Chevonne Baker does this job because she is good at it, because she cares. She gets a sense of pride when her clients brighten up as she walks into the room. She credits her success as a care worker to her brisk efficiency, tempered with empathy. When a client is difficult, Baker keeps her cool, sometimes stepping outside the room for a few moments to compose herself. She is a master of small talk, keeping up a steady stream of cheerful banalities as she opens curtains, dusts and stacks crockery and attends to personal care.
She understands that she may be the only person her elderly clients see all day, so she makes an effort to draw them into conversation. She understands that if they are rude it is because they have no one else at whom they can vent their frustration. She understands that a care worker’s job is about more than personal care. She is a confidante, a support network, a healthcare professional and a companion.
Baker is 23 and has been working for the at-home care provider Right at Home in Basingstoke for two and a half years. With her university degree – Baker studied performing arts at the University of Winchester – she could probably earn more in a different sector. She makes between £11 and £12 an hour, depending on whether she is working weekends, and is reimbursed for her mileage. (Relative to other at-home care providers, Right at Home’s pay is generous. Many firms pay only the minimum wage.)
Her responsibilities vary. Sometimes she washes and dresses her clients. She may give them their medication and monitor their mood. Other times she prepares meals, or does housework, or takes them to social clubs, or simply sits with them and talks. She makes tea, endless cups of it – so many that she loses count each day.
Baker fell into care work. She had planned to become a primary school teacher, but halfway through her final year of university she realised that she had had enough of academia. She moved to Basingstoke with a group of three friends and found a job working in a cafe, but it went bust. “I’ll be honest,” she says. “I really needed money. I thought: ‘I’ll do anything for now.’” A friend suggested care work. She didn’t expect to like it. “And then I came out of my first week and realised I couldn’t stop smiling,” she says. “So I thought I’d stay for a bit longer – and I never left.” Her parents weren’t thrilled; they thought she could do better. “I spent months convincing them I do actually like my job,” she says.
Photograph: pikselstock/Alamy. Posed by models
Baker finds the perception that care work is low-skilled frustrating. “It takes a certain kind of person to be able to have the level of compassion, but also the technical skills,” she says. “We have to do a lot of manual handling and you want to make sure you do it safely. We use hoists and we give people medication.” Then there is the emotional labour: no matter how Baker feels, she has to control her emotions to project an attitude of cheery professionalism.
“About a year and a half ago, I went through a period when I was not a happy bunny,” she says. “I would wake up feeling really sad every morning and cry in the car. But when I pulled up outside the client’s house, I would put a smile on my face, no matter how fake it might be. And just by going in and saying good morning, I would forget I was upset. Because the client doesn’t deserve to know I am upset. They need to know that I am there for them.” When she was driving between appointments, she let the tears flow freely again.
As care workers go, Baker is the best. You would trust her with your mother. But this has not been an easy winter for Britain’s beleaguered social care sector. Baker has required all her wit to navigate the past few months.
Late November. The care sector is almost permanently short-staffed, with little capacity in the system for people to be off sick, and this year is no exception. People are coming down with coughs and sniffles and, given the Covid risk, having to self‑isolate as they await PCR results. Almost everyone, Baker included, is being asked to cover extra shifts by their managers.
Because Right at Home struggles to recruit care workers, it has to turn away new clients often. An office manager tells Baker that they got a call about a client who was taken into hospital. A condition of her discharge was that she got an extra visit in the evenings, but they didn’t have the care workers to meet this demand and provide continuity of care, meaning the woman had to be moved to a different care company. Right at Home recently increased its pay by 7% to help recruit and retain staff.
This is a nationwide problem. Providers simply aren’t able to get the staff they need. A November 2021 survey of providers by the Homecare Association found that 85% said recruitment was “the hardest it had ever been”, while 45% of providers were unable to take on new work. Like many providers, Right at Home has lost EU workers who returned to mainland Europe after Brexit. To make matters worse, demand for their services has never been higher.
“Across the board, everyone has seen an increase in demand,” says Dr Jane Townson, the chief executive of the Homecare Association. Since 2020, the number of hours of home care purchased by public bodies has increased by 11%. This is because more older and disabled people are living longer, but also due to the pandemic: because of the NHS backlog, some people with chronic conditions deteriorated as they were waiting for hospital care. “Family members have been propping everyone up, but they are at their wits’ end,” says Townson.
