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As featured in Issue 27 of The Carer.

​It’s hard to fathom that up to only eight or nine months ago, care homes were sitting quietly in the background of a busy world, expertly tending to those in their care as they always have. Fast-forward those eight or nine months and care homes remain under the harshest of spotlights having been shoved under it following the coronavirus pandemic.

Throughout this period, not only did care homes become one of the most talked about institutions, the struggles they faced created internal issues beyond the immediate safety of residents. A key issue was staffing and getting the personnel in to maintain stability at a time of extraordinary turbulence.

Underlying tensions surface

Unpredictable and fluctuating requirements in care services, coupled with high attrition and sickness in the sector, has given precipitated the need for care agencies to support shortages.

Over time, a quiet but growing contempt for agency workers and services that use them has in some quarters become commonplace.

During the pandemic as the focus shifted to care homes, the emerging suggestion that agency staff working between services were unknowingly spreading the virus served to deepen the divide, in spite of the overwhelming spirit to work together in the face of the challenges.

Long before that, though, there has been a feeling amongst some that temporary carers lacked the competence of their full-time counterparts and were using the renewed demand on them simply to fill time sheets. As such, an ‘Us and Them’ culture between full-time and agency workers has intensified.

Adding to this sense of mistrust were those care homes who avoided using agency carers and used this a marketing tool, thereby casting further doubt on the competency of temporary carers.

There’s a different side to this story

In the interest of honesty and objectivity, it is incumbent upon temporary agencies to concede that there were some problems with a minority of temporary carers. Stories of agency staff arriving late or cancelling last minute, failing to put in the necessary effort, and generally not adhering to the high standards expected of the sector, were not without foundation. The responsibility for quality improvement rests firmly at the agency’s door and their commitment to it should be absolutely paramount. However, in most cases, agency carers performed an outstanding service and were it not for their endeavours, the care home sector might have struggled a lot more than it did during the worst days of the crisis.

There’s also the fact that, though there may have been instances where agency carers transmitted the virus, they were often going into care homes lacking adequate levels of PPE. Wherever the blame for that lies, it is not with the agency carers.

It is also worth addressing the myth that agency carers are somehow not as competent as their full-time counterparts. The reality is that a distinct majority of agency carers are every bit as skilled, qualified, and experienced as full-time staff, it’s just that agency work is a better fit for their personal circumstances. Some are highly capable students on work placements, some are on working visas, others just prefer having control over their shift patterns.

Care homes and temporary agencies need a relationship reset

Speaking as someone who has been at the forefront of arranging temporary carer placements during the pandemic, we have been doing what we can to make improvements; and looked beyond smarter roster management to ensure that staff rotation was limited and requested staff were happy to be assigned to just one service where they truly felt valued and part of a team

In truth, most agencies are doing what they can, but a commitment to improvement should come from all sides. There needs to be a review of care homes advertising themselves as never using temporary carers. It acts a none-too-subtle slight against those equally hard-working care homes that do and bolsters the narrative that temporary workers are an unsatisfactory option.

Those care homes that do partner with agencies might need to monitor the relationships more closely between temporary and full-time carers. It is common for temporary carers to return to their agencies describing unfriendly environments. They are disproportionately tasked with menial jobs and in some cases not even referred to by their names, just as ‘agency’.

Then there is the key component of any healthy relationship between care home and agency of feedback. Often, the only feedback an agency will receive will be when there has been a problem with a carer. Important as it is to know when there have been issues, agencies also need to know when a placement has gone well. The better an agency understands the type of professional who fits within the culture of a care home, the better chance they have of organising suitable placements.

Better relationships benefit everyone

When relationships between care homes and temporary agencies, and full-time and temporary carers falter, there are no winners. Central to preventing this, is building better relationships.

At the care home/agency level, the most productive relationships are formed when the care home maintains links with only one or two agencies. Where this happens, the agency can quickly build a more accurate picture of the type of worker the care home prefers, thereby minimising unsatisfactory placements. This requires constant and open lines of communication where care home managers can provide feedback on carers, both good and bad.

Then, of course, there’s the ‘Us and Them’ culture between full-time and temporary workers that is so widespread within care homes. These divisions can make for hostile environments that benefit no-one, not least the residents who don’t deserve to be exposed to such conflict, however low-level it may be.

Together, care homes, agencies, temporary and full-time carers, we can create working relationships that benefit everyone, in all kinds of ways. We can make our lives easier, more productive, and more pleasant. We all just need to show a bit more willing.