A Nursing Home In Lockdown

Dec 20

During lockdown 1.0, I abruptly moved home from medical school and started working part-time as a junior carer at a local nursing home, not quite realising how much I would learn and the impact that this experience would have on me.

On the 72nd birthday of the NHS (5 July 2020), Sir Simon Stevens (Head of NHS England) starkly said “We do not have a fair and properly resourced adult social care system…[Covid-19] has shone a very harsh spotlight on the resilience and support in social care.” (BBC News, 2020). Stevens’ words struck me. Yes, working as a carer is not pretty; it’s hard work and requires mental resilience (trust me, in those first few shifts I really didn’t think I was going to last long!), but the real hardship is the underfunded, undervalued and, quite frankly, crumbling social care system that exists in the UK.

I was working in a relatively small nursing home that doesn’t ‘break the bank’ in comparison to some of the other options in my area. At capacity it’s home to 28 residents, with those downstairs mobile and rather independent, whilst upstairs the majority of residents are sadly bed-bound. Like many, this nursing home is not independent but finds itself under the umbrella of a small care group. Day to day home management was friendly and enjoyable, with a manager and clinical lead who really did care for the elderly. However, as with any business, getting through to the top appeared, from my perspective, quite the challenge at times. The home manager could only do so much before their hands became tied.

Privatisation of social care does have its benefits, but the systems’ treatment of staff and holding-out-till-the-last-minute-to-buy-a-new-washing-machine attitude (and laundry is pretty essential in a nursing home..!) didn’t sit particularly well with me. It is probably a step too far to think of it as ‘making a profit’, but when morale was low on a stressful day, I did sometimes wonder if ‘cost-benefit’ was the underpinning rationale.

It is important to note that my experience was in the height of a pandemic, and I want to make clear that this is not an attack on all care providers, but, as Stevens highlighted, these are not new problems. While the privatised care system provides care homes and care groups with greater financial liberty, it also brings serious dangers with the threat of poor management if not held to account. Where I was working the pay was low, there was no food provided for staff on a 12-hour shift and no extra holiday pay. No wonder the social care field is notorious for having such high staff turnover.

Stories from colleagues and photos around the home suggested that it was usually a bustling and rowdy place, especially on the weekends. During the pandemic this could not have been further from the truth. Weekends proved especially tough for residents with fewer staff present and only a small number of activities to participate in. As has been widely covered in the press, care homes have been at the epicentre of the pandemic and it is essential that measures aren’t relaxed too quickly given the vulnerable group that they provide a home for. However, explaining this to an 85-year-old with advanced dementia wasn’t easy.

Towards the end of my 3 months there the team had stabilised (agency staff were instructed to stay at the same home during lockdown, which helped with rapport whilst also minimising risk), and having ‘learnt the ropes’ I grew to appreciate the job that I was doing and the impact that I could have on a resident from what, for me, was a very small act. I cannot praise my colleagues enough for their hard work and perseverance through these tough times, especially on a personal level when I had no idea what I was supposed to be doing! For me, this was a part-time job to keep me busy and get some experience of elderly care whilst I had, albeit abruptly, moved back to my family home during lockdown.

Having just finished my third year of medicine, I have been in hospitals and healthcare environments enough for wandering the identical-looking wards looking very lost being second nature now. However, this experience of working in social care has taught me more than anything I have seen as a medical student. Social care is not medicine. Good social care without medical help is counterproductive, but good medical care without social care is disastrous. The lack of integration between the two sectors is all too prevalent.

Reflecting on my short time at the nursing home I am left with many emotions. I’m proud of myself for sticking at it when I felt I was thrown into the deep end with minimal training, but then think of all those that do this day in day out with little appreciation. I am sad as I think about who might not be there anymore when I pop in at Christmas to say ‘Hello’. I am scared that an outbreak of COVID-19, that we were so lucky not to have in the home, will occur, and I am angry at the struggle we faced to get proper PPE and guidance.

More than most I am saddened by the hierarchy that appears to be very much still established within the health and social care fields. Team ‘banter’ frequently included me being called “Doctor” by my colleagues. Yes, I worked hard, but this was a job for me as much as it was for anyone else. So what if I will, eventually, become a doctor? I know it was all meant out of goodwill and sincerity, but I couldn’t help but feel slightly uncomfortable. As healthcare professionals we will only work well if we work as a team, helping each other out where we can and appreciating every single person’s role.

I hope that my experience of being a carer will help me in my career as a doctor. But more than anything, I hope that our vocations can work together to provide excellent care and wellbeing for all; that is patients, residents and staff.