Who is the client? – carers working with couples.

A carer’s account of why she left a client’s home within 48 hours triggered a memory. The same had happened to me ten years earlier when I left a client’s home after one week. Some years later I realised what happened and why. My observations and learning of the offering that eluded me at the time are shared here.

Sometimes, live-in carers are assigned to support a client who lives with a partner,wife or husband.  Care plans written by care agencies tend to be written with a singular focus on the one with the clinical ill-health condition, say Alzheimer’s Disease. The wife or partner is usually ignored as part of this plan.

This is the first pitfall. My first-hand experience of a situation like this, is that while one person is labelled ‘client’, if there are two people in a relationship in the home, both need attending to and care plans must also reflect this.

They rarely do.

When the carer described the consequences that led her to leave within 48 hours, I was alerted. It was clear, like in my own case, she had been briefed to attend to the needs of the man, and not his wife as well. The agency had not assessed how the wife was coping with her husband’s diagnosis. 

It takes a care agency with depth and insight to respond to the whole and not part of the whole that is just the one person.

All emphasis was on the man with Alzheimer’s, problems standing, frequently falling over and out of bed. There were real challenges in the role. There was also the woman he lived with, his wife. Less than 48 hours after being assigned to work in this home, the carer felt compelled to ask the care agency to replace her because in her words the wife was ‘difficult’ and abusive towards her.

Yes, the woman was angry, yes, she shouted and yes she was rude. But isn’t this only a version (or only part) of what plays out? 

A deeper reading suggests something more.

This woman was consumed emotionally and, as a result, likely exhausted. Not only was she angry, she was furious, in shock, grieving the loss of the man she still called her husband, who had lost all mental capacity and now barely knew who she was. She was in denial and unable to accept her husband as he was in the here and now. When a second woman (carer) enters ‘their’ or ‘her’ space and begins to attend to ‘her’ husband and seemingly ignores her, comparison, jealousy and rage is inevitable, especially if the man responds to the carer.  The wife’s perception of events leads her to rage internally and shriek at her husband, ‘How dare you?’ ‘I’m your wife’.  To the carer, she openly hurls criticism, blame and insults. The wife is in complete inner emotional turmoil. Her anger a cry for help.

It takes a carer with presence and maturity to respond to this situation with steadiness and love.

Something I did not have when I was first presented with this type of situation which I now see as an offering.

When a carer deals with abuse through reaction, neither carer nor client benefits. Rather, the offering becomes an opportunity missed: to relate to the hurt party, in this case, the wife and husband with Alzheimer’s.

To be in true service calls the carer to put themselves aside and not personalise, otherwise they cannot be of service to either person.  Practically, this means having no judgement, regardless of how the injured or hurt party expresses. What is called for is an inner steadiness as well as stating clearly that they will not accept verbal abuse, (the behaviour), which is different from not accepting the person who is wielding the abuse.

When I walked out of a placement after a short period, I now understand that I had my own unresolved hurts, insecurities and feelings of rejection. The experience revealed I had expectations of what the placement and client had to offer me.  For a carer to expect to be liked by a client and entitled to an easy assignment inevitably leads to disappointment and resentment.  In care work, as in life there are no such guarantees.  Our responsibility is to walk in and meet clients without expectation, entitlement, knowledge and judgement.

Our role is then to simply observe and respond to whatever is presented.

And what of the role of the care agencies?

It takes a care agency with depth and maturity to respond and not react.

Typically, when these occurrences are reported, everyone reacts, the husband or wife, carer and agency.  The care agency reacts if it immediately replaces the carer without any true conversation about what happened, followed by reflection and response.  When an agency reacts, the affected carer leaves the home convinced the client’s wife was ‘difficult’ and the one in the wrong. They may even believe that they have failed in some way. If there is no reflection on their part, on the situation, without any blaming, there is no learning and again everyone loses.

The incoming carer (called to replace the one leaving) also loses out, if they are not briefed on the true nature of the job – that there are two clients not one and both must be equally attended to. Without this, complication is created where none need exist.  This does not mean a carer may not experience challenge or difficulty.

It takes a care industry that truly values carers to prepare and develop them to fully support themselves so they can be truly responsive to those they work with.

Simplicity is the offering, to observe and respond to things as they are, not as we would like them to be.

In my case the carer that replaced me, inadequately briefed as I was, left within a week. An opportunity to heal, deepen and build relationships was missed by clients, partners, carers and agency managers.

Care worker training is rudimentary and sits within a rigid mandatory and regulatory framework. Its primary focus, functional and practical, excludes foundational and true learning opportunities based on the qualities of observation, self-awareness, non-emotionality, non-judgement, responsiveness, true client-carer relationships (inclusive of family) and reflective practice.  Care work, in essence, attends to and builds relationships with clients and their families. It is not ‘just a job’ nor an unskilled job; relationships are not built overnight.