Social care in the community
Social care in the community

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Social care in the community

2.2 The service user’s perspective

We now switch from the care worker’s perspective to that of the service user – or client as they are referred to in our case study. The Local Government Ombudsman (LGO, 2012) highlighted the following points from complaints it had handled:

  • Unreliability: care workers did not always come when they were expected, or they were late.
  • Short visits: some as brief as 15 minutes, which did not allow time to complete the tasks, or exchange pleasantries.
  • Frequent changes of staff: this meant that service users did not get to know the workers.
  • Poorly trained staff: staff did not always have the right skills or attitudes, or did not treat service users with respect.

This creates a pretty bleak picture of home care. The next activity provides a different perspective on it.

Activity 3 Home care: the client's perspective

Allow about 1 hour

For this activity, you go back to the scenes you viewed in Activity 2, but this time, you look at them from the client’s perspective.

As you watch each case study again, consider the following questions.

  • What are the client’s reasons for having home care?
  • Is there any choice of care worker?
  • What does the client value about the care worker?
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Skip transcript: Video 2 Case 1: Kevin and Elvis visit Brian

Transcript: Video 2 Case 1: Kevin and Elvis visit Brian

[ELVIS AND KEVIN SPEAK QUIETLY]

[DOORBELL RINGS]

Kevin Madden
Good morning my dear.
Elvis Malcolm
Morning
June Hole
You alright?
Kevin Madden
You bet.
June Hole
Chair's over there.
Brian Hole
Sorry?
June Hole
Sling's over there.
Brian Hole
I went into the hospital in June, and come out in December. I went in with two gangrenous toes. So I come out with no toes, no legs. And it's called vasculitis, isn't it? When I was being discharged, the social worker up at the hospital, she wanted me to stay another week or a fortnight because she didn't have a care package in place. And my daughter knew of this company. And she phoned her, and she said, have you got any, you know, and they arranged it between them that way. So we went back to Social Services then. And they said, that's OK, carry on.
Elvis Malcolm
You have to know how to move him to and from - from chair to bed to chair. You just have to monitor how we move him. Or you put the strap on to get him in the chair. You have to make sure they're definitely accurate. [INAUDIBLE]
Kevin Madden:
[INAUDIBLE] Want to take it up? There we go. You're back. With Brian, obviously, he's an amputee, 'cos of gangrene. He can't do a lot for himself. So obviously, because he's a double-hander, June can't do it all her own. So the most important thing is get him out of the bed in the mornings, make sure he's up, dressed, ready for breakfast.
Elvis Malcolm
You try to make the client feel safe, and relating to them. When I'm washing him, if you notice, I tell him, yeah, I'm going to wash your face, stop me. You don't put up your hand like you might think, you know what I mean? So you tell him definitely. You talk him through it, so that's the situation.
Brian Hole
Not a very pretty sight, is it? It's getting all over the place.
It's Phillipe and Tiago, two brothers, Portuguese. They're very good. Obviously, you have two men, two ladies, or two girls, or one of each. But there's always - they won't do it one on their own. See, you're double handed with me. So they won't do a single-handed. So if nobody turns up, then they gotta wait and wait on them.
Elvis Malcolm
You going to stop me when the milk's enough?
June Hole
Yeah. You're spoiling him.

[Kevin talks to June in the background]

Elvis Malcolm
That's OK?
Brian Hole
That's OK, yeah.
June Hole
You should be so lucky.
Elvis Malcolm
That's luck.
Kevin Madden
And then his wife is available most of the day. She's got the wheelchair in the day. She's got the car outside, which transports him back and forth two times a week. He said, she'll take him to the hospital for dialysis and stuff. So that's June's role, if you like, as a wife. But in the meantime, she's at least two carers going in sorting the main, you know.
Ok, that's it.
June Hole
You'll be off?
Kevin Madden
Thank you. At the end of the day, the man appreciates everything you do. And everything's fine with him.
End transcript: Video 2 Case 1: Kevin and Elvis visit Brian
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Skip transcript: Video 3 Case 2: Liz visits Clarice

