Constituents of effective support for homecare workers providing care to people with dementia at end of life

• Published in: International journal of geriatric psychiatry Vol. 34; no. 2; pp. 352 - 359
• Main Authors: Yeh, I‐Ling, Samsi, Kritika, Vandrevala, Tushna, Manthorpe, Jill
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.02.2019
• Subjects: Adaptation, Psychological; Adolescent; Adult; Caregivers - psychology; community care; Data processing; Dementia; Dementia - nursing; Dementia - psychology; Dementia disorders; Emotions; end‐of‐life care; England; Fatigue; Female; Geriatric psychiatry; Health Personnel - psychology; Home Care Services; homecare workers; Humans; Male; Middle Aged; Mood; Terminal Care - psychology; Workers; Young Adult; England; dementia; community care; homecare workers; end-of-life care
• ISSN: 0885-6230; 1099-1166
• DOI: 10.1002/gps.5027

Objective The aim of this study was to enhance understanding about homecare workers providing care to people with dementia at end of life by exploring homecare workers' perceptions of challenges and the support they needed and sometimes received. Methods Qualitative semi‐structured interviews were conducted with 29 homecare workers and 13 homecare managers in England. Framework analysis was used to analyse the data. Findings Four overarching challenges were identified: working with clients with dementia, including clients' sometimes unpredictable responses, communication difficulties, and mood changes; caring for the dying; conflict with family members; and working alone, which often left homecare workers at risk of exhaustion, fatigue, and a sense of isolation. When their work entailed high levels of emotion, such as a client's death or getting embroiled in a client's family conflict, they felt emotionally drained, under‐prepared, and overwhelmed. Supportive elements include receiving encouragement and learning from experienced peers and their feelings being acknowledged by managers at their employing homecare agency. Some workers were offered time off or encouraged to attend the client's funeral as a means of supporting the process of bereavement. Conclusions Peer and manager support are essential and effective in coping with work pressures. There is a need to develop models of effective support to alleviate staff's practical, emotional, and interpersonal pressures. However, due to the isolating nature of homecare work, managers may not recognise early signs of their staff finding stress unmanageable and miss the opportunity to mitigate these negative effects.