Professional carers vs Family carers

Professional carers vs Family carers

 

I have seen situations when people are cared for by both family carers or separately by professional carers or what is more common is a combination.  And issues arise around which is better, because there is a belief that because professional carers have training that they must be better.  In some cases that it true and for some skill requirements that is true, however skills can be learnt and the key issue that family carers have is that they can be more persistent and love more.

 

Professional carers are often trained to deal with both challenging issues and medical needs.  They often don’t work through the night (although sometimes they do) and they get breaks, holiday and a private life, so they can be revitalised by their time off.  Professional carers can refuse to work with some individuals or change jobs.  They have skills and patience because they are refreshed to deal with their clients.  Due to the training they are given, they also have the skills to deal with the unplanned when things change and go wrong.  Family carers can sometimes feel intimidated by the training and skill and feel that what they do is inferior.  What they do is different.

 

Family carers don’t choose that they loved one is unwell, so end up in a job that they did not apply for.  They do their best and often work as well as care, so although they can become very tired, they still don’t give up and continue to care.  If family carers are faced with a particular medical task, they can be trained to carry out that task, some of which are more complicated than others.  Changing a pad doesn’t take lots of detailed training, emptying a catheter bag takes more knowledge and titrating insulin to be injected takes even more skill.  These are all things that I have known family carers take on to care for their loved one.

 

Family carers are also not “on the clock”, so there is no clocking off time or day, they work as long as they are able or as long as is needed.  The key thing that they provide is the love of a family member and I have heard family members talk about the time they spend with their loved one making sure that they feel loved.  Professional carers care, they often get very attached to the people that they care for and miss them when they are gone, but it isn’t the same.

 

How professionals and family members view certain events, if they happen can be very different.  If a person deteriorates and has an acute episode and goes to hospital or if they deteriorate to the extent that they need to go into full time care, professional carers view this as a normal part of the deteriorating health journey.  Family members see it as failure and often as their own failure, their failure to look after their loved ones well enough.  Life is not without its adversities, and that includes illness, so how healthcare professionals view acute episodes is likely to be the realistic way to view it.  And when someone has a deteriorating condition, they can cope for a while at home with support, but when they need more support and/or more skilled support than that which can be provided at home, then the right decision is professional 24hr support.  It is better for everyone, as the carer is not so worn out and the person in care gets more and/or better care.  The family can still visit.  This is not a moment of failure, but a moment of making a guilt ridden choice.

 

So the best combination of care package is both, the skills, training and workplace resilience of professional carers along with the love and persistence of family carers.  Neither should feel inferior to the other, they each have their abilities and benefits to offer to the situation.

Issues that arise in assessment meetings

Issues that arise in assessment meetings

 

I recently attended an assessment for NHS Continuing Care Funding, the person being assessed was an elderly person who had severe dementia and other healthcare issues.  They had been for a long time in a residential home and had deteriorated over the time that they were there.

 

NHS Continuing Care assessments look at all the needs of the person and the nurse assessors can offer advice, support and suggestions for how the person should be cared for and often do.  They will suggest that previous assessment done by some of the specialisms within the NHS are updated, if there is a health issue that is no longer such an issue, yet the medication for it persists, for example.  Often when people are first diagnosed with dementia and they already have other healthcare issues, it is often the other issues that have the bigger impact on them.  So when someone has minor memory problems, but major mobility issues and keeps falling over, them falling is more important than forgetting that they have already bought milk.  As time goes on, this balance of what issues are key will change, as their disease progression changes, so an updated assessment by an expert for a particular need is of value.

 

However at this recent assessment, there was a focus on the placement, as the district nurse was coming to the home to support the carers and asked them how they were managing and had concerns about the carers response.  This issue then raised concerns and the NHS Continuing Care assessment shifted priority from looking at the persons needs in relation to that assessment to advising the family that the person needed to be moved to a nursing home.  The family were resistant, as they wanted their loved one to stay in the familiar home, surrounded by carers who knew them well and where they were stimulated by the activities.

 

Since the messages were being mediated through me and I held my position that it was the decision of the Health and Welfare Attorney and not the NHS or Social Services decision, but that the attorney should listen to the opinions of what is being said and why before they make a final decision.  Having full information is the best basis for making a good decision!  Still the persistence of the need to move was suggested, even after it was first rejected, so to resolve the issue of the various parties not discussing the situation together at the same time, I asked for a discussion meeting to be convened.  The issues were raised, resolved and the insistence on moving to a different home was ceased, which was creating stressful pressure on the family members.

 

The focus then went back to whether they were eligible for NHS Continuing Care Funding and how this person’s needs could be met and if there was any further support or advice on optimising the persons quality of life.  In the end it was a good result, but was tricky for a while and needed good advocacy to get the result and to relieve some of the pressure that was felt by the family.