Transcript: Video 3 Case 2: Liz visits Clarice

Clarice Jones
Hello, Liz.
Liz Randall
Morning.
Clarice Jones
Oh, you got your hair up. You have.
Liz Randall
Thank you.
Clarice Jones
I'm all right.
Liz Randall
Oh, good.
Clarice Jones
[INAUDIBLE]
Liz Randall
Excellent. [Laughs]
Clarice Jones
It is excellent, isn't it? Yes, because I thought I might be bad.
They say if you have carers to look after you in the mornings, then you stay out of a home. And that's the main thing, because I don't want to go in a home. So that's why I have them. And I like them. They tend to me very well, you know. So I'm comfortable with them. Yes.
Liz Randall
The care plan for Clarice is personal - helping her to wash, dress. She actually does her own breakfast - make a cup of coffee. She has that seven days a week, but just a morning call. She doesn't have evening care. As soon as she's up and dressed, then she sort of muddles on herself through the day. And she likes to do that, so that's why she only has morning care.
Clarice Jones
She comes an hour on Monday and gives me a bath. So that takes time. And Friday, I have a bath. And then Tuesday, Wednesday and Thursday, I have half an hour. And then I have an hour shopping on Wednesday.
If I want extra and I ring Tracy up, she will fix it up that one of them will push me in and give me an extra half an hour. Yes. Definitely so. If I'm really bad, you know, and I can't even go out there and make a sandwich or anything, she'll fix something up.
She really knows me. She knows everything that I want to do and every comfort. You know, and even to the shopping, she knows my shopping list better than I do, really.
Liz Randall
No rice pudding this week?
Clarice Jones
No, I got enough of that.
Liz Randall
You've got enough of that.
Clarice Jones
They took her off me for a little while in the summer, and I complained. I said, look, I'm paying for it, why can't I have who I choose? The one that replaced her was very nice, but she wasn't Liz. And the boss saw that I had her back. And that's much better now. I'm comfortable again now.
Liz Randall
She's a very nice lady. I'm quite fond of her, but it still has to stay professional. When I say goodbye to her, you know, I have no more contact with her ’til the following morning.
Clarice Jones
That'll be that, won't it?
Liz Randall
Okie cokie.
Clarice Jones
See you tomorrow then.
Liz Randall
Yeah
She probably thinks of me as her friend. And while I'm there, yes, although I'm caring for her, I am a friend as well. But that's where it stops. When I leave her house, I go on to do my next – wherever I'm going. And that's where it stops.
Bye.
Clarice Jones
By, dear. Bye.
End transcript: Video 3 Case 2: Liz visits Clarice
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Skip transcript: Video 4 Case 3: Elvis goes with Aerwyn to his class

Transcript: Video 4 Case 3: Elvis goes with Aerwyn to his class

Elvis Malcolm
The first time the company got Aerwyn, they sent out a guy there – and when they sent him there, Aerwyn never liked the guy. So I went. And the first day I went and I go in and I said, hello, hi. And he was like, hello, you want a cup of tea? So we sit down, we chat, play with his dog, and stuff like that.
Tutor
Since you're going to Dubai, why don't you put in Dubai and see what you can find out about that area?
Aerwyn Hall
Yeah.
Tutor
See if you can find some information for your holiday. You might find some places. So that's D-U-B..
Aerwyn Hall
Me and Elvis get on good. And we have a good laugh. And he likes his music, he does. I think it's all the rap music, so Elvis likes all that. So he puts the music up and he's all really happy. So my mum knows him as well, and he likes Millie a lot.
Tutor
– on the Google search. There we are.
Aerwyn Hall
Ooh.
Tutor
So it's telling you all about Dubai. So scroll down and you can have a look. You might even find your hotel on there, where you're going.
Elvis Malcolm
What's the name of it?
Aerwyn Hall
Well, no. We're not staying in the hotel. My cousin's got a house out there as well.
Tutor
Ooh, lovely.
Elvis Malcolm
He don't see me as his carer, he see me as his friend. So like him, I can't wear a uniform to be with him – he feel uncomfortable. If we go anywhere, he say, Elvis my friend, and things like that.
Aerwyn Hall
Oh, they've got horse racing there as well.
Elvis Malcolm
Yeah.
So it's like a work and a friendship relationship between me and him right there.
Aerwyn Hall
Oh, look at the buildings. Oh, look at the hotel.
It was Social Services that set it up. You know, to just take me out on a Monday and Wednesday, yeah. And I'm really enjoying it. I really like it, yeah.
I've got to take my phone oou there as well. Have to be – mobile phone.
He takes me to Snooker down at Penarth. And then I got a membership card. And I'm really – two hours I'm out with him, so we have three games of snooker on a Monday. And then I comes home and then I haves my lunch. Just put the telly on to see what's on telly.
Tutor
A well deserved break now, is it Aerwyn?
Aerwyn Hall
Yeah.
Tutor
There we go. That's 50 there. Have you got the change there?
Aerwyn Hall
All right. All right – 10, 20, 30, 40, 50.
Tutor
That's lovely. Thank you very much.
Aerwyn Hall
All right.
Tutor
That's lovely. OK.
Aerwyn Hall
Do you know, my mom told me a joke one day. It said, if I was to go out there, she said she would get a half a dozen camels coming back.
Elvis Malcolm
Your mum was going to sell you!
Aerwyn Hall
Sell me out there.
Elvis Malcolm
[INAUDIBLE]
Aerwyn Hall
Ah, it's funny, that one.
Elvis Malcolm
It's a close relationship, working with him, but you have to give him that friendship to make him comfortable. But on the other side, you know you're doing a job. So you know your limit. You know where to step over the line, or not to step over the line.
Snooker Monday, and then your gone.
Aerwyn Hall
Yeah, well, that's it. Yeah, snooker on Monday, and that's it.
End transcript: Video 4 Case 3: Elvis goes with Aerwyn to his class
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Skip transcript: Video 5 Case 4: Maria goes shopping with Lyn

