Day in the Life... Hospital Carer Support Adviser

A day in the life of…
Naheeda, ACS Hospital Carer Support Adviser

I joined Action for Carers in January 2020, so just before lockdown – a challenging time to start a new role!

This is a role where you need to take ownership, be very organised and crucially establish strong relationships across the hospital, including the carer leads. (Hospital care leads have a dual role, they have their professional expertise, eg a dementia specialist nurse, but also focus on the carers’ and patients’ needs.)

It’s also important to establish a social care contact, and to understand which social worker covers which wards. I also need to connect with the main hospital departments involved in discharge planning – the discharge teams, occupational therapy, social care and physio. I fortunately set up an excellent relationship with the OT lead at our hospital early on, and now when I’m in hospital I sit with the Dementia Specialist Nurse and some of the dietician staff.

Finding carers

A big part of my working day is getting carer referrals. You’ll then either contact the referring professional for more information, or go direct to the carer, depending on the situation. Then your work develops from that point. Often you need to give emotional support, and through this support and conversations, you work out how to best support the carer overall with their hospital experience.

For example, I recently had a referral from one of the hospital OTs. The carer was the wife, and the husband was in hospital with complex conditions. The carer was asked to attend a Multiple disciplinary team (MDT) meeting to discuss her husband’s possible discharge to a care/nursing home. This came as a shock to her. I had to firstly deal with this emotional shock, before moving on to the help they needed. So, you need to decipher the situation, the carers’ and cared for’s needs, their wishes, and the hospital’s views, and then make a plan; often a very complex and emotional situation that calls on all your skills.

The carer in this case also had disabilities of her own, but wanted to bring her husband home. Our role is to advocate for the carers and what they want, but we also have to balance that with their own needs, looking to get the most realistic and best outcome for all. In this case the carer would have found it very tough, and her husband’s condition was likely to deteriorate. So my role was to talk it through gently with her (she was in a state of denial and shock) to help her come to understand what was best for both of them. You have to be sensitive, but realistic, and using prompting questions such as ‘have you thought about what would happen if he has a fall’, she could see bringing him home wasn’t right for either of them.

Understanding situations

I tap into my experiences of caring for my parents, and then my daughter, as well as my previous role in Special Educational Needs Team with Surrey County Council – so drawing on my life experiences, and common sense!

Attending MDTs can be interesting because our position is in the middle – supporting the carer, but working out where the hospital staff are coming from and trying to be clear on what the health and care needs are.

I won’t take sides in a meeting; I always wait until all the staff have gone and then reflect with the carer neutrally. Crucially, if a carer still says, even after all views are expressed – I don’t care about the disruption, I absolutely want him/her home, then I advocate for that outcome, supporting the carer to get the infrastructure needed to make this happen.

In other situations, we may be very concerned about the safety of the carer and cared for if they are discharged home. For example, when the hospital’s discharge care expectations exceed the carer’s abilities. Then we share our concerns with the discharge planning team and other hospital staff, occasionally raising safeguarding concerns if we feel someone will be put at risk.

Carer’s needs

We always have the Care Act in mind, and often remind the hospital they must ask the carer whether they are willing to provide that care. Though that question can get lost in lots of other information though, so we ensure the carer knows. I’ll say things like ‘You need to make sure you can provide this support’. You need to be very sensitive as the person can feel very guilty. We all care deeply about our loved ones, and of course, we want to look after them, but we need to ask, ‘Can I provide what they need? Is it fair?’ What is the best outcome for all?’. Some carers are adamant, and we’ll support them in that decision.

Sometimes care at home can break down as it wasn’t the right thing to do, but fixing things in the community takes much longer. That’s why we stress that it’s better to push for the right level of care support needed for home, while the person is still in hospital, even if it means a slightly longer stay.

Promoting ACS

It’s important that we promote our role, and ACS overall in the hospital to staff and the public as well as carers/patients. We have information stands, do staff training, raise awareness through posters, the hospital website, etc. It’s important that we support the many staff who are carers too. At the royal Surrey we have a ‘Staff Carers Café’. We’ve also started Manager Pods – so supporting managers to understand how best to support an unpaid carer – following hospital policy, best practice and using ACS support.

Working practices and skills

I’m on site two days a week, and the rest of my time at home – where it’s better to make confidential and often very sensitive calls.

I think key skills for this role include: building relationships; being very flexible; being self-reliant; thinking on your feet; being very sensitive to carers’ needs and in tune emotionally; being assertive; and thinking outside the box to ensure carers get the best possible outcome (eg contacting other charities for specific support).

It’s a unique role and every day is different. You are operating alone, but with the backing of your ACS Hospital Team colleagues (we Zoom check-in regularly), and you can make the job your own. I love the job because every day, whether big or small, I’m making an impact.