Representing home care as ‘low-skill’ relies on an artificially impoverished notion of ‘good care’

Harri Kaloudis
Jul 22, 2017 · 2 min read

It is only possible to describe domiciliary care as ‘low-skill’ and ‘low-knowledge’ if you exclude from it key attributes of good care such as a) recognising changes in a person’s physical, mental and emotional state; b) identifying and being familiar with the range of resources that may address a person’s changing needs; c) communicating a person’s changing needs to relevant specialists in a clear and appropriate language; d) identifying the side effects of medication; e) supporting people to manage medication and its effects on their bodies; f) being able to interact competently with clinical specialists, follow their advice, ask them pertinent questions, provide them with a person’s medical and personal history; g) have the confidence to challenge clinicians and specialists when there is evidence that their prescriptions and recommendations are unhelpful; h) act as a link between a healthcare specialist in a specialist setting such as a hospital ward and a person’s family; I) being able to form a working relationship between the client and their family that is based on trust and openness; j) identify opportunities to increase a person’s welfare; k) problem-solve with the person; l) show sensitivity to the emotional aspect of dealing with convalescence, the loss of functions, the loss of social status, the emotional side of receiving care; m) prevent problems before they arise; n) help a person navigate the complexities of the care system; o) advice and coach a person to health; transfer skills of self-care and confidence to them; p) and the list could go on. The point of this is to show how restrictive are the operational definitions of home care around which much wider issues of commissioning, insurance, and public policy are based. Home care workers are often assumed not to have any role to play in any of the above.

The neo-Taylorist conception of ‘task-and-time’ care is also supported by a particular conception of the ‘cared-for’ person who is assumed a) to fully know their own care needs. These are assumed to be transparent to the person; b) to know the resources and ways their care needs could be met or to be able to search appropriate sources for this information; c) to be able to exercise choice between them and to form preferences around them; d) to be able to clearly and assertively communicate these preferences and choices; e) to be able to ‘exit’ from service provision they find unsatisfactory; f) to enter into new negotiated arrangements of care provision; g) to exercise ‘voice’. and, comment, complain about or compliment the service they are receiving; h) to challenge poor practices or bad ‘customer service’; I) to self-direct their care. Even if the person is not physically, emotionally or mentally able to meet these requirements, it is assumed that other actors in the person’s social network such as family and friends will. In any case, these are not considerations that are presumed to fall within the responsibility of the social care provision system and certainly not of home care.

Harri Kaloudis

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"Together we may find some of what we're looking for - laughter, beauty, love, and the chance to create" Saul Alinsky - Rules for Radicals

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