Carers are quite vocal within the home care sector about what they perceive as poor employment conditions and unfair treatment. They point out problems like wages barely above the minimum wage, no guarantee of hours, limited career pathways and lack of engagement or being listened to.
Leaving aside the merits of their arguments for this piece, I wanted to look at what is in the power of carers to do practically, to address these issues themselves? Themselves being the important word, as in these types of situations, rarely does a white knight come riding to the rescue.
Generally, the underlying reason behind some party being treated poorly by another party, is an imbalance of power. Where one party holds all the cards, the natural inclination is to use those cards to their own advantage and to try an abstract the maximum advantage from the imbalance.
In the case of the home care sector this imbalance comes from the dependency of carers on their traditional employers, home care agencies for their incomes. In large part, this dependency is created by the HSE insisting that state funding for home care has to go through a limited list of agency providers. This confers great power on those agencies on the list.
So what can the disadvantaged party in this case, carers, do to counteract this imbalance of power? I would suggest there are various practical options for carers all based around giving themselves more options and choices.
The easiest and quickest solution is probably just to change sectors. At this present time in Ireland with very little unemployment, that’s a pretty good option. What could detract from this option, is if the person loves caring as a job and doesn’t want to leave the sector or if they have very little training or experience outside home care, it might be more difficult.
Even the threat of leaving the sector can have a beneficial effect for the carer if they are good at their job and have good availability.
Join A Union
Unions were set up originally to counteract extreme exploitative practices of employers during the industrial revolution. Thankfully conditions for workers in general have improved greatly since then. Unions have been quite effective within the public home help sector, where they have won some major concessions such as guaranteed hours and higher rates of pay. However, the presence and effectiveness of Unions like SIPTU in the private home care sector is extremely limited. With carers being such a dispersed workforce, mobilising them is quite difficult unless carers themselves actively search to join a union.
Another option here would be for private home care workers to band together and form their own union. This would be a difficult task and take a lot of commitment and effort.
In life in general, once you have choices or options, you have a better chance of being able to say no in any negotiation and having the ability to say no gives you power. For carers to have the ability to say no to a set of employment conditions they don’t like, they need to create other options.
The obvious alternative option in home care is doing private work. Private work doesn’t come along just like that. Unlike an agency where they provide you with work, you have to put in the effort and get the word out by talking to families directly and letting them know you are available for private work or putting up adds in local shops or organisations you are involved in. At Home Care Direct, we know from experience, that the first private client is always difficult to get but it tends to be a bit of a snowball effect once you get going, because of referrals.
If you want to do it legally and above board which is what most families prefer, yes there are complications like getting insurance, invoicing, handling payments and general administration. Options to handle all that would be to hire an accountant or work through a platform like Home Care Direct which does all that for you.
There is a lot of private work out there so this is a real option to break too much of a dependency on agency work. We have seen many carers in Home Care Direct increase their rewards significantly and find a renewed love for their career.
Our view is that there are many great carers out there well capable of working directly with families and giving a great service. It doesn’t mean they have to give up their agency work but by having private clients on our platform it puts them in a stronger position when dealing with agencies. In fact, we have carers who by simply getting their profile up on our platform but not having any work, have been able to negotiate better terms with their agency!
Strength In Numbers
Amazingly, paid carers don’t really have a national organisation to represent them. Family carers have Family Carers Ireland, a well-funded and professional organisation, that appear regularly in the media, showing the huge benefits of having a national representative organisation fighting your corner.
Because paid carers don’t have a national organisation representing them, their issues are not properly heard in the corridors of power. When budget time comes around or when important decisions are being made that affect them, they aren’t sitting at the table banging their fists and making their case. Agencies however, ensure they are being heard effectively at those tables, through the vocal and effective work of Home and Community Care Ireland (HCCI).
Interestingly, efforts were made in the past by Allison Metcalf to set up a national representative organisation but support seemed to be luke-warm. Does this mean that the issues carers like to highlight aren’t actually that bad or that important to them? Or were carers afraid to put their heads above the parapet for fear of repercussions?
There is no doubt that if someone wants things to change, they have to be prepared to stand up and put in the effort!
Personal Budgets and Direct Payments
This issue is connected to the last, in that the roll out of personal budgets and direct payments are exactly the type of national issues that could have a huge positive effect on carers, that a national organisation should be pushing for.
How could personal budgets and direct payments help carers? Well personal budgets and direct payments are all about putting more power into the hands of families and people needing care, to decide what their care looks like but also importantly, who delivers that care. We know that families’ loyalties properly lie directly with the carers delivering care to their loved ones and what personal budgets could do if implemented correctly, is allow families the choice of contracting directly with those local carers where that was appropriate. The reasons they would do that is to make their personal budgets go further but also to ensure continuity of care with the same carer.
This would mean that more money could go to the carer, where families opted for that approach.
We are seeing a lot more personal budgets in the disability sector than with older people but they are proving that there can be a significant upside for carers when they are brought in. We have personal assistants on our Home Care Direct platform earning €21/hr and above. The work in the disability sector also tends to be somewhat more stable.
Personal budgets are more and more prevalent in other countries like the UK and Australia where families are working more and more directly with carers.
What better way to improve your own situation than by putting yourself in control! Carer coops are one of the best ways for carers to give themselves other options. A co-op run by carers and for carers, should have the ability to offer better terms and conditions to carers. It will also show to carers the issues and problems agencies face and maybe contribute to better understanding on both sides.
We already have a carer co-op in Ireland, The Great Carer Co-op, so supporting them to grow is another way of giving carers choice and options, although probably a bit more in the medium term.
Proactively Transfer To Agencies Who Treat their Carers Better
While carers may feel they get a raw deal from agencies, its unfair to paint them all with the same brush. Some agencies do treat their carers better than others. If carers actively looked to move to those agencies with better pay and conditions, those agencies lagging behind would be forced to up their game.
How could carers easily track what agencies are offering?
I used to work in the dairy sector and the plight of farmers in many ways is quite similar to carers in that they are dispersed and meat factories hold all the cards. However, the farmers did something very interesting. They created what they called the milk price league, where every month they published the prices each factory was paying for milk. Some factories initially were reluctant to give their prices but they in fact looked even worse for not doing so.
What if someone put together a Carer Pay League for home care each month, by ringing agencies to ask the rates they pay carers. If agencies refused to give prices they would look bad, as if they were trying to hid something or the agency could just take the risk that rates could also just be got from market information.
The Carer Pay League would have to ensure it is comparing apples with apples, so they could assume a newly joined carer with two QQI modules and get rates for a couple of different scenarios like 1hr of care Monday to Friday, 1hr of care at the weekend, rate for weekday night sift, rate for 3hr day shift Monday to Friday and 3 hr day shift at weekends. You could also have a column indicating if that fictious carer would get paid for mileage.
With a Carer Pay League, there would be much more transparency and those better agencies would benefit while the agencies who treat their carers poorly might be shamed into improving. Carers would be able to see at a glance who was treating their carers best. It is often said that sunlight is the best disinfectant.
A Carer Pay League is something that we will be looking at promoting in the near future.
One of our original aims at Home Care Direct was to give carers options and choices. We don’t pretend that our platform is suitable for all carers and we fully recognise that agencies have a role to play in the home care sector. However, we are firm believers in openness and transparency, with employment offerings in the home care sector having to live on their true merits. We also believe in there being a more equilibrated balance of power between agencies and carers, which we believe would have a hugely beneficial affect on the quality of home care provision and the sectors overall ability to play a much more important role in the health care continuum.