“It’s a privilege to work with the elderly – I wouldn’t have it any other way. I was always meant to look after older people. I love hearing them talk about their life experiences. They give us so much.”

Sharon Batchelor, deputy manager at Barchester Canmore Lodge Care Home in Dunfermline, Fife, is reflecting on what caring for older people means to her. Ms Batchelor, and so many like her, are dedicated to this role.

While having a devastating impact, the Covid-19 pandemic has also shone a light on the value of those working in older people’s care, highlighting their resilience and commitment to supporting patients and colleagues during what continues to be the most challenging of times in healthcare.

The reasons that inspire people to decide to pursue a career in caring for older people, and the routes into this area, are as many and as varied as the opportunities on offer.

David Attwood is a GP Partner and GPwSI Older People at Pathfields Medical Group, Plymouth, honorary secretary of the British Geriatrics Society, and clinical lead for the Integrated Care of Older People in Devon.

His interest in older people’s care was sparked by his mother, a district nurse “who was passionate about caring for older people”, he says. As a teenager he spent six years as a care assistant in a nursing home and became “passionate about caring for older people too”.

When he qualified as a doctor he remained “very interested in geriatric based specialties”, and now as a GP partner he is the care home lead for his practice as well as working with an ‘Ageing Well’ team – a joint collaborative of hospital and community services supporting older people’s health.

When president of the British Geriatrics Society and consultant geriatrician Dr Jennifer Burns began her medical career she hadn’t planned to specialise in older people’s care.

She chose this career path having had “a very positive experience of being taught by geriatricians both as a medical student in Glasgow and then working in a unit as a junior doctor with a team of really excellent geriatricians”.

Dr Burns noticed that geriatricians were “very holistic in their approach to patients”, and she also wanted to provide holistic care. And she was also inspired by her early experiences of working in the community, when she visited older people to try and work out what was causing their ill health and trying to support them to continue to live at home.

Working in older people’s care happened by chance for Linda Nazarko, a consultant nurse in older people’s care for many years and also a Royal College of Nursing fellow for the care of older people.

“When I qualified as a nurse I went into neuro surgery, and worked abroad. When I came back to the UK I enrolled at a nursing agency who put me forward for roles caring for older people. I realised the care of older people in nursing was absolutely crucial, that it really mattered, and that it was very skilled work,” says Ms Nazarko.

A career working in older people's care

There are many ways for practitioners working in older people’s care to further their careers, and a variety of skills they can acquire. They can access training, gain new skills and qualifications, and share their knowledge through teaching.

Having qualified as a geriatrician, clinicians can opt to work in subspecialty areas, such as falls and fractures or stroke medicine. As part of her work, Dr Burns runs a movement disorder service and works with people with Parkinson’s disease.

Dr Attwood believes that "there is no substitute for experience”, and says his experience of working in numerous medical specialities, including acute medicine and A&E during his training has proved “incredibly beneficial” as a GP when caring for older people.

When Ms Nazarko began working in older people’s care she enrolled on such relevant courses as stoma care and  incontinence care to develop her knowledge and skills. Later, as a consultant in older people’s care she has worked as a lecturer, and shares her expertise in this area.

Care home organisations can offer all kinds of support to assist staff in developing their knowledge and skills. Ms Batchelor, who did her nurse training “late in life”, and moved to the private care sector 12 years ago, regularly takes advantage of the training on offer to Barchester staff. And her achievements have been formally acknowledged – she recently won Registered Nurse of the Year at the Barchester Care Awards 2021, which celebrate the staff who go the extra mile for the benefit of residents.

Kindness, curiosity, and resilience

While caring for older people in general doesn’t necessarily demand a rigid set of qualifications, it does require certain qualities. For Ms Nazarko, the most important quality is that “you have to be kind”.

“You’ve also got to be curious to find out how to help people. And you need to be resilient. When people fold their arms and say ‘we couldn’t possibly’, or ‘we tried that twenty years ago and it didn’t work’, you’ve got to be resilient to get them on board,” she says.

