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23 May 2018

More support needed to protect home carers from emotional pressures of providing support to people with dementia

Care workers who provide personal and domestic care to older people with dementia in their own homes are at risk of feeling under emotional strain and some don't get as much support as they need, according to a new study.

Older and younger person doing a puzzle
Older and younger person doing a puzzle

Researchers from King's College London and Kingston University explored some of the pressures facing homecare workers in London and the South East of England. They found that, while managers and home care workers had clear ideas of what their professional boundaries should be, home carers sometimes found themselves crossing that line, or being asked to take on tasks beyond their job role.

Led by Professor Jill Manthorpe, Director of the Social Care Workforce Research Unit at King's, the team found that the combined impact of supporting older people with complex needs, such as those arising from dementia or those requiring end-of-life care, alongside working in someone's own home, where typical workplace conventions may not exist, add to such pressures the researchers found.

More than half a million people receive care in their own homes in England, according to the health and social care regulator, the Care Quality Commission (CQC). Most of them are aged over 65 and have care needs arising from long-term health conditions, including dementia.

This new research interviewed 30 homecare workers and 13 managers and found that some homecare workers find it difficult to refuse requests to carry out extra tasks from their client's families, particularly if there is strong emotional attachment. Homecare workers juggle a desire to be compassionate and helpful, with maintaining professional boundaries.

"Dementia Action Week provides a great opportunity to support home care workers who are the backbone of support for many people with dementia and their family members," said Professor Manthorpe.

"It is sometimes a hard and lonely job - so Dementia Friendly Communities and other groups have a key role in helping such staff feel valued. Our research contributes to the growing evidence that home care workers need support themselves, especially when the going gets tough."

Dr Tushna Vandrevala, part of the research team and health psychologist and senior lecturer at Kingston University's School of Social and Behavioural Sciences, said that home care workers sometimes seem to over-invest emotionally and find it hard to set boundaries.

"Many are torn between their professional role and wanting to go beyond that to help the person they have grown attached to. They are often supporting clients' families and their emotions, and this can be very difficult – sometimes placing considerable emotional and mental strain on themselves," she said.

The home care workforce in the United Kingdom largely now works for independent or commercial agencies, Dr Vandrevala said. "This means that support and guidance sometimes vary and much may depend on the support of an individual manager." 

The research recommends more discussion with home care workers and their managers about what can be done to support staff. The need for this support might be growing as more people with dementia want to stay at home. "Looking after people with dementia can be rewarding but unpredictable and often require home care workers to be flexible, prepared for change and able to put in place creative solutions," Dr Vandrevala added.

In addition to the emotional pressures home care workers might face on a daily basis, a small number of those who had looked after people with dementia revealed that they sometimes felt vulnerable working in people's own homes. While acknowledging policies are not able to reduce feelings of vulnerability completely, the researchers found some care workers thought that more employer support could help reduce these risks.

Kingston University research assistant on the study, Dr Ruth Abrams, said managers and staff need to discuss what is acceptable and achievable in their roles, and this information could be shared across the sector. "Professional boundaries are important and managers have a duty of care to protect their staff. Some are already making sure that their workers are well supported and that responsibilities are clear to all."


Read the published report in Ageing and Society