When people aren’t able to access the social care they need in the community, they are more likely to “block” hospital beds. “When I was on the board of an NHS trust, 80% of our inpatients were over the age of 80,” says Townson. “When you can’t discharge people out of the back door into social care, you end up with ambulances stacking up at the front door.” In desperation, healthcare bosses in Cornwall have been offering families £1,200 cash grants to take elderly relatives out of hospital to free up bed space. Other NHS trusts are discharging people into so-called “care hotels”, to be looked after by live-in carers.
Baker visits one of her regular clients, a woman in her mid-80s. Dora is stylish and kind. She jokes that she doesn’t have the waistline she used to. Normally, Baker would take Dora to a social club at a nearby church, but this week she refuses to go. Dora says it is because she is waiting for a phone call, but Baker suspects that she is worried about Covid.
“It’s been hard work – not just with her, but with several other clients – to actually get them out of the house, even now the restrictions have eased,” says Baker. “They’ve had a year of being told not to go out because they’re vulnerable, and now they’re being told that it’s actually OK and they won’t get ill.”
Not only is Dora unwilling to go out to her social club, but she doesn’t want her family to come to visit her. “She’s so worried about the virus,” Baker says. She insisted on spending Christmas 2020 alone. “It’s for a selfless reason,” Baker says. “She’s worried about giving them the virus. She doesn’t want to cause any risk at all.”
Baker bids goodbye to another of her clients, a woman in her 90s who is being moved into a care home. “She told me that I was a literal angel,” Baker says. “I said: ‘You go to church a lot. Are you in touch with the big guy? Is there something I need to know?’” The client cries as she says goodbye. Baker struggles to stay composed. “I form connections with clients really quickly,” she says. The client tells her what a difference she has made to her life. Baker will probably never see her again.
Later in November. The office has been getting phone calls, requesting end-of-life care packages, but it is unable to help: they don’t have the staff. End-of-life services are the most labour-intensive they provide, usually requiring two carers, who spend close to 24 hours a day at the client’s bedside.
Baker’s first ever end-of-life call was terrifying. The client was a woman in her 90s who had declined sharply in the space of 24 hours before plateauing again. Although Baker was paired with a more experienced carer, she was frightened that she would get something wrong. Now she doesn’t mind the end-of-life calls. If a doctor has determined one of her clients will soon die, Baker always wants to care for them if she can.
Last autumn, when England was deep in its second national lockdown, Baker attended to Harry, who was more than 100. “He was lovely,” she says. “He always wanted to know if I was married.” Harry’s wife, Jill, was in hospital at the time. A relative was staying with them, but they would go out for breaks and leave their dog. Baker would sit with Harry, cuddling the dog. He would be asleep almost all of the time, but she would still talk to him, tell him about her day. “You don’t know if they can hear you, but sometimes knowing you are there can make them feel better,” she says.
Towards the end, Harry would ask Baker if he was dying and tell her that he wanted to die. She would tell him that he was getting comfortable. When he died, in January 2021, Baker was relieved. “It sounds horrible to say this, but you just want them to be at peace,” she says. “Especially if they’re in pain.”
Early December. Baker has been off sick with a chest infection. Although she is on a zero-hours contract, she got sick pay, which she is grateful for. She spent most of her time at home feeling guilty that she wasn’t working. “There were all these messages on the work chat: ‘Can you cover this shift?’ And I wanted to, but I couldn’t.” She kept reading the clients’ notes on the system, to see how they were doing – her boyfriend would tell her off and take the phone out of her hand. “When you don’t see clients, you worry about them,” she says.
Now she is back – and working an extra 12 hours a week to make up for staffing shortages. “When new year comes, everything will calm down,” she says, hopefully. Baker has the boundless energy of a children’s TV presenter, but even she is flagging. Her low mood is compounded by the fact that one of her former clients, Jane, has just died. She had been living in a care home. They used to sing I Could Have Danced All Night, from the musical My Fair Lady, together. “That was our song,” she says.
Jane was a joy to care for: vivacious and straight-talking. She would tell Baker she needed to get her roots done and chastised her for laying out outfits with clashing colours. But the lockdown hit Jane hard. She missed her daughter, who was unable to visit due to the restrictions. Baker says: “When she was able to visit, you’d never seen joy like it.” Baker didn’t get the chance to say goodbye to Jane: she was put into the care home at short notice.
Mid-December. Baker is back at Dora’s house. One of her relatives recently died and the funeral is being livestreamed. They sit side by side and watch it, holding hands. Dora sings along to the hymn, which Baker finds so unexpectedly touching that it moves her to tears. Afterwards, they watch Catchphrase.
