‘You can’t just put somebody in a situation with no armour’. An ethnographic exploration of the training and support needs of homecare workers caring for people living with dementia

Abstract

Background Homecare workers carry out complex work with people living with dementia, while under-supported, undervalued and undertrained. In this ethnographic study, we explore the skills, training and support needs of homecare workers supporting people living with dementia. Research Design and Methods We conducted 82 interviews with people living with dementia ( n = 11), family caregivers ( n = 22), homecare staff ( n = 30) and health and social care professionals ( n = 19) and conducted 100-hours of participant observations with homecare workers ( n = 16). We triangulated interview and observational findings and analysed data thematically. Results We developed four themes: 1) ‘Navigating the homecare identity and role’: describing challenges of moving between different role identities and managing associated expectations, 2) ‘Developing and utilising relational and emotional skills’: boundaries between caring and getting emotionally involved felt blurred and difficult to manage, 3) ‘Managing clients who resist care’: homecare workers experienced clients’ reactions as challenging and felt “thrown to the wolves” without sufficient training, and 4) ‘Drawing on agency and team support’: homecare work could be isolating, with no shared workplace, busy schedules and limited opportunity for peer support. Discussion and Implications It is important that training and support for homecare workers addresses the relational, emotional and rights-based aspects of the role. Where a flexible, responsive, person-centred service is required, corresponding training and support is needed, alongside organisational practices, taking account of the broader context of the homecare sector.