Carers in the health and social care sector are a frequent soft-target for complaint. You can blame them for anything, and they often are the butt of the frustrations of those they support.
You rarely hear complaints about the people running the agencies that employ the carers, ‘Those damn managers/executives/share-holders.’
Caring or, the work of an carer is one of the most intimate non-professional roles in our society.
An army of carers support our old, frail and vulnerable.
Many receive minimum wage.
Many also work to zero hours contracts.
No sick leave, no training, no holiday pay.
We love our mothers and fathers; we care about them although the system allows them to be supported by people who are treated in ways that you would consider inappropriate for those closest to you.
I had a patient complain about his carers today.
The thing is, he didn’t tell me that they were too young, or came at inconvenient times or were mechanistic in the way they came and went; no, for my patient today, the problem was that they were too good.
It started after I fell. I was standing there, and somehow tripped-over my oxygen tubing, falling and crashing into that sideboard; it showed me I had a hard head… I ended-up in A&E and struggled at first to walk. All the time I wanted home and eventually it was agreed, I could go, with carers.
They came, three times a day, breakfast, lunch and dinner. Preparing my meals, washing-up; supporting me.
I became lazy.
At first, I would do my usual thing – cook, wash, potter; then they would arrive and have nothing to do.
This awkwardness led to my letting them get on with it.
I sat and waited, was fed and supported.
Now I do very little.
We often talk of a psychological phenomenon called learned helplessness. This is a situation where an individual discovers that a great way to gain attention, focus, even love is to become dependent.
The less you do, the more others come to your aid.
My patient developed learned dependence; he fitted into a role that allowed his carers and, likely the system to do their thing.
You see, there is something, not much discussed in healthcare these days called enablement or, occasionally, re-ablement.
The idea is that a carer, perhaps supported by a therapist, gradually reduces the level of involvement and support to allow the patient to regain their independence; with little steps they move away until the person is doing their thing, on their own – the same way we help our children to walk.
The thing about this process is that it is not as straightforward as caring – indeed, in order to achieve this level of engagement you probably have to care more than is required. You have to care yourself into redundancy.
This did not happen for my patient.
His dependence increased and now his ability to function on his own has gone. He wouldn’t know where to start. Confidence collapsed; he hasn’t left his house in months.
Caring is good, it is fundamental to the smooth running of system, yet, over-care, just like smothering, over-burdening love for children than stunts their growth, is a hazard we must keep in check.
The irony of this situation is that the carers providing the support probably knew and realised what they were doing, they were merely trapped in a dysfunctional system that results in continued dependence.
By allowing more training and support for the carers, by providing a framework that explains their purpose, their value, we could perhaps move towards something more meaningful and satisfying for everyone involved.