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Introduction

The Open University — Mon, 26 Oct 2015 00:00:00 GMT

In this course you will explore social care, a major area of provision in health and social care. All societies face the challenge of supporting people who, for a variety of reasons, are unable to function without assistance or supervision.

It will focus on one important area of social care – home care for older people.

Core Questions

How do people access social care services?
What do home carers do?

This OpenLearn course is an adapted extract from the Open University course K101 An introduction to health and social care.

Learning outcomes

The Open University — Mon, 26 Oct 2015 00:00:00 GMT

After studying this course, you should be able to:

understand the variety of caring activity within the UK for older people in the home
describe care situations for older people in the home objectively
identify aspects of care relationships which conform to principles of good care practice.

1 Entering the world of social care

The Open University — Mon, 26 Oct 2015 00:00:00 GMT

To give you an understanding of why people need social care and how it works, we begin with a case study. This is Ann and Angus’s story:

Activity 1 Getting to know Ann, Angus and their family

Allow about 45 minutes

To bring the subject of family care to life, you are about to listen to a case study in the form of an audio drama. This will bring out issues vividly – you’ll hear tensions mounting and be able to imagine the scenes for yourself. The people you will hear are actors but what happens is based on real lives.

Task 1 An incident on the stairs

The aim of this first part of the activity is to get yourself involved in the complexity of daily life in Ann and Angus’s family. Families provide the setting for many key life processes, so people’s experiences of caring and being cared for are always interwoven with other important strands of family life.

Listen to Audio 1. After listening, make notes in answer to the following questions:

What are the needs of each family member during the audio clip?
What is each family member feeling during the audio clip?
Are they happy?

Download this audio clip.Audio player: Audio 1 Incident on the stairs >

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Audio 1 Incident on the stairs

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Transcript: Audio 1 Incident on the stairs

Angus

Aye.

Ann

Come on, Dad. It’s just one more step.

Angus

I can do it!

Ann

Oh. You alright?

Angus

I can do it. I don’t need help. I’m all right.

Ann

Just hold on the banister. Oh. Have you got it?

Angus

Annie, Annie. I’m going to fall.

Ann

Dad? OK. Hang on to me. Hang on a minute.

Angus

Ah, help. Ah, Ah.

Ann

Are you all right Dad? Dad? Ah, no broken bones.

Angus

You made me fall! Why, why did you not hold me up?

Ann

I did, Dad, I was holding you, I just said to you to wait on the stairs for a minute!

Angus

What is happening to me, Annie? This Parkinson’s. It’s cruel. I cannae hold myself up any more.

Ann

Just hold on and I’ll get you up.

Angus

Aye. I need the …

Ann

Just put your arm around me.

Angus

I need the toilet now.

Bob

Hello? Ann? I’m back!

Ann

Bob, we’re up here! Could you give us a wee hand?

Bob

Oh for Christ’s sake, not again! Are you both all right?

Angus

You keep out of it, Bob, it’s nothing to do with you, I can look after myself.

Bob

So why are you lying on the landing?

Ann

Bob, we’ve just had a wee fall, we don’t need a row about it. Now could you just help us up please?

Bob

Ann, this is ridiculous! We’ve got to get some help for him!

Ann

Will you just give us a wee hand? We can talk about this later.

Angus

Aye, talk about me behind my back, why don’t you?

Bob

Come on, Angus, let’s get you up.

Zoe

I’m home!

Bob

That’s it, Angus, a few more steps to the bathroom. That’s it.

Zoe

I said I’m home!

Ann

Oh, hang on Zoe, we’re a wee bit tied up just now!

Zoe

Mum I failed my English.

Bob

Zoe, we’ll talk to you in a minute, all right? We’re kind of busy at the moment!

Zoe

Yous lot don’t care if I live or die! I hate you!

Ann

Oh, Zoe!

Angus

I need the toilet.

Bob

Ann, I’ve got to go out quite soon – is the tea on?

Ann

What you talking about?

Bob

I’ve got a football match.

Ann

What? I’m supposed to be meeting Cheryl!

