Written by
Laura Kane, PhD student, Centre for Applied Psychological Science
PhD supervisors: Dr Judith Eberhardt, Dr Steph Kilinc, Professor Jonathon Ling
There is an estimated 55million people living with dementia globally (WHO, 2022). In the UK there is an estimated 885,000 people living with dementia, of which 400,000 receive homecare support enabling them to live in their own homes (Alzheimer’s Society, 2016). Additionally, in 2019, dementia cost 34.7 billion for the UK alone. This figure is set to triple by 2040, as is the rate of dementia (The London School of Economics, 2019). To reduce overall cost and increase person-centred practice, policy level changes were made to increase homecare service provisions for people living with dementia. However, the homecare sector experiences considerable challenges, which act as a barrier to person-centred practice, for all recipients, nevertheless, due to the symptoms of dementia, people living with this condition are affected more severely than any other population in receipt of homecare services (Coogle, 2007). The aim of my PhD is to address such challenges and facilitate person-centred practice, improving the health and wellbeing of both people living with dementia and homecare workers. The outcome of this will lead to both parties feeling more fulfilled and experiencing greater quality of life.
In theory homecare services are the most person-centred provision of care, however the reality of homecare is time and task orientated, thus people living with dementia and those providing care and support continually experience unmet needs (Alzheimer’s Society, 2016). The greatest challenge to person-centred care in homecare is staff turnover (Yeh et al., 2019). Staff turnover decreases quality of care and leads to people living with dementia experiencing unfamiliarity with their care workers, which reduces their wellbeing. Therefore, decreasing staff turnover is key to improving care experiences for people living with dementia.
I conducted a systematic review on the challenges homecare workers experience when caring for clients living with dementia, this review was conducted globally, however only seven papers were identified. Thus, evidencing this as a severely under researched area. Analysis of the seven papers showed how homecare workers do not receive adequate training and education on caring for a client living with dementia, the isolating nature of their role, the emotional labour experienced, and the impact of working with their clients’ families. This review evidences the unmet educational and psychosocial needs of homecare workers, and the changes required to improve working conditions and care experiences for both provider and recipient.
The challenges experienced by homecare workers were:
- Lack of dementia-specific person-centred training
- Social isolation
- Grief and bereavement following the death of a client
- Experiencing abuse and conflict from client’s families
These challenges led to homecare workers experiencing emotional distress, burnout, and an inability to provide person-centred care. Thus, clients living with dementia often did not have their needs met. Homecare agencies often intensified their staff’s feelings of distress and burnout due to the lack of organisational support offered. Homecare workers felt dementia-specific education, peer support and emotional support from their agencies would reduce their distress and increase their ability to care for their clients living with dementia.
It is essential to meet the needs of homecare workers to improve their working conditions and consequently reduce staff turnover and increase person-centred care provisions for clients living with dementia. Increasing the health and wellbeing of our ageing society and those who provide their care and support is essential. To ensure homecare workers needs are met and subsequently their clients’, a co-produced intervention will be conducted in the future. The voices of homecare workers and people living with dementia often go unheard, and their experiences overlooked, but now it’s time to listen and act.
References
Carter, D. (2016). Fix dementia care: Homecare. Alzheimer’s Society.
Coogle, C. L., Parham, I. A., Jablonski, R. and Rachel, J. A. (2007). Enhanced care assistant training to address the workforce crisis in home care: changes related to job satisfaction and career commitment. Care Management Journals, 8, 71–81.
World Health Organisation (WHO). Home/Newsroom/Fact sheets/Detail/Dementia. 2022. Retrieved from https://www.who.int/news-room/fact-sheets/detail/dementia
Wittenberg, R., Hu, B., Barraza-Araiza, L., & Rehill, A. (2019). Projections of older people with dementia and costs of dementia care in the United Kingdom, 2019–2040. London: London School of Economics.
Yeh, I., Samsi, K., Vandrevala, T., & Manthorpe, J. (2019). Constituents of effective support for homecare workers providing care to people with dementia at end of life. International Journal of Geriatric Psychiatry, 34(2), 352-359. https://doi.org/10.1002/gps.5027