Transcript: Video 5 Case 4: Maria goes shopping with Lyn

Don
Hello Lyn, it's Don from VEST. How are you? All right?
Maria Williams
Hello.
Lyn Smith
Hiya. How are you? Nice to see you, Don
Don
And you, sweetheart. And you.
Lyn Smith
Yeah, I haven't seen you for a while.
Don
A couple of weeks.
Lyn Smith
Yeah.
Don
They're keeping us apart.
Lyn Smith
Yeah, that's it, because we have such a laugh when we're together.
Don
Indeed, we do.
Lyn Smith
Yeah.

[WHIRRING]

Maria Williams
Right, now then, let's have a look.
Lyn Smith
Oh, Maria's brilliant. She's very good. She's good company and she knows what she's doing.
She never rushes you, and she's always so - well, she's so jolly. And there's never enough that she won't do for you. She's so kind.
I think what I might do - I might try getting the still ones - the orange and peach. We've still got to find out where the air freshener is - and the milk. I can't find it now.
Maria Williams
I think it's down the other end, isn't it, Lyn?
Lyn Smith
Down that end?
Maria Williams
I think so.
Lyn Smith
Right.
I'm a free agent. I may be disabled, but I know exactly what I want. And I don't let anybody tell me what I've got to do or what I've got to buy. It's always up to me.
And all my carers know that, and they treat me as a human individual. They don't treat me as somebody with a disability.
And that's the other thing I like about Somebody Cares - you're not treated any different from anybody else.

[REGISTER BEEPING]

Lyn Smith
Right.
Cashier
Would you like some help with your packing?
Lyn Smith
Um, do we want help?
Maria Williams
Yeah.
Lyn Smith
Yes, please.
Cashier
Ok.
Maria Williams
Do you want to go down a bit further, Lyn?
Lyn Smith
In the mornings it's funded by the Social Services, but in the afternoons I get the Independent Living Fund.
And they fund most of it, but I have to fund for some of it myself, as well. I pay 75 pounds a week towards my afternoon care.
She's not a friend, she's a carer. That's the difference, because with a friend, you meet, and you go out, and you socialise after hours.
With Maria, everything's done within the hours, if you know what I mean. There's no - we're not allowed to communicate with them after work and stuff like that, so we don't.
Maria Williams
There we are.
Lyn Smith
Right, ok.
Maria Williams
You ok?
Lyn Smith
Yeah. Thank you.
Maria Williams
You keep everything professional. And everything is done, then, obviously by the book - even though with Lyn, you can have a laugh and a joke, and - it's a nice atmosphere.
Lyn Smith
As long as you've got the right agency and you've got the right carers, then you're all right.
And I - touch wood - I'm very, very lucky I've been able to manage with my own life.
And with the support of the carers, I've done really well.
End transcript: Video 5 Case 4: Maria goes shopping with Lyn
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Discussion

Here are our thoughts. Again, don’t worry if they are different from yours.

Table 3

  Brian and June (Kevin and Elvis) Clarice (Liz) Aerwyn (Elvis) Lyn (Maria)
What are the reasons for having home care? Needed help at home to get out of hospital quickly after amputation Keeps her out of a care home, allowing her to stay in her own home To keep him company and attend classes, play snooker and have a laugh with him Allows her to be a free agent and live her own life, despite disability
Is there any choice of care worker? Brian does not always have the same care team (sometimes it’s two men, sometimes two women) Choice is important to Clarice, who complained when Liz was taken away, and got her back Elvis says Aerwyn did not like the first worker he was offered, and asked for a change Lyn has a variety of workers, and seems to like them all
What does the client value about the care worker? Brian appreciates the work done for him, whoever does it, as it has got him out of hospital Clarice values Liz’s approach, and the fact Liz knows her so well, even down to the shopping list Regards Elvis as a friend Says: ‘All my carers treat me as a human individual’, and that Maria is kind, jolly, good company, and never rushes her

You have seen the value of home care as a way of enabling people to live in their own homes, with a reasonable quality of life, rather than in a residential home or, in Brian’s case, a hospital.

These service users get a higher standard of care than those who complained to the Local Government Ombudsman (LGO). There is some choice of care worker, some flexibility, and the fact that no one comments on reliability suggests that they can indeed rely on people arriving when they are due. They value people who get to know how they like things done, who are friendly, who treat them as human beings.

Meeting people’s needs in ways that are both professional and friendly, and flexible and reliable is not straightforward. It is, however, a very important responsibility. How would Clarice manage if for any reason Liz or another worker was unable to come? She might be in considerable difficulty and distress. To run a care agency that can provide the flexibility and, at the same time, the reliability of service that clients want is a significant challenge.

K101_2

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