Four years ago, I heard there was a vacancy for a carer at a local residential care home for the elderly. I had no idea what the job entailed because I’d never before set foot in such a place. Initially, I didn’t imagine I’d be a suitable candidate. For the past few years, I’d worked from home as a blog editor and at a primary school as a supervisor. Before that I’d worked as an editor for a breastfeeding charity while having three children and before that I’d qualified as a solicitor and worked in legal publishing. Already in my fifties, I still didn’t know how I really wanted to earn my living. At this point in my life, I felt in need of a change and some interview practice. Straven House is a short walk away from where I live, so I headed up the hill to take a look.
A career change
Impulsively, I accepted the job offer at the interview, thinking I’d just ‘give it a go’ for a couple of weeks. I pictured myself reading the newspaper to old ladies while drinking endless cups of tea. I quickly discovered that ‘personal cares’ was something of a euphemism and rather more personal than I had guessed. And, oh my goodness, 12-hour shifts were really a thing! To begin, I had absolutely no idea what I was expected to do. I was a fish out of water. I didn’t know how to operate a wheelchair let alone a hoist and I’d never even heard of a catheter. For weeks, I must have been a dead weight as my co-workers had to explain every little thing to me. I felt I was in the way, interrupting the flow of this efficient team-machine.
In the first few months, I felt physically and emotionally drained but also very moved and inspired by the warmth and kindness I witnessed in the work of the home. I experienced the power there is in a gentle squeeze of the hand and a big smile. When one resident told me I was a real comfort to her, I knew that this was a job that mattered, both to her and to me. I was helping her to cope, to feel good rather than just helping her to exist in a failing body. While I might have to keep practising to become proficient, I began to want to. That feeling steeled me to master the nitty gritty. Patience is a quality that I do have and one that is vital in a caregiver.
Keeping pace with the structured routine of each day began to make sense. The routine provides a social framework that is frequently missing for the elderly, especially if they live alone. Being able to anticipate what’s coming next helps alleviate anxiety, particularly for those suffering from dementia and it ensures that everyone in the home community receives the care and attention they require in a timely and fair manner.
What had initially resembled military manoeuvres when moving everyone to the dining room, I now saw as opportunities to encourage mobility in sometimes stationary residents. Wheelchair transfers offer moments for contact and conversation. These brief and frequent interactions convey a great deal of reassurance to people who have lost the power to walk unaided. There is a skill in moving and handling human cargo that goes way beyond the physical safety aspect of the process. Maintaining a person’s dignity when they have lost the ability to take care of their own body or even communicate their needs requires both sensitivity and quick wittedness as well as basic manual dexterity.
Person centred care
Getting to really know the residents is important as no two people on this earth are the same. How best to help different people achieve the same ends can vary. For instance, someone who has lost the ability to use a knife and fork may be happy to have you cut up their food, or guide them hand over hand, or even be happy to be spoon-fed, while another person may resent any help and prefer to pick up food with their hands or to eat extremely slowly so long as they are able to do it unaided. You can still help by being observant, perhaps handing them a fork or spoon or cutting up their food before presenting it. A plate guard might stop food from tipping on to the table. Just turning a plate around halfway through the meal can enable someone to eat more, as then it’s easier to reach the remaining food, or to see the food or to process the parts of the picture they do see.
The loss of physical ability in old age is often accompanied by cognitive decline, which can range from simple forgetfulness to the inability to hold a thought to the end of a sentence. Someone with dementia may not be able to tell you whether they want tea or coffee because they have already forgotten your question the same moment you asked which drink they would like. Remembering individuals’ preferences helps, as may the use of visual cues when offering choices. Once you have learnt that someone takes sugar and only ever drinks tea and not coffee, you now know that, even when they are no longer able to communicate that to you.
As well as what people like to eat and drink and how much, you learn countless specifics that help you take care of the everyday stuff, such as how many layers of clothing a person likes to wear and in which order they like to put them on. Whether they wear a necklace, glasses, dentures, a watch, scarf, or hearing aid. You learn to anticipate when they might need to go to the lavatory and how they will get there, what time they like to go to bed and rise in the morning.
The sense of self
Besides the many hundreds of practical details you acquire about each resident, you need to learn what makes them tick: The activities they enjoy and what they like to talk about. The things that make them anxious or sad and what calms them down or brightens their mood. Do they like to sit quietly or have company? Do they like to read and/or listen to music? There is no substitute for building up a genuine understanding of each individual. Everyone has a story, a history that has made them who they are. Holding on to a sense of identity is crucial, regardless of how incapacitated someone becomes in their old age.
When someone asks where their long-gone spouse is, reminding them that the person is dead is both unkind and unnecessary. Some people may relish an opportunity to talk about their loved one. One lady liked to tell the story of how she met her husband when travelling and even though she had shared that story many times, asking her yet again, ‘How did you meet your husband?’ always allowed her to revisit this happy memory that never faded and always alleviated her anxiety. Another person may be happier to be distracted away from thoughts of someone whom they have lost. Sometimes it may be one or the other approach that is more helpful. You need to be sensitive to the moment every time.
It’s not uncommon for elderly people to have forgotten who the people in their photographs are but looking at them together and showing an interest is often pleasurable. You don’t need to know their significance to be able to engage. ‘What a happy occasion!’ ‘What a beautiful dress!’ can suffice to start a conversation or to produce a smile. ‘The man in the hat looks very full of fun’ might coax out a memory about a favourite uncle. If there are no photos, then other memorabilia can evoke happy times from days gone by.
Sometimes when an elderly person wants to find a loved one who has passed away or wants to ‘go home’, what they are really looking for is the warmth and security that those once represented. Your task is to find ways to bring a sense of calm and wellbeing. This can be challenging, particularly when you are very busy and feel you are being pulled in all directions. Quite literally you have to care enough to care. You have to be able to put yourself in someone else’s shoes, to empathise with how they are feeling. You can learn from individual carers what things are most helpful in specific situations but there is no rule book and no substitute for sincerity. Continued education and training in caregiving are very useful but there is no system of awards for emotional intelligence. The carers I have met who stay in care tend to have this quality by the bucketful. While demonstrating it, they have taught me the value of teamwork and the joy of community.
When you have tried to make someone feel safe, clean, and comfortable, when you have offered a listening ear, held a hand, or even sang a song to someone, you go home feeling that you are making a positive contribution. Sometimes that feels frustratingly small. I’m just one person who can only do so much and many times that feels inadequate. It is tiring. Some days, I have clocked up 15,000 steps on a shift and on my rest days, I can feel too exhausted to do anything. At the start, I wondered whether I would be wasting my education in a care job, poorly paid and regarded by many as a low skilled worker. I discovered that education is never wasted and I now ask myself, how many jobs could begin to give me such a strong sense of self-worth as this one? Of course, this is hard work but isn’t taking care of one another actually what makes us human?