Resilience is also required to deal with the sadness and loss that is all part of caring for older people. “When something sad happens I need to be quite tough to cover for that and not show residents that I’m overly upset,” says Ms Batchelor.

“However, I do need to show empathy, such as when residents come into a care setting for the first time and are feeling very anxious. You need to reassure them that everything will be ok.”

And the ability to really listen to older people is also important, she says, as  “it builds up rapport and trust”.

Collaborating as part of a team 

Being a good diagnostician is an important part of older people’s care. “Often patients have more than one illness so you have to work out what is the right route to take in terms of investigations and treatments,” says Dr Burns.

Teamworking is an essential quality for supporting older people. “You have to be excellent at team working, because if you’re not collaborating with your multi-disciplinary team you won’t be providing the best care for your patients,” says Dr Burns.

“I work with a team that includes specialist nurses, physiotherapists, occupational therapists, dieticians and speech and language therapists, all of whom contribute individually to patients’ care, and I as a geriatrician I have to coordinate and lead that team. Being able to do that well is an important key skill,” she says.

Working in older people’s care involves not only collaborating as part of a team but also with the patients themselves, says Dr Attwood. “When I see an older patient I never make

medical decisions about them. It’s a shared decision making process, where I inform them and their families about the benefits and risks of treatment decisions and let them arrive at their own judgements, while at the same time offering guidance,” he says.

Joys of the role

What makes caring for older people so special are the people themselves, practitioners say, who say how much they enjoy their wisdom, their humour and their life experiences.

“There’s the lifetime experience and the strength of character that so many older patients have, and they often share elements of their life stories with you. It’s always interesting to hear those stories and to try and work out what their priorities are in terms of their health wishes and their treatment. It’s that richness of their personal stories that’s so interesting and rewarding as a physician,” says Dr Burns.

Caring for older people means no two days are ever the same. “I’ve never felt bored at work. I always feel stimulated by the diversity of individual patients and their journeys,” says Dr Burns. 

She says a key reward is that “you’re supporting people who are often in the most need of help from health professionals and seeing that support lead to improvement.

“Of course, support doesn’t always lead to recovery and  sometimes involves end of life care – but ensuring it is good care is also a rewarding part of the job, as is knowing you have made a difference to individuals and to their families.”

As a GP, Dr Attwood says caring for older people is “rewarding and challenging – in a good way – in equal measure”, and “every day I continue to be challenged and continue to learn”.

Every day is an education supporting older people. And it’s also an area where research is flourishing, in particular frailty management, medications, and dementia, says Dr Attwood.

Practitioners involved with caring for older people talk of how even the smallest acts of support can be of great benefit. “It’s really satisfying knowing you’re making a difference,” says Ms Batchelor. “

Deep and special bonds

The deep and special bonds between carers and those they are caring for, and the challenges they face, particularly in care homes, have been highlighted during the pandemic.

Throughout the pandemic, practitioner’s collective skills and qualities - including their ability to respond quickly to changing demands and to adapt to new ways of working - really came into their own. Colleagues have been working even more closely together to support each other.

“The pandemic has really emphasised the need for strong teams and good teamworking to support individuals delivering care and to sustain them through the challenging times,” says Dr Burns.

Community connections have also strengthened during this time, in particular when Covid-19 forced care homes to close to visitors. “People in our local community were leaving sandwiches and cake at our door,” says Ms Batchelor.  

Despite the challenges those working in older people’s care are facing, practitioners continue to find joy and satisfaction in what they do. “It’s very fulfilling getting to know all about a patient’s life and helping them to move forward with their lives,” says Ms Nazarko.

To those considering this career, Dr Burns says: “There has never been a more important time for people to be looking to specialise in this area. Older people’s care really makes a difference, not only to patients but to the wider health service. By training and getting the right skills to do this type of work you will be sustaining the future of health delivery,” she says.

And to those just starting out in older people’s care, Ms Batchelor says: “There’s so many opportunities, so much learning. It’s a great job to do. And I’m passionate about it.”