Bob

Look I have to go, Ann! They can’t get somebody else at short notice just to fill in for me can they? It’s not my fault you’re having a bad day.

Ann

I’m not having a bad day. Look, I’ll phone Cheryl and see if I can rearrange.

Angus

I need the toilet.

End transcript: Audio 1 Incident on the stairs

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Discussion

Angus needs to get to the toilet. Needs physical help getting upstairs. Needs understanding of the experiences and difficulties he faces. Needs moral support.
Ann needs help with the physical task of supporting Angus. Needs moral support.
Bob needs to be greeted, to relax after work, have his tea, then go off to play football.
Zoe needs to be greeted – to talk about implications of failing English – have tea.
Angus feels frightened by sudden loss of strength or control and by his fall. Bitter about Parkinson’s. Anxious to get to the toilet. Seems hostile to Bob. Doesn’t want help from him.
Ann feels frightened about Angus’s fall. Anxious not to be distracted from helping him. Cross that Bob prioritises football. Frustrated by Zoe’s tantrum.
Bob feels frustrated that Ann continues to run such risks helping Angus. Anxious about getting to football.
Zoe feels anxious about failure and what her parents will think. Angry about being ignored.

It seems that no one in the family is happy, at least not at this point. This two minute insight into the family’s life demonstrates both the responsibility of caring and the negative effects it can have on people’s lives.

Now do Task 2.

Task 2 What is happening to Ann’s life?

The next audio is in two parts. In the first, the family is in the living room. In the second part, Ann meets her friend Cheryl in a pub.

Listen to Audio 2 and make notes in answer to the following questions:

What are the sources of tension between the family members?
What is Cheryl trying to achieve?
What is Ann’s response to Cheryl?

Download this audio clip.Audio player: Audio 2 Tensions round the television – Cheryl makes Ann think >

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Audio 2 Tensions round the television – Cheryl makes Ann think

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Transcript: Audio 2 Tensions round the television – Cheryl makes Ann think

Angus

Aye, now. That’s more like it!

Zoe

Grandad!

Angus

This is what I call proper TV!

Zoe

Grandad, could you turn it down!

Bob

Angus, can I get the remote?

Zoe

Grandad, could you turn the telly down? I’m trying to do my homework!

Angus

All the local news.

Zoe

Grandad, it’s important! Dad, can you make him turn it down?

Bob

Just a minute, Zoe, it’s the football.

Zoe

Mum, they won’t let me do my homework!

Bob

Just a minute, Zoe! Angus! Can I get the remote? The football’s on!

Ann

Zoe, just go up to your room and do it.

Angus

What?

Bob

Will you give me the remote?

Zoe

Why’s it always me that has to move? Why can’t he go up to HIS room?

Ann

Zoe, have some respect for your Grandad.

Zoe

Daft old bugger.

Ann:

Zoe, that’s enough! Go to your room NOW!

Zoe

Don’t worry! I’m going!

Ann

Are you going to let her speak to her Grandad like that?

Bob

You stop her! He’s your father!

Ann

Bob, I could do with a wee bit of cooperation around here! It’s not easy with Dad!

Bob

Angus, will you give me the bloody remote?

Angus

I’m watching this. You can have it when this programme’s over!

Bob

For God’s sake Angus, it’s Rangers Celtic! You’re, you’re just being stubborn for the sake of it!

Angus

Look here, you. It’s my house, it’s my TV, it’s my remote. As long as you stay under my roof, you’ll watch what I want to watch. And if you don’t like it you can, you can get out and pay for your own lodgings.

Bob

For Christ’s sake! Ann, do you have to do that now?

Ann

Oh, it’ll only take a minute!

Angus

Annie! I cannae hear the television!

Ann

Oh for goodness’ sake, I’m going to be two minutes, when else do I get a chance to do it?

Bob

I’ve had enough of this; I’m going to Stuart’s, all right?

Angus

Can I have a wee cup of tea? Can I?

Ann

Dad, I’ll get you one in a minute! For goodness’ sake, just let me finish this off!

Angus

But I need a wee cup of tea!

