‘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

Monica Leverton; Alexandra Burton; Jules Beresford-Dent; Penny Rapaport; Jill Manthorpe; Hassan Mansour; Stefanny Guerra Ceballos; Murna Downs; Quincy Samus; Briony Dow; Kathryn Lord; Claudia Cooper

doi:10.1177/14713012211023676

‘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

Monica Leverton, Alexandra Burton, Jules Beresford-Dent, Penny Rapaport, Jill Manthorpe, Hassan Mansour, Stefanny Guerra Ceballos, Murna Downs, Quincy Samus, Briony Dow, Kathryn Lord, Claudia Cooper

Research output: Contribution to journal › Article › peer-review

20 Citations (Scopus)

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.

Original language	English
Pages (from-to)	2982-3005
Number of pages	24
Journal	Dementia: The International Journal of Social Research and Practice
Volume	20
Issue number	8
DOIs	https://doi.org/10.1177/14713012211023676
Publication status	Published - Nov 2021

Keywords

dementia care
dementia training
domiciliary care
ethnography
qualitative research methods

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10.1177/14713012211023676

Cite this

Leverton, M., Burton, A., Beresford-Dent, J., Rapaport, P., Manthorpe, J., Mansour, H., Ceballos, S. G., Downs, M., Samus, Q., Dow, B., Lord, K., & Cooper, C. (2021). ‘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. Dementia: The International Journal of Social Research and Practice, 20(8), 2982-3005. https://doi.org/10.1177/14713012211023676

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title = "{\textquoteleft}You can{\textquoteright}t just put somebody in a situation with no armour{\textquoteright}. 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) {\textquoteleft}Navigating the homecare identity and role{\textquoteright}: describing challenges of moving between different role identities and managing associated expectations, 2) {\textquoteleft}Developing and utilising relational and emotional skills{\textquoteright}: boundaries between caring and getting emotionally involved felt blurred and difficult to manage, 3) {\textquoteleft}Managing clients who resist care{\textquoteright}: homecare workers experienced clients{\textquoteright} reactions as challenging and felt “thrown to the wolves” without sufficient training, and 4) {\textquoteleft}Drawing on agency and team support{\textquoteright}: 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.",

keywords = "dementia care, dementia training, domiciliary care, ethnography, qualitative research methods",

author = "Monica Leverton and Alexandra Burton and Jules Beresford-Dent and Penny Rapaport and Jill Manthorpe and Hassan Mansour and Ceballos, {Stefanny Guerra} and Murna Downs and Quincy Samus and Briony Dow and Kathryn Lord and Claudia Cooper",

note = "Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: This work was supported by the Alzheimer{\textquoteright}s Society [Alzheimer{\textquoteright}s Society Centre of Excellence grant number 330] and was carried out within the UCL Alzheimer{\textquoteright}s Society Centre of Excellence for Independence at Home, NIDUS programme (New Interventions for Independence in Dementia Study). Publisher Copyright: {\textcopyright} The Author(s) 2021. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",

year = "2021",

month = nov,

doi = "10.1177/14713012211023676",

language = "English",

volume = "20",

pages = "2982--3005",

journal = "Dementia: The International Journal of Social Research and Practice",

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Leverton, M, Burton, A, Beresford-Dent, J, Rapaport, P, Manthorpe, J, Mansour, H, Ceballos, SG, Downs, M, Samus, Q, Dow, B, Lord, K & Cooper, C 2021, '‘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', Dementia: The International Journal of Social Research and Practice, vol. 20, no. 8, pp. 2982-3005. https://doi.org/10.1177/14713012211023676

‘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. / Leverton, Monica; Burton, Alexandra; Beresford-Dent, Jules et al.
In: Dementia: The International Journal of Social Research and Practice, Vol. 20, No. 8, 11.2021, p. 2982-3005.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - ‘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

AU - Leverton, Monica

AU - Burton, Alexandra

AU - Beresford-Dent, Jules

AU - Rapaport, Penny

AU - Manthorpe, Jill

AU - Mansour, Hassan

AU - Ceballos, Stefanny Guerra

AU - Downs, Murna

AU - Samus, Quincy

AU - Dow, Briony

AU - Lord, Kathryn

AU - Cooper, Claudia

N1 - Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: This work was supported by the Alzheimer’s Society [Alzheimer’s Society Centre of Excellence grant number 330] and was carried out within the UCL Alzheimer’s Society Centre of Excellence for Independence at Home, NIDUS programme (New Interventions for Independence in Dementia Study). Publisher Copyright: © The Author(s) 2021. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/11

Y1 - 2021/11

N2 - 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.

AB - 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.

KW - dementia care

KW - dementia training

KW - domiciliary care

KW - ethnography

KW - qualitative research methods

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DO - 10.1177/14713012211023676

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JO - Dementia: The International Journal of Social Research and Practice

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Leverton M, Burton A, Beresford-Dent J, Rapaport P, Manthorpe J, Mansour H et al. ‘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. Dementia: The International Journal of Social Research and Practice. 2021 Nov;20(8):2982-3005. doi: 10.1177/14713012211023676

‘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

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