says. "But there are many people who enjoy taking care of others, who get satisfaction from helping people in this way."

The Unison survey, conducted by NOP among more than 3,000 union members who completed questionnaires, lends some support to this. Notwithstanding the overwhelming concern about the job's growing stress, 35% said they were happy and satisfied at work and just 23% expressed a contrary view, the remainder not giving an opinion.

One respondent said: "Although I am off work at the moment with back pain, work-related, I enjoy my job and I do get a lot of satisfaction in knowing that I am helping to keep people in their own environment." Another commented: "Despite the negative comments, I love my job and hope to see things improve soon."

Almost all the respondents were employed by a local authority or had recently been transferred to a contractor. More than 97% were women and one in three was over 55, indicating a looming issue of replacing retirees. Ninety-six per cent said they normally looked after elderly people, but 75% said their clients also included those with dementia or mental health problems, 46% younger people with disabilities and 20% people with learning disabilities.

Only one in 10 of those surveyed said they never worked unsocial hours. One said: "I personally work from 7.30 to 10.30 every weekday night and alternate weekends. But I am not paid for unsocial hours. I get the same basic rate as daytime staff, which I feel is unfair." Another reported: "Split shifts sometimes means working from 7am to 11pm in one day, with a couple of hours off in between - not conducive to family life." A third said: "I am on the run all day, checking my watch for my next job. We are very short of good staff."

Whereas domestic tasks were largely done during the day, personal care tends to focus on helping people get up and helping them prepare for bed. Again, this shift has prompted a change in the type of person attracted to the job, militating against those with child care responsibilities.

As one respondent put it: "We carers, I feel, are taking on the job of district nurses almost." And the survey report, Homecare - the Forgotten Service, expresses concern at the kind of tasks - medication, dressings, catheter and even colostomy assistance - being expected of the workers without apparent specialist training. It asks: "Who should be doing this work, who should be paying for it and what would happen to clients if they stopped?"

Mickleborough points out that the immediate shortage of home care workers is likely to ease when the economy slows, with the disappearance of competing job vacancies in the retail and service sectors. He also believes that the development of "assisted living" or "very sheltered" housing schemes will help cluster demand, saving some carers the journeys between clients, and that technological advance will do away with the need for visits simply to check on the client.

Yet both Mickleborough and McClimont agree with Unison that home care is fundamentally underfunded. Unless and until local authorities are able to offer more for the service, facilitating the payment of better terms and conditions, they say it is always going to struggle to recruit and retain staff of the right calibre.

Home care contractors have faced a decade or more of prices being driven down, says McClimont. "What we need to see is local authorities setting a floor at least on pay and conditions, so that the competition takes place on the management of the service and the value that the provider is adding, rather than always bearing down on the workers' remuneration."

Homecare - the Forgotten Service is available free from Local Government, Unison, 1 Mabledon Place, London WC1H 9AJ.

As a home care worker myself, I would agree with the above comments. With little training, I have dealt with catheters, hoists,convenes. The agencies are making good money. I have seen individual invoices.