Partial Truths

Actually, if you include the obligatory shadow shift then the training period works out as 16 hours, 35 minutes.

My shadow shift was simultaneously terrifying, stimulating, revealing, rewarding and exhausting. It was a morning shift, so 7.30am-2.15pm, and I was grateful to be shadowing L*, who is a registered nurse but also works shifts as a carer. This took place in the same home that I have been working in since, and L remains my preferred work partner, for her patience with both me and the residents, and the compassionate manner in which she works. The morning shift follows this general pattern: Wake up, wash and dress those residents who have breakfast out of bed; serve breakfast (feeding to those who need it) and clear up; wash and dress the remaining residents on your corridor, bathing those whose day it is (residents are washed daily and given a full bath weekly); attend to general needs (assisting with use of commodes, changing incontinence pads, and other such fragrant tasks); serve lunch (feeding as necessary) and clear up; attend to general needs. Go home and have a nap.

The late shift, for comparison, runs from 2.15-9.00pm and is roughly as follows: Get info from morning staff about how people are doing that day – who has had “a bowel action” (pooed) and who needs to, and any bad moods, aches and pains, food refusals etc., that we need to know about; begin to do rounds of undressing and putting to bed certain residents; checking pads, cleaning up and changing where necessary; serving (and feeding) dinner, then clearing up; putting majority of other residents to bed; attending to general needs; serving hot drinks and biscuits in bed. Go home. Eat. Sleep.

I prefer late shifts, which I have since stuck to, partly because I don’t function well on the lack of sleep that inevitably results from having to start work at 7.30am, but also because I prefer the atmosphere that comes with winding down rather than up. I prefer helping residents get ready for the night, putting nighties and pajamas on, tucking them up in bed, taking round the Horlicks and Ovaltine just before I go home, wishing them sweet dreams.

As I said before, as with most jobs, you can only learn this one by doing it. This applies to the practical aspects of knowing where things are kept, which disposable apron is worn for what, who keeps their vest and socks on at night (J), who likes yoghurt for pudding and who doesn’t (P). All vital stuff, the gradual learning of which has begun to ease the mild panic which pervaded my first few shifts. But beyond this, you begin to learn so much more – about what the job really entails, who chooses to do it and why, what it demands of you, how you react to certain things, about what it is to grow old, to be completely dependent, to begin to lose agency and voice. All of this will take a lot more writing about. But I’ll get to it.

* I’m unsure what to do about names. I’m not comfortable using people’s full names because I don’t have their permission to write about them. But to use pseudonyms for dozens of different people would be too confusing to keep track of, so I’ve opted for first initials. I may later distinguish between residents using characteristics as well – it’s difficult because varying degrees of dehumanisation are suffered by so many older people, and this is frequently demonstrated in nursing homes by the use of room numbers rather than names for identification, and I don’t want to contribute to that. But equally, these residents (and staff, for that matter) don’t know that I’m writing about them and to use their real names feels presumptuous. So I won’t.

The company I work for appears to pride itself on the thoroughness of its training. I don’t intend to mock this entirely – after all, it must only be in recent years that any concept of training for care staff has been introduced. And it’s tricky, because the attitude required to be good at the job can’t, in my opinion, be learnt – it’s innate, and if you aren’t possessed of a natural empathy for your fellow humans then those fellow humans you are supposedly working for are going to sense it immediately. This doesn’t necessarily mean that your standards of physical care aren’t good enough, but the emotional aspect is going to be lacking which means, as far as I’m concerned, that you shouldn’t be in the job.

Equally, if you are possessed of the necessary empathy, then virtually everything you need to learn comes through doing the job. Which means that the “training” therefore consists of a combination of patronising lectures regarding the meaning of dignity and equal opportunities delivered with faux-earnest which dissolves the second the trainer stops addressing trainees and switches to bitching about people with fellow staff members; a couple of physical moving and handling and first aid sessions, which were by far the most valuable of the lot; and a whole pile of low-budget videos, the highlight of which proved to be the immense acting talent of an old man who demonstrates the potential danger of leaving cleaning fluids in drinking receptacles within reach (a vital lesson I’m glad I learned), by pretending to take a sip before doubling over in agony. It’s a classic scene – you’ll find it in “Health and Safety in the Care Home”, no doubt in your local Blockbuster.

So in sum, the training breaks down as follows:

• Induction Session – covering mainly policies and procedures (meaning paperwork), complete with fun workbook which I think I’m supposed to have filled in and returned but I don’t expect to be asked for it. By the end of this session, my brain was reduced to blancmange and I wanted to cry. (2.5 hours).
• Moving and Handling – covering back-care (which within the first hour of the first shift becomes laughable), use of the hoist (which we are told should always be used in pairs – again, “ha ha”.), slide sheet, aiding with standing, etc. A valuable and well-instructed session, but as with everything, assumes that you will somehow have ten minutes to spare helping a resident get out of a chair – you won’t. This is not to say you shouldn’t have, but you won’t. Course should be renamed, “Moving and Handling in an Ideal World” (2 hours).
• First Aid and CPR – covering emergency response to unconsciousness, shock, heart attack, choking, cuts, fractures. I enjoyed this and would like to learn more. Though I will hopefully never have to discover that my suspicion that I would freeze and forget everything if faced with an actual casualty is entirely correct. Hardest part to act on would no doubt be the instruction that if someone falls, you are not to attempt to catch them, or break their fall. I understand the pragmatics of it (avoiding a potential double casualty), but to stand back and let some of the bird-like women I work with go crashing to the floor would surely be impossible, and override every natural instinct (2 hours).
• Basic Care – covering nutrition, feeding, incontinence (which proves to dictate 90% of the job), basic biology (“where is your bladder?”), catheters, handwashing (do you remember to wash your thumbs?), and a general exposition of my fellow trainee’s utter lack of common sense or capacity for independent thought (2 hours).
• Videos: Health and Safety in the Care Home (30 mins)/Fire Safety in the Care Home (20 mins)/Infection Control (30 mins)/Food Hygiene (these 20 precious minutes of your life could be equally well spent bashing your head against a nearby wall)/Adult Abuse (more on this, and how it is essentially a manifesto for the permanent closure of virtually every care home in Britain, later. 40 mins).
• Total training time: 10 hours, 50 mins.