No time for that! Practicing relational care in the UK homecare sector
The Centre for Care recently hosted Professor Mary Larkin, Jenny Kartupelis MBE and Dr Manik Gopinath to discuss their work with the Open University on relational care in the context of care homes (Gopinath et al, 2023). Kartupelis previously describes the concept of relational care as building upon an ethics of care (which provides a philosophical foundation of interdependent relationships and responsibilities) and moving beyond person-centred care (promoting choice for disabled and older people) to emphasise care that is multidirectional. This means caring about the wellbeing of everyone involved in terms of self-worth, dignity, knowing others, being known, safety and security. Recognising care as reciprocal mean that care workers wellbeing also matters, which may be improved by paying a decent and fair wage, allowing time to care and facilitate relationships, providing support through demanding aspects of the role and job flexibility to meet care workers needs and balance the intensity of ‘giving’ (Kartupelis, 2021).
Watch the seminar by Professor Mary Larkin, Jenny Kartupelis MBE and Dr Manik Gopinath below:
In the UK context there are a number of obstacles to practicing relational care, but I want to focus on ‘time’ in particular, in the context of homecare. During my PhD interviews with ‘care at home’ workers we’ve explored job-related risks to wellbeing and the subject of ‘time’ seems to be especially salient for homecare workers.
Beginning with a homecare worker’s contract, paid time is often not guaranteed with around fifty percent of homecare workers in the UK on zero-hours contracts that provides minimum income security (a key aspect of wellbeing). Hourly pay may also average out at below the legislated National Minimum Wage due to the widespread practice of not paying homecare workers for time travelling between home visits. It was quite common for homecare workers I interviewed to be ‘working’ fifteen hours a day in order to earn seven or eight hours wages. The hours are divided into short visits to disabled or older people’s homes requiring help with daily personal tasks or more complex health conditions. These visits form a weekly rota which (depending on the employer) can be released a few days (or sometimes the day) before its due to start and is subject to changes through the week. I spoke to one homecare worker who explained “…You’ll find out the day before which clients you see…but you get halfway through Monday and your manager will say, ’tomorrow I need you to see this person and tonight go and see that person.’…you just live your life minute to minute”. The ability to plan one’s life is another key feature of wellbeing but when a homecare worker’s hours and schedules are regularly changing it must feel like the ground is constantly shifting beneath them. This can cause stress and have an impact on relationships, family care responsibilities, even the ability to prepare healthy meals; “…you just end up eating some crap in the car”, as another homecare worker explained.
‘Bounded clock-time’
Home visits are often extremely short. The homecare workers I interviewed had visits scheduled for fifteen to thirty minutes, up to forty-five minutes in rare examples. ‘Time’ in homecare has previously been conceptualised as ‘bounded clock-time’ (Burns et al, 2023) which refers to care ‘tasks’ set to the clock and combined into schedules. Tasks are standardised for cost, pace and intensity, but there is tension between the precision of clock-time and the context which homecare workers operate in, dealing with unpredictable care needs and community settings. For example, route planning technology used by homecare organisations accurately estimates travel time between home visits but it cannot foresee delays such as new roadworks, a slow moving vehicle, a bus cancellation for those using public transport or adverse weather for those who cycle. Small delays can accumulate causing stress for both homecare workers and the person they are due to visit who might receive medication late or have their meals served at unsuitable times. This makes the practice of unpaid travel time contentious amongst the homecare workers I spoke to who argued that it does not recognise the stress involved in keeping to a schedule.
Once at the home visit, access to the property can be delayed by a homecare worker being unfamiliar with the property or a disabled or older person’s mobility or sensory impairments. One homecare worker recalled that colleagues have unfairly directed frustration at the disabled or older person for delaying the schedule “…You get a lot of people who don’t care anymore, and it’s because there’s so much stress and pressure.” Others are far more empathetic towards people they visit but nevertheless described ultimately unsatisfying work set to the clock “…if they start chatting to you, that’s where the problem starts because the time is ticking and the other people are waiting,” explains one homecare worker, “…this is all they want, just to have a five minute chat to you but you can’t give that, which is very sad.” To get back on schedule after a delay, some homecare workers may even weigh the needs of the people they are visiting against each other to determine which calls can be cut short. These are typical dilemmas for care workers in the context of marketised social care in the UK which situates them between their own caring values and the logic of markets which values resource efficiency.
‘Negotiated clock-time’
Diane Burns and colleagues have identified ‘negotiated clock-time’ as a strategy for addressing this dilemma. Homecare workers may speak to their employer and request more time for someone with a deteriorating condition or who may be experiencing loneliness, as one homecare worker explains “…if you can prove that they need ten extra minute for psychological reasons…for people who really desperately need it, who haven’t got anyone, hasn’t got any families, then it can be done.” These requests can take months to resolve and in the meantime, or if they resolve unsatisfactorily, homecare workers do what care workers often do; give up their free time to practice care that matches their values when their paid time doesn’t allow it, as one homecare worker revealed, “…You pop in and see clients outside of work because they’ve got nobody else and they’re not going to see anybody else and it’s horrible. They’ll (employer) say, ‘You’re not supposed to’ but at the end of the day we’re still human beings.” However, acting on altruistic impulses is perhaps more challenging for homecare settings than other care settings which can offer pockets of opportunity through the working day to practice relational care. One care worker in a supported living complex told me that they’d regularly stop by a resident’s room to provide a hot drink and a chat during the evening rounds although it wasn’t on their schedule. In homecare this is harder as more space demands more time and the additional effort to provide a little extra care can mean travelling across towns rather than between rooms.
A ‘companionship’ care worker I spoke to worked shifts lasting four hour and would encounter homecare workers finishing their visits when her shift began. Observing the time pressure they were under, she often helped with their tasks ‘…we help each other’ she explained, ‘we’re not working against each other, but are all working in the tradition of care.’ Nevertheless, homecare workers do often work alone and against the clock. The examples raised here are illustrative of homecare workers operating in a sector starved of resources, with time rationed beyond all practicality. For some, this creates a daily struggle to provide basic levels of care and an impulse to draw on their altruism to practice care at a level that is valued by everyone involved. In return, they are often left feeling unsettled, unsupported and undervalued; experiences that in no way reflect the principles of relational care.
About the author
Nick’s PhD research is supervised by Prof. Sue Yeandle and Prof. Majella Kilkey working in collaboration with The Care Workers’ Charity with additional supervision from their CEO Karolina Gerlich. It seeks to understand the risks to wellbeing experienced by care workers before and during the Covid-19 pandemic using a mixed-methods approach to analyse applications to the charity’s financial support grants followed by interviews with care workers and stakeholders.
