Clients are at the centre of all that homecare providers do. Enabling someone to stay in their own home and allowing them to have truly person-centred care is one of the most satisfying services to supply.
However, the last couple of years have seen a constant flex and change in this care arena. For many homecare providers, the reality of providing care now has a whole new level of complexity never faced before and we feel the voice of homecare providers needs to be heard.
In homecare, along with many other care environments, the workforce has gone above and beyond throughout COVID-19, showing courage and commitment. Supplying services to enable clients to remain safe at home was a challenge met on a daily basis throughout the pandemic. In addition to the challenges, such as PPE requirements, managing staff travel and staff cohorting to minimise risk, costs have increased with little rise in income paid to providers. Therefore, many providers and staff now feel undervalued and unrecognised for the huge contribution they have made.
The current homecare position is tenuous, with demand outstripping supply. Many local authorities have long lists of clients requiring care that they cannot place with a provider, and provider services are closing because they feel they cannot meet the challenges they face.
The fundamental issue
We are now at the stage where staff burnout is evident throughout the whole sector – with many care workers, nurses and registered managers deciding to leave care for good. The situation is concerning and, despite years of warning, the Government seems to have no concept of the fragility of the homecare market. We are aware of a few providers who have lost care workers to retail and hospitality work, because they would rather do this than continue to provide care.
Luckily, the change in vaccine guidance means that we stand a chance of retaining the 100,000 homecare workers who remain unvaccinated. However, what is more worrying is that Government had no contingency plan for the possible loss of those 100,000 staff if the vaccination as a condition of deployment (VCOD) legislation had come into force.
Unfortunately, the indecision around vaccinations has added to the already huge amount of resource, money and time being spent on a vaccine plan, contingency plans and managing the process. Providers have had to launch large recruitment drives to attract new staff, sometimes with minimal results. We are in a national staffing crisis in care, with the usual associated induction, training and support of new workers all adding to the workload.
The current system cannot carry on without correct funding and support for the workforce. This will not be news to any homecare provider but, as time goes on, we are having to undertake more and more difficult conversations with our clients, our staff, our funders and others.
An impossible situation
In amongst the general difficulties recruiting, over the last four months providers have had the added pressure of having to speak to staff who excel in their care role and explain that they will no longer have a job within care services if they do not have the COVID-19 vaccine. Many registered managers and care providers report these conversations as some of the most distressing conversations they have ever had – and they turned out to be completely unnecessary.
On top of this, registered managers are having to ask care workers to cover extra shifts due to the lack of staff. This seems to be a constant request that is stressful for both managers and care workers who want to ensure that the people they look after receive the care they need.
Where this is not possible, having to tell a client you can no longer provide a service to them because you do not have enough staff to meet their requirements is one of, if not the, toughest conversations many of us have had. Unfortunately, this is now becoming a regular conversation for many providers. We also know that those very people we have cared for and looked after will struggle to gain further provision in the current market, which cannot be right and does not sit well with any of us.
One provider told us that they have handed back a number of care packages to their local authority, having looked after specific clients for many years. Tears were shed by those receiving the news and by those who had to give it. This is upsetting for all involved, but mostly for the clients and their families who will lose care workers who they have come to know and trust.
Not only is this difficult in terms of telling the client that you can no longer provide their care, but it also creates difficulties in relationships with the people who organise care, for example local authorities.
A lack of staff means not accepting or handing back packages to local authorities and/or CCGs to ensure a safe service. It is always an intention to provide good care to clients referred to your service and in the past accepting packages on a daily basis was common practice. However, in a time where carers are leaving and recruiting is slow as well as services struggling with the level of administration required, the acceptance of packages is now becoming a much rarer event. Providers are having to have difficult conversations with their funders about not be able to take on new clients and sometimes about handing back clients/packages.
Some providers feel they have been put in a position where care is not optimal and potentially unsafe as they have neither the time nor the staff to provide the right level of care, which has led to the provider having to speak with the funder to say they need to hand back some care packages. These issues are only compounded by the fact that the NHS is under pressure and has fewer staff to manage the discharge and placement process. Hospital beds are at a premium but social care and Continuing Health Care referrals have been struggling to keep up with demand. People are being sent home from hospital with no care in place and the lists of required care held by some local authorities are longer than ever. Many local authorities are offering financial incentives for providers to take some of these packages and help to cover costs, but even with this in place the lists remain.
In this time of challenging conversations there is a lot of strain on our health and wellbeing. We need to ask what we are doing to help ourselves. Some of the practical advice given is as follows:
- Ensure you have good professional supervision – there are many types of supervision and it is recommended you seek different types. Management supervision should be carried out but for support there should also be peer-to-peer or non-management supervision undertaken by trained staff or an external source.
- Attend network/support meetings – this allows you to hear others’ experiences and realise you are not alone. If run well, it can be positive as the group will likely share hints and tips as well as problem solve together.
- Training in difficult conversations – there are plenty of online and face-to-face training sessions on carrying out difficult conversations which would be of value to a number of people in the workforce.
- Downtime – make sure you have time when you can focus on other areas of your life such as hobbies, meeting friends and spending time with family. It is important to get a good work-life balance.
- Self-care – in times of stress it is easy not to look after yourself. But it is more important than ever to ensure you are healthy (whatever that means to you). Try to eat well, relax regularly and take exercise when you can – perhaps try some meditation or a walk in nature.
- Remain calm – remember the other party could be stressed too, making difficult conversations harder. It may be better to reschedule the chat for another time if needed.
- Talk to someone when you need to – if you feel near burnout or you are not coping then it is important to talk to someone. Speak to your GP and perhaps arrange some counselling. Talk to someone you trust or contact the Samaritans on 116 123 or online at
Times are challenging within homecare and difficult conversations are likely to remain a regular occurrence for some time. However, there are some strategies we can take to help protect ourselves from burnout and stress. It is important we pay attention to these and support staff to do the same.
Lynn James is an Independent Healthcare Consultant, Trustee for Rusthall Care Home and Non-executive Director for Social Arts for Education. Email: email@example.com
What have been your most difficult conversations as a result of the pandemic? How have you overcome the difficulties and navigated to a solution? Share your experiences and feedback on this article in the comments below.
Joanna and Lynn will be presenting a complex care workshop at the Homecare Association conference on 16th March at Kia Oval in London.