The carers took my independence

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.


Published by rodkersh1948

Trying to understand the world, one emotion at a time.

7 thoughts on “The carers took my independence

  1. An absolutely excellent post. During my career as a rehab engineer I occasionally encountered learned helplessness but fortunately I was more involved with the re-ablement of those who desired independence. It was a truly joyful experience.

    Liked by 1 person

  2. Reblogged this on Dr Rod’s Odd Blog (almondemotion) and commented:

    I thought this was worth re-blogging today as last week I had a lesson in patient independence, or perhaps, autonomy.

    I can’t give too much away to protect their anonymity.

    Suffice it to say, this is one of our patients who ticks the box of being ‘housebound’ – which you will know I regard as a moveable feast, a condition open to interpretation and review.

    I popped in with a Covid-booster.

    It was drawn-up, just out of the cooler, quarter of a millilitre of immunological goodness.

    My patient was surprised to see me.

    ‘I’ve come to give you your fourth jab!’ I said.

    ‘I don’t want it.’

    There I was, syringe and sharps bin at the ready, face-masked, etc and he said no.

    I said, ‘Oh, I didn’t realised, I am sorry, I didn’t mean to invade your privacy,’ (As with most house-calls in the UK I just knock the door and walk-in) (I can’t imagine they do that in America).

    We had a short chat. He said he was doing fine.

    He was attached to oxygen and in his bed.

    Fine is a relative term.

    I said cheerio and left.

    Some might think, ‘What an ungrateful patient! The doctor went to all the trouble of…’ Others, ‘What a waste of vaccina! Shame!’

    I thought, ‘What a guy.’

    So many patients are easily cowed or railroaded into receiving treatments or investigations that they do not want, for someone to say, ‘No.’ Is not as straightforward as it might seem.

    Most of us are easily manoeuvred or nudged into doing things we don’t necessarily want, it is part of what allows us to live in crowded cities and societies with too many rules and regulations.

    At our best and our worst we are compliant.

    My patient expressing their wishes, demonstrating their autonomy, their refusal to comply, to do what the doctor wants to avoid disappointment was, I thought, fantastic.

    I had another patient who died a few months ago.

    She was even more disabled.

    She was equally vehement in her consent and assent. She required a talking-aid to communicate, something I can’t imagine.

    Me, I am free to do what I want.

    Ironically, had I refused the vaccine a year ago it would have caused a massive hoo-ha and potentially would have led to my unemployment.


    Here is to being human!


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