[Scene Two]

Ann

Oh. Hi Cheryl!

Cheryl

Ann! How are you?

Ann

All right. Sorry I’m so late! I thought I’d never get out!

Cheryl

Well, you’re here now! Here, have a drink!

Ann

Oh brilliant. That’s just what I need to calm down. Sorry. Cheers!

Cheryl

Cheers!

Ann

Ahh. Oh, that is better. So how’s it all going?

Cheryl

Oh me? I’m doing great. Busy at work, expanding you know, missing you, though. Oh, we had some fun, didn’t we?

Ann

Aye, we did.

Cheryl

You know, they’d give you your old job back in a shot.

Ann

Ah. It’s really lovely to hear that. I wish I could. It would be like a holiday.

Cheryl

Well, why don’t you? I mean, it sounds like just what you need.

Ann

Oh, I’m all right. It’s just, going through a bit of a bad patch at the moment – you know.

Cheryl

But seriously though, what’s stopping you?

Ann

A promise that I made to my mum.

Cheryl

Oh, pet. Your mum, she was lovely but she wouldn’t have wanted you to ruin your life.

Ann

I’m not ruining my life, Cheryl! I’m just looking after my family.

Cheryl

Hey, Ann, I am on your side! I know you promised your mum you’d look after your dad. And that’s great. But you are knackered.

Ann

I know, look I’m sorry, Cheryl. I really didn’t mean to snap at you.

Cheryl

I’m your mate, that’s what mates are for. I know it’s not easy being a carer.

Ann

I’m not a ‘carer’! It’s just Dad, Bob and Zoe. And don’t forget we do live for free in Dad’s house. That’s worth quite a lot you know.

Cheryl

So what do you do for them?

Ann

Oh, you know. The usual family stuff. Cheryl, this is really boring, can we talk about something else?

Cheryl

Will you just humour me, yeah?

Ann

You know! Cooking, cleaning, things like that. You know, my dad’s not too mobile, so just help him up and down the stairs. Washing. Dressing. Toilet.

Cheryl

Hmm, that’s an awful lot, pet.

Ann

Aye, but he’s my dad. I love him.

Cheryl

Seriously, Ann, I’d say you were a full-time carer.

Ann

A full-time wife and mother. Like a lot of other women who don’t make a big deal out of it, OK? Now can we change the subject? I came out for a good time tonight.

Cheryl

Right, you’re on. Hey, look, get a load of that fellow over there. In with a chance, I reckon.

Ann

Cheryl, will you behave yourself? I’m a respectable married woman!

Cheryl

So am I! But I’m still allowed to window shop!

Ann

Oh, you’re terrible! Now go and get me another drink!

End transcript: Audio 2 Tensions round the television – Cheryl makes Ann think

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Discussion

Table 1

	Who and what is annoying them?	Underlying reasons
Zoe	Annoyed with Angus for having the television on so loud while she is doing homework – also irritated that his needs get priority.	Maybe she’s worried about school failures and wants help with homework? Is she upset that Angus’s needs seem to dominate family life, and that her mother seems preoccupied by caring duties?
Bob	Wants to watch football – growing irritation at Angus assuming control of television – annoyed at being expected to discipline Zoe – angered by Angus asserting ownership and suggesting he moves out.	Bob has to live in his father-in-law’s house on Angus’s terms because Ann is committed to caring for him. Does he feel that if he isn’t allowed to be ‘the man’ in his own home, why take responsibility for Zoe’s discipline?
Ann	The arguing gets to her – she turns on Zoe – then on Bob – then starts vacuum cleaning in frustration – annoyed with them all for not getting on together.	Does she feel guilty for spending less time with Zoe and Bob than she’d like – and responsible for their frustrations with Angus? Does she worry that things are falling apart?
Angus	Has few enough remaining pleasures – can’t even watch his own television in peace – inadequate son-in-law always wants to watch football and tries to throw his weight around.	Is Angus in pain? Does he find company tiring and confusing – especially young people like Zoe? Is he worried Bob will lure Ann away and leave him helpless? Has he always thought Ann wasted herself on Bob?

