By Janice Turner in THE TIMES, 22 February 2020
The carers at my mother’s nursing home did a course on dying this week. They learnt not just how to nurse a fading old person, about pain relief and legal protocols, but delicate matters I’d never considered: if a family is fractured, siblings not speaking, how do you choreograph visits, who do you give bad news to first?
I say “learnt” but the Pams, Sharons and Lynnes who attend my mum already have PhDs in death. They know, as their residents know, it’s the last stop on the line. To make the journey comfortable, let alone convince passengers to forget their destination, is a remarkable feat of patience, emotional vigilance, of repeating yourself ever louder, getting calories inside someone who won’t eat, retaining an old man’s dignity while you give him a bath.
If my mum slips down in the bed I can’t pull her back up without hurting her. I call the carers and they come, one each side. They fluff pillows then disappear into a darkened room where another old lady is motionless, her family gathering. Among all the tears and shit and fear, while looking mortality square on, they dispense jokes and tea.
It is absurd that the government categorises me, sitting on my backside writing this, as “skilled” and the (mainly) women who will gently guide my mother — most of our mothers — towards her maker as “unskilled”. This is not, as some have said, an administrative glitch in the new immigration rules which conflates low-paid with low-skilled. The truth is that if we regarded caring as skilful we wouldn’t pay less for it than working a till at Aldi.
Forget that the care industry demands training in nutrition, physical handling of patients, safeguarding, continence and, with disabled adults, managing complex apparatus like tracheostomy and gastrostomy tubes or ventilators, duties which when performed in hospitals are deemed high-skill tasks. The truth is that caring is seen as low-grade because it is work women used to do for free: a natural expression of our feminine empathy and selflessness. Indeed I’m asked, inevitably by men, why I don’t abandon my career to nurse my mum (as if I would have a clue).
The government says that, perversely, it is Labour upholding the globalised free market using a limitless pool of cheap labour to suppress wages, while the Conservatives are simply allowing the market to “level up”. After Brexit, agencies will be compelled to pay more for British carers. Isn’t that a good thing? Well perhaps, if there weren’t already 122,000 vacancies in a sector with a huge staff churn.
Who wouldn’t like British care workers to be better paid? Perhaps more importantly it is reassuring for our parents, in their confusion and dotage, to be surrounded by people who share their background, accent, references and sense of humour, which for my mum means northern ladies who know how to toast a tea-cake. Women like her daughter, only nicer. That is not to diminish the dedication of the Magdas and Kajas who’ve cared for her too. But the notion that care should be outsourced to citizens of poorer economies because we hold it in low esteem does not seem a progressive plan.
Besides, care homes will find it hard to pass on extra wage costs to customers. They might squeeze a bit more out of richer residents with pensions and assets. But these “self payers” are already subsidising residents without capital, for whom local authorities foot their bills. With their budgets cut, councils pay homes what amounts to staff costs far below the minimum wage. For homes to offer better salaries the government must drastically increase council funding for social care. Otherwise chains of nursing homes will tumble, with responsibility for frail elderly landing once more on the NHS — or us.
No wonder it is seen as a downbeat job when care homes are never in the news except for an abuse scandal. Doctors and nurses receive public thanks and kudos for treating cancer patients or performing breakthrough operations. But care’s unglamorous quotidian business remains invisible. Except to those who have seen what carers do and, since we are living longer, that ultimately will be most of us. So, as with Teach First or the “We Are the NHS, We Are Nurses” recruitment campaigns, the government should raise its profile.
Tell human stories about the young man who quells an aggressive dementia patient by dancing her round the room; the home help who although ill and overworked still visits my mum unpaid; the many who cradle and console, break bad news, know when to withdraw and when to administer a hug; those who hold our parents’ hands at the last because we didn’t get there in time. The very opposite of unskilled.