We work in domiciliary care, supporting people in various ways in their own homes. The relationship between paid homecare workers and the people we support is often complex.
The intrinsically ‘social’ part of social care means we are encouraged to form genuine relationships with the people we visit. Companionship and emotional support are, therefore, a central component of our responsibilities. We get to know people’s likes and dislikes, and often assist with the most intimate of daily routines. This must all be done while maintaining strict professional and personal boundaries. Unsurprisingly, the lines sometimes become blurred.
Professional boundaries are the official rules and limits in place between a paid care worker and the person they support, as set by legal, ethical, and organisational frameworks. For example, we should not accept gifts from clients, overshare personal details about ourselves or exchange personal phone numbers.
Yet due to the social nature of our roles, it may feel natural for the people we support to want to treat us as a friend or extension to their family, which could mean offering gifts on occasions like our birthdays, or when we visit them on Christmas Day. To maintain strict professional boundaries in these circumstances can be awkward to say the least and, depending on the individual, cause real offence.
Continuity of care is hugely important to the wellbeing of the people we support. I (Hannah) remember an individual being upset because in one week she had seen ten different caregivers: some familiar, some not. Imagine ten people coming into your home at different times, seeing you at your most vulnerable? This can be very anxiety-inducing. Aside from a general sense of unease, there is also the frustration of having to explain specific preferences, routines, the places that things are kept and so on, to each new caregiver. Two people may get into a good routine and then all of a sudden somebody new takes the caregiver’s place and the process must begin again from scratch. Good continuity of care also allows us to pick up on small but sometimes important changes that an unfamiliar face is unlikely to notice. Whether that’s a change in behaviour, eating habits or general wellbeing. Our employers benefit from ensuring good continuity of care because it allows them to develop consistent runs, keeping both employees and clients happy.
With clear benefits to all involved, you would expect continuity of care to be a fine-tuned art. So how come so many people live with a ‘revolving door’ of different faces turning up at their home?
To an extent, change and unpredictability are inevitable features of adult social care, particularly in a domiciliary context, whereby the people we support often vary due to hospitalisation, relocation to care homes and lives coming to an end. This leads to regular rota changes, which can cause frequent disruption to an individual’s care package.
Of greater significance is the fact that employment in domiciliary care generally offers little to buffer these unpredictabilities. The most common scenario in which a paid care worker provides support to someone in their own home is when they are employed by a homecare agency, of which there were over 13,000 in England alone at Skills For Care’s last count. The individual in need of support buys the services of the agency. Homecare workers are often paid for contact time only, their pay relying on a patchwork of visits rather than consistent shifts. When the inevitable happens and a client goes into hospital or passes away, this is experienced by workers as an immediate loss of income until a new client can be found to fill the gaps. This unpredictability of income is why many homecare workers move to roles in residential care settings like care homes or nursing homes, where they will be paid for a full shift regardless of whether some of the beds are empty.
Most but not all homecare employers set their hourly rate of pay at least a couple of pounds higher than the National Minimum Wage in an effort to ensure workers are paid at least this amount once unpaid gaps between visits are taken into account (legally payable up to 60 minutes). Yet Homecare Voices’ true hourly pay calculator finds evidence of widespread underpayment of the National Minimum Wage in homecare as a result of these unpaid gaps. This is a known issue throughout the sector. Due to these realities of pay and working conditions in homecare, many of us do not stay in the role for long, with resounding implications for continuity of care.
For paid care workers, there is a drawback to forming strong relationships with the people we support. Doing so can put pressure on us to put up with poor pay and working conditions imposed on us by an employer, since we do not wish to let down the people we support. Unfortunately, a ‘labour of love, not money’ culture alongside a pressure to always be prepared to ‘take one for the team’ can be taken advantage of by those managing homecare agencies.
On the earlier point of professional boundaries, from a practical point of view, it can be difficult to maintain these since we are generally expected to use our personal phones for work purposes. Employers will often ask us to contact clients using these, for example, to let them know if we’re running late. Sometimes employers specifically request that we keep a line of communication open with certain clients or their family members, using our personal phones to do so. Since the majority of us are employed via zero-hours contracts or restrictive Certificates of Sponsorship, there is pressure to do as instructed by our employer in such scenarios.
Our priority as homecare workers is to ensure people can lead the life they wish to with our well-placed support. We will continue to establish good relationships where possible, doing our utmost to remain on the right side of that professional boundary and accepting that change is an inevitable part of the work we do.
Homecare Voices is a free-to-join, not-for-profit peer support network run by and for domiciliary care workers throughout the UK. Established in 2023, over 500 homecare workers are now part of this growing community, which aims not only to ensure access to high-quality, peer-led support for lone workers in high-responsibility roles but also to bring the voices of more homecare workers to national conversations about the future of adult social care.
Rachel Kelso is a domiciliary care worker and the founder of Homecare Voices: a free-to-join, not-for-profit peer support network and advocacy body run by and for domiciliary care workers in the UK. With daily talking points and fortnightly online meetups, Homecare Voices is a trusted community of best practice for lone workers in notoriously precarious roles. By connecting people with opportunities to participate in research and attend external events, Homecare Voices provides a channel through which the insights of those at the helm of the adult social care system may be heard.
Hannah Reseigh-Lincoln is a Senior Care Giver who works full-time in the community, travelling to people’s homes to provide care. She has been in the caregiving profession for nearly three years following a significant career change. Hannah is a volunteer member of the Care Workers Charity Advisory Board and the Champions Project, as well as a member of the Homecare Voices community, founded by Rachel.
Image credit: Alex Boyd via Unsplash