These are only ideas – after all, it’s a fictitious case study, so anything goes. The point is to think about how much goes on below the surface of family life.

Cheryl seems worried that Ann is letting herself be ground down by her sense of duty to Angus and her promise to her mother. Cheryl wants Ann to recognise that she is a carer and needs support.

Ann resists seeing herself as a carer. She sees what she is doing as fairly normal, and thinks she ought to be able to cope.

2 Home care: workers and users

The Open University — Mon, 26 Oct 2015 00:00:00 GMT

Most often, family and friends provide much of the support older people require. However, some people don’t have family and friends to draw on. And for those who do, sometimes there is a struggle to meet a person’s full care needs – as was the case with Ann in the audio. This is where social care comes in and – in the following activity – you will find out how people access these services and what they might receive.

View larger image

Figure 1 For several decades now, home care workers have been an important source of support

Long description

You now turn your attention to the people on the front line of social care: those who provide home care, and those who receive it. If people, like Angus, are to be able to stay in their own homes, despite significant health problems, the workers who support them become ever more important.

2.1 What is the job?

The Open University — Mon, 26 Oct 2015 00:00:00 GMT

Going into someone else’s home demands a range of skills in order to work with different people. Some home care clients are seriously ill and need skilled care, including the use of sophisticated equipment. Others need help only with personal care, such as washing, dressing or shopping. The needs of others may involve countering isolation by helping them to maintain social contact with people.

Underpinning these different tasks is the need to establish the right kind of relationships with the client. Home carers have to balance being friendly and providing company with professionalism and doing the job within the time allowed in the care plan.

This is a challenge for many people who work in health and social care, but it is particularly acute for people who work in home care, because their job involves going into people’s homes. They are not working in their own workplace where they can be in control. Rather, they have to adapt to each person in their home.

In the next activity, you will look at how this role plays out in practice.

A home carer’s job

The Open University — Mon, 26 Oct 2015 00:00:00 GMT

In this activity you explore what it’s like to be a home care worker and a user of home care services. You will observe visits by home care workers to four clients of the Cardiff-based agency, Somebody Cares.

Activity 2 The home carer’s job

Allow about 1 hour

Somebody Cares provided personal care, domestic help and support with the activities of daily life such as shopping. Since these videos were made, Somebody Cares was sold on to another company and then was shut down when the company reorganised

In this activity, think about the following questions.

What does the home carer’s job involve?
What skills does it take to do the job and manage relationships?

Task 1 Getting to know the case study

Start by familiarising yourself with the Somebody Cares case study in Video 1. Watch the whole case study right through, so that you get to know the people involved, including their different:

care needs
forms of support provided
domestic situations.

Download this video clip.Video player: Video 1 Somebody Cares case study >

Video 1 Somebody Cares case study

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Transcript: Video 1 Somebody Cares case study

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.

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.

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.

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 1 Somebody Cares case study

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Now that you have viewed the whole case study, it’s time to focus in more closely.

Task 2 Focusing in on the job of home carer

Revisit each of the four cases in the video.

As you watch each one, ask yourself the following questions:

What work does the home carer do for the client?
What practical skills do they need?
How would you describe their attitude to the job?

Use the text boxes below each video to record your answers. While you are working on a case, use the menu at the bottom of the screen to pause the video. You will probably need to watch each case through more than once.

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[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

Elvis Malcolm

Kevin Madden:

Elvis Malcolm

Brian Hole

Not a very pretty sight, is it? It's getting all over the place.

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

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.

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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.

Liz Randall

Clarice Jones

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

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

Bye.

Clarice Jones

By, dear. Bye.

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Elvis Malcolm

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

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.