Dora would have attended the funeral, but she is anxious about the Covid risk. Baker is also concerned. Omicron cases are rising and there is talk of another lockdown. “Isolation hit our clients really hard,” she says. “The ones with Alzheimer’s couldn’t understand why their families couldn’t visit. You’d explain it to them, but they wouldn’t remember. You’d have to be three different people to them at once: a care worker, a housekeeper and as close to a family member as possible, so they didn’t feel lonely.”
Christmas Eve. Omicron is surging across the country, with 102,729 cases reported in England alone that day. Lateral flow tests seem to be unavailable to the general public. There are long queues at PCR testing centres. Baker works a 12-hour shift, from 7am to 7pm. She dresses in a sequined Christmas jumper featuring a dog wearing antlers.
Her first client is a woman in her mid-80s who lives alone. The woman is distressed. Her relatives were meant to come to visit, but they can’t, because they have just tested positive for Covid. The woman tries to put on a brave face and tells Baker that it will be nice to have a quiet Christmas. “It breaks my heart,” she says. “I just wanted to scoop her up and bring her with me, as unfeasible as that is. I felt horrific leaving her.”
Her second visit is to Jill. This will be her first Christmas without Harry. Baker talks to Jill while she showers, to take away the awkwardness, before rolling on her compression stockings and bringing her tea and toast. The walls of her one-bedroom flat in an assisted‑living facility are covered in black‑and-white photos of her and Harry on their wedding day. There is a framed letter from the Queen to commemorate their diamond anniversary.
Baker runs home for a slice of pizza at lunch. She rarely eats lunch out; she can’t afford it on a care worker’s wage. If she must pick up something in between clients, it is a Tesco meal deal, which she eats in her car. Her phone pings constantly with messages from her family about Christmas plans. Baker will work Christmas morning and then drive to her parents’ house in Portsmouth for lunch. Care workers’ clients need them all year round, even on Christmas Day.
“It only hits you when you stop,” she says. “Whenever I go to visit my family, I just sleep.”
In the first week of January, four members of Baker’s team are off with Covid. Baker gets her booster, but she has a bad reaction. She is hot and can’t move her arm. She calls the office, but they tell her they can’t afford to be another care worker down, as they are so short-staffed. Baker pushes through, surviving on a few bites of food and cups of tea, then gets home and collapses into bed. “It was OK,” she insists, in a tone that suggests it was not.
This is characteristic of Baker, who is a relentlessly sunny presence and fond of an archaic turn of phrase, referring to her favourite clients as “crackers” and telling them she will be back in a “tickety-boo”. Her sugary-sweet manner seldom slips; if it does, it is only for a second. (“I said to my boyfriend the other day: ‘I feel like an old lady. All I do is talk about the weather,’” she says.) When pressed, Baker will reluctantly suggest things that could make her life better. “It sounds really superficial, but I want a house and a family, and I don’t think I can do that on a job with an hourly wage,” she says, apologetically.
More money would be helpful for lots of reasons, of course. When her car failed its MOT in 2019, her dad had to loan her £2,000 to buy a replacement. She can’t afford to go on foreign holidays and seldom takes time off; because she accrues holiday pay while working, it is too tempting to take the money instead of having a break. In her two and a half years of care work, her longest break has been a six-day camping trip in the UK.
It is for this reason that she sometimes considers leaving for a better-paid job. Nursing would be the obvious choice: the care sector routinely loses staff to the NHS. “Because nursing is a regulated profession that requires qualifications, they are able to negotiate for higher pay,” says Prof Adam Gordon, an expert in the care of older people at the University of Nottingham. “There are no specific qualifications required to be a care worker. Historically, they have not unionised and haven’t been able to negotiate better pay.” Another factor, he says, is the makeup of the workforce. “It’s a predominantly female sector that’s been dependent on migrant labour. This type of work is undervalued in our society.”
Because the domiciliary care sector is run on low margins, it is difficult for employers to increase pay and maintain profitability. “Conditions in the market are tempered by what local authorities are willing to pay,” explains Gordon. According to the market intelligence firm LaingBuisson, councils typically buy about 70% of home care hours from private providers. These rates are non‑negotiable and set by councils under considerable financial pressure, due to a decade of austerity – amounting to a real-world cut of about 50% to English local authority funding between 2010 and 2017.
English councils pay an average of £18.54 an hour for social care. The minimum needed to comply with minimum wage laws and other associated costs is £21.43 an hour, meaning that many providers are making a loss when providing state-funded home care. “This is why employers struggle to increase wages,” says Townson at the Homecare Association. “Many would really love to do that. It’s actually no fun having your workforce leave every five minutes.”
