The Forgotten Frontline: homecare during the pandemic

The Forgotten Frontline

As I sit here writing this I am looking out of my window and seeing two workers who have become a familiar sight as I work from home in the last few weeks. They are homecare staff coming to do their early morning shift in the sheltered housing complex beside which I live. They are there like clockwork morning, noon and late evening. They drive in two separate cars, get out, put their PPE on and enter the building. Their laughter and humour punctures the silence of the street. Their humanity is obvious, their care compassion needing no badge.

According to the latest data there are 71,000 women and men who work in Scotland’s care at home and housing support sectors. They work for local authority, charitable, voluntary and private providers.

In some senses during this pandemic they have been the forgotten frontline. The devastating impact of the virus on residential and nursing homes and the acute loss of life has rightly gained public and media attention and focus. But we should not forget as I think we have been prone to do, the impact of this virus on the lives of those who are supported in their own homes.

Perhaps one of the reasons for this forgetfulness is the reality that many individuals do not actually know what happens in homecare. Yet more people are supported in their own home every day of the year than in our NHS hospitals and care homes combined. Homecare services are a lifeline to thousands of our neighbours.

So why is homecare important? Why is it that thousands of women and men are putting their lives on the line, leaving their families, donning their PPE to go into the homes of others to deliver care and support?

This pandemic has shone a light on the extent to which, so few people understand what homecare is. For too many there is still an outdated image of homecare as ‘mopping and shopping,’ as a set of practical activities designed to make people feel better but not much more than that. As almost like an added luxury!  The truth could not be further than that.

Too often there is a convenient and wrong conflation of social care with health care. So at Scottish Care we have stated that social care should be seen as :

‘The enabling of those who require support or care to achieve their full citizenship as independent and autonomous individuals. It involves the fostering of contribution, the achievement of potential, the nurturing of belonging to enable the individual person to flourish.’

Homecare is that care and support which enables and empowers an individual to be free, autonomous and independent in their own home. It is the energy which gives purpose to someone wanting to remain in their own space and place, it is the structure of support and care which enables citizens to remain connected to their families and friends, their neighbours, streets and villages. It is not an added extra but the essential care that enables life to be lived to its fullest.

The best of homecare is a care that changes life and gives life.

Some of my blog readers may know that I am a bit of a Bruce Springsteen obsessive. In an interview which he gave around the time he launched his autobiography in 2016, Springsteen said that:

‘You can change a life in three minutes with the right song.’

At the time the sense of words and music changing and transforming a life struck me as being a powerful description of the musicality of one of the greats of his genre. But I also think that it is a description of the essential life changing and enabling power which lies at the heart of all care. It is this ability to change a life through care and support which has become so evident in this pandemic.

The women and men who work in homecare are life-changers. The reason that statement is true is that by their acts of personal care, by supporting someone to take their medicines, to get up in the morning; by making sure their space and place is tidy and safe, that hazards are controlled or removed; in ordinary times by taking someone to a club or to their family, to an activity or simply to belong somewhere, these women and men who are the workers of care are the gifters of purpose and meaning to so many. This is not incidental it is essential. It is this work that binds a community together, that truly creates neighbourhood, and moulds togetherness in the midst of our cities, towns and villages.

Most of us are able to be independent – to get around on our own, to have control so that we need not be dependent upon another. As life changes through age or illness the loss of that independence and the forming of bonds which make us reliant upon another can be both challenging and difficult for our sense of identity and self-worth. It is in this territory that the marvellous work of support and care locates itself and comes to the fore.

Good care is not about taking over another person’s autonomy, good support is not about creating dependency – they are both the total reverse. They are the actions and deeds, the words and encouragement that enable others to either re-discover or find for the first time, the abilities to make decisions, to exercise choice, to be in control and to be independent even if support is needed to achieve that goal.

This is why homecare is important –  this is why during this pandemic we cannot forget this frontline force of life and change.

Yet homecare has always existed on the knife-edge of economic sustainability. Delivering care and support is a costly exercise and for too long as a society we have sought to buy care on the cheap. Before the pandemic you could earn more money for walking a dog in Edinburgh than you could for caring for a fellow human being in their own home. During this pandemic faced with extortionate cost rises in PPE equipment homecare organisations would never ordinarily use, there is a real danger many of our small Scottish organisations may go out of business. As families have been on lockdown hundreds of care packages have been cancelled because folks are home looking after brother, sister, mum or dad. Some local authorities have cancelled contracts prioritising what they have termed as critical support. This has had a profound impact on care organisations.

We urgently need to ‘wrap our arms of care’ around those who care in our streets and the homes of our neighbours, the providers and workforce alike.

The autonomy that homecare gives a supported person enables them to flourish to their best and continue to grow into the person they want to be.

I hope we will all of us grow in valuing and recognising the work and the workers who I see every morning. If a good song can change a life in three minutes then good care and support changes a future forever. Yet if we forget this frontline during the pandemic the song will be silent and lives will not be lived to their full potential.