Experiences of residential care assistants working with people with dementia

Respondents attached their independence, memory and relationships with living independently and had low opinions of residential care.

There is increasing interest in comparing the work situation of people working in social care with that of people working in healthcare services. This may seem a bit of a UK preoccupation since our health and social care divide is particularly evident. The impetus towards integration is a further prompt to such comparisons.

From a social care perspective it is interesting how many such comparisons seem to end up with recommendations that healthcare practices should be adopted by and assimilated into social care. This article is one such example. Readers may wish to consider whether this is a positive development or indeed possible to implement.

Method

This article reports interviews with eight care assistants homes in England. Confusingly, these staff are referred to as healthcare assistants. This term is more commonly used in NHS settings.  The participants had no professional nursing qualifications. They all had a National Vocational Qualification (NVQ) level 2 in health and social care. Two pilot interviews were conducted but are not included in the analysis.

Interviews are a popular if time-consuming method of exploring feelings and experiences. As followers of the Social Care Elf will recall, there have been several such recent studies. Sadly few researchers have offered to share interview transcripts but of course what one person is looking for is perhaps only marginal to the interest of another.

In this study the researchers wrote to the managers of five local (to them) residential care homes.  The care homes had no on-site nurses. The managers agreed to circulate study information to their staff. Staff from three homes contacted the researchers to express willingness to participate.  Their managers agreed that interviews could be held in the home and during work time. As might be expected, the interviews were recorded and transcribed.

The researchers describe their approach as an interpretative phenomenological analysis. This is a bit of a mouthful so it is usually referred to as IPA. There is not much information given about why this method of analysis was chosen instead of thematic analysis, which was the method used for the two pilot interviews. The result of the IPA analysis was a set of three superordinate (overarching) themes under which are subordinate themes (three of each).

Motivational interviewing...

Eight participants were interviewed in their work setting.  Results were analysed to identify themes around experiences of looking after people with dementia in residential care.

Findings

Like many health and care interviews, the eight participants talked about the importance of relationships with care home residents but also with residents’ families and their colleagues (Theme 1).

Interesting, in light of the great emphasis currently on recognising dementia, the researchers suggested that the staff might be better able to connect with individual residents if they ‘forgot’ the diagnostic label of ‘dementia’.

Interesting too, when comparing health and social care sector ideas about professional boundaries, most of the care assistants talked about the inevitability of forming attachments with residents; but conveyed a sense that this enhances care. There was a sense however that emotional distance might help staff cope better with the likelihood of resident deaths.

Overall all the participants talked about getting mutual support from colleagues. Most expressed commitment to their work and saw is as ‘special’ and a ‘calling’ or vocation. Praise from families was highly valued, but sometimes their high levels of commitment were thought to be taken advantage of by their employer.

Not everything was so positive. There were problems in making residents ‘comfortable’ or feeling ‘helpless’ when witnessing residents’ deterioration, or feeling torn between administrative work (form filling) and direct care. Care work was portrayed as emotionally challenging and this aspect of their work insufficiently supported or acknowledged. This applied to work in the present but also troubling personal reflections on a future self that might include being a person with dementia.

Emotional support

The emotional challenges of care work were not sufficiently acknowledged or supported.

Limitations of the study

As the researchers note, the participants were not representative of the social care workforce and, as they don’t tell us about the care homes, we don’t know if these were typical. Those interviewed were long-standing care workers – on average they had been working with people with dementia (location unspecified) for well over 8 years. Their average age was 37 (range 20-49) and half worked full time. This group of people in workforce jargon are sometimes referred to as ‘stickers’ or ‘stayers’: they are a valuable group to talk to and while this is only a small number of interviews they  might shed light on why they have stayed in this work – the ‘pull factors’ (collegiality or peer support; positive feedback and so on), and how they manage possible push factors’ (feelings of lack of recognition or being taken advantage of) that might be overwhelming for other staff.

One problem with not knowing much about the care homes (actually almost nothing) is that we can’t set individual accounts in the ‘culture’ of the home. For researchers who want to see the questions posed to the participants (researchers like to do this sort of ‘mining’) it would have been helpful to have had a summary of the interview schedule. We also don’t know who did the interviews (one or all of the authors?) and if that would be recommended or otherwise. Finally, this study took up the managers’ time, the care workers’ time and presumably took time away from residents. What should researchers do to compensate for this? In the NHS this would be paid for – in social care not so.

Discussion

The researchers suggest a few things for care home managers to consider (strangely calling this ‘clinical implications’ whereas they are more likely to be seen as managerial). They encourage improved ‘clinical supervision’, although this may also be a more health profession concept and tradition.

Like most researchers their final message is that more research is needed. For me the study adds to the literature on care workers who enjoy and value their work which is less often reported when recruitment and retention assume urgency. In particular retention is an under-explored but intriguing subject raising the question of whether we should ask more about employers than employees.

Links

Primary paper

Katherine Law, Tom G Patterson and Jane Muers (2017) Experiences of healthcare assistants working with clients with dementia in residential care homes, Dementia 2017; in press, first published 13 January 2017.

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