Turnover in the sector is chronically high, which creates a negative cycle: new care workers join, become overworked due to staff shortages, then leave almost immediately. “People tend to leave in the first month,” Baker says. “They try it, decide it’s not for them and move on.” Any leavers the NHS doesn’t vacuum up go to work in retail or hospitality, which offers similar pay without the stress and unsociable hours. “When I speak to people who run these agencies, the biggest threat to their employment is an Amazon opening down the road,” says Gordon. “Amazon offers golden handshake incentives of thousands of pounds. Domiciliary care can’t compete with that.”
Of course, one way to stop care workers jumping ship would be to increase funding for the sector. But this is impossible without a significant investment from national governments. “Social care is the poor relative of the health service in the UK,” says Gordon. In September 2021, the UK government announced plans to raise the rate of national insurance by 1.25 percentage points, to raise an additional £12bn a year for health and social care. However, only £1.8bn a year of this will go to social care.
The Health Foundation estimates that additional funding of between £3bn and £5bn a year is needed simply to stabilise the social care system over the coming years, without increasing pay or meeting future demand. To build resilience into the system and pay care workers a higher wage, £7bn to £9bn a year would be necessary. “That sounds like a big number to you or me,” says Townson. “But to put that into context, the government has spent at least £10bn on Covid [PPE] contracts. It is amazing how they can find the money when they want to.”
The problems in the social care sector will only get worse, as our ageing population lives longer due to advances in medical science. “There will be more and more people needing complex care,” says Gordon. “We’re already struggling to recruit the staff we need.”
But Baker isn’t planning to jump ship, at least for now. “Nursing seems more stressful and you spend less time with people,” she says. “And there’s more regulation.” She hasn’t ruled out teaching, but the training is expensive and time-consuming. Baker thinks she will stay in the care sector, but try to move into the office, in a salaried position. “I’d miss my clients, though,” she says.
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Baker bustles into Jill’s house. It is the second week of January and she has been up since 6am, –she had to de-ice the car because it is so cold. “Minus two when I got up this morning,” she bellows. (She has to project her voice, as most of her clients are hard of hearing.) They talk about the news: the lawsuit against Prince Andrew, mostly. Older people love to talk about the royal family. Baker finds it amusing when they say they feel sorry for the Queen, as if they know her personally.
Her next visit is with Angie, who can be difficult, says Baker, euphemistically. Angie has dementia. “The last time I was there, she told me to go away. That is the polite way of putting it.” Angie would refuse care and tell Baker that she was an annoying child. Baker would sometimes have to leave the room to compose herself. “I don’t like being shouted at,” she says. “I will just cry.” The office placed a more experienced care worker into the call, to assist – such visits are called “double-ups” – and this helped to calm the situation.
Angie’s husband, Jake, answers the door. He is a slim man, dressed neatly in a grey wool jumper. He is devoted to his wife. Angie’s care costs are considerable and the family is meeting them personally, out of her pension; she isn’t eligible for local authority support. The family didn’t want external help, but Angie had a few falls and they realised they had no choice. Even now, Jake rarely leaves her side for more than a few minutes. Sometimes he walks around the block for 30 minutes, when she is being washed by the evening carers. “She has been good to me,” he says, stroking Angie’s face lovingly. “Now it’s my turn to be good to her.” Baker washes and dresses Angie, apologising that her hands are cold.
Later, she visits Tom, a 95-year-old second world war veteran who lives with his stepson. Tom is funny, independent and needs very little support. He cycles on his stationary exercise bike every day. Baker makes him lunch and they play rummy in the conservatory. He always insists on making her a cup of tea. Today, they talk about the allegations that Boris Johnson broke the lockdown rules. “I’m guilty, because I voted for him,” says Tom. They talk about the royal family. Tom once saw the Queen Mother stepping out of a Rolls-Royce in Brighton, when he was a child. He went home and told his mother, but she didn’t believe him.
These are the moments when Baker truly loves her job. “He is the sweetest man,” she says. “You never see him upset. The whole team loves him. Just seeing him brightens your day.” Sometimes Tom plays Baker the piano. Sometimes they talk about the past. Tom served in the navy. He was on the first ship into Singapore after the atomic bombs. He saw the Australian prisoners of war, who had been held in the notorious Changi jail, lined up along the quay. “Sorry souls,” he says.
At times like this, Baker feels that she has her hand in the cooling bathwater of the past. “I get to live through history with them,” she says. Baker knows that it is a privilege to do this job. She wishes that other people would see it the same way.
Some names and identifying details have been changed