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

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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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 2

	Elvis and Kevin with Brian	Liz with Clarice	Elvis with Aerwyn	Maria with Lyn
What work do they do for the client?	Move Brian with hoist, wash and dress him, prepare breakfast	Make bed, help wash and dress, bath twice a week, shopping	Accompany Aerwyn to computer class and snooker	Accompany Lyn and help with shopping as directed
What practical skills do they need?	Use hoist, help Brian to feel safe as they wash him, basic cooking, health and safety knowledge	Domestic skills, social skills	Social skills, keeping Aerwyn company, supporting him without taking over	Mainly social skills
How would you describe their attitude to the job?	Very professional, but also friendly, see themselves as supporting June’s carer role, with defined roles and responsibilities	Ready to be flexible and friendly, but also very professional and clear about boundary between work and friendship	Ready to be flexible (e.g. abandons uniform at Aerwyn’s request), but clear about boundary between work and friendship	Maria carefully follows Lyn’s instructions, they have a cup of coffee together, but both know it is a working relationship

Boundaries

The Open University — Mon, 26 Oct 2015 00:00:00 GMT

As you have seen, being a home care worker is not straightforward. It is not about being a friend, although it is about being friendly. Workers must respect health and safety requirements, they must be clear about their responsibilities, and they must be competent to carry out quite a range of tasks. They need to manage relationships so that they can do what they need to do in the time available. Clients cannot contact them individually outside the allocated working hours.

Figure 2 Preserving the boundaries between client and care worker

Long description

Marking out the boundaries between work and friendship is important. Uniforms help. As well as being practical, they indicate that this is a job, not just a casual helping-out arrangement. Despite these professional boundaries, home care workers can find the job quite upsetting. Liz Randall, whom you saw on the video working with Clarice, commented to the team who recorded the film how hard it could be:

I think it’s hard keeping it so professional. A lot of them die in our job. The office can’t contact us all, letting us know, and you might find out a couple of days later. I think regular carers obviously they’re contacted. But it might be somebody who I only go to once a week, but I’ve been going there for twelve months or so. And you find out that they’ve suddenly gone into hospital, and when they come back out, well maybe in for a fortnight, two months, three months whatever … they might not come back on my rota. And I think ‘Oh I can’t go’ … you can’t go and see them. Unless it’s down on your rota to go down and see them. So that’s quite hard. Because you do get fond of them, you can’t help it. Well you wouldn’t be human I think, if you didn’t.

Liz’s reflection is a reminder that there is an emotional side to home care work for which workers may well need support.

2.2 The service user’s perspective

The Open University — Mon, 26 Oct 2015 00:00:00 GMT

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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[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

Elvis Malcolm

Kevin Madden:

Elvis Malcolm

Brian Hole

Not a very pretty sight, is it? It's getting all over the place.

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

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.

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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.

Liz Randall

Clarice Jones

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

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

Bye.

Clarice Jones

By, dear. Bye.

End transcript: Video 3 Case 2: Liz visits Clarice

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Elvis Malcolm

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

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.

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

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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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.

Conclusion

The Open University — Mon, 26 Oct 2015 00:00:00 GMT

Access to social care starts with an assessment of need by the local authority. The benefits and barriers associated with accessing social care can shape how easily people adapt to this change in their circumstances. Having looked at access, you then considered what home care workers do in their provision of social care. Home carers help people to live independently in their own home. Flexibility and reliability, kindness and respect were seen as key personal qualities. Friendliness is important but care workers must maintain personal boundaries and not become friends.

Home care workers provide a vital service in enabling people to stay in their own homes when they have care needs.
Home care workers work to a care plan which determines what they do for each client.
Home care workers need to manage relationships with clients so that there are clear boundaries between being friendly and being ‘a friend’. At times this makes considerable emotional demands.
Personal qualities are important, but not enough. Home carers need technical skills too.
People value home care that is reliable and flexible, and which is delivered with kindness and with respect for them as individuals.

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The Open University — Mon, 26 Oct 2015 00:00:00 GMT

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References

The Open University — Mon, 26 Oct 2015 00:00:00 GMT

Local Government Ombudsman (LGO) (2012) LGO reports on key emerging trends in adult social care complaints [Online]. Available at www.lgo.org.uk/news/2012/jul/lgo-reports-key-emerging-trends-adult-social-care-complaints/ (Accessed 8 January 2014).

Acknowledgements

The Open University — Mon, 26 Oct 2015 00:00:00 GMT

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