The People We Don’t Talk About Enough

There are people in care services who become part of someone’s everyday life without ever being described that way.

The maintenance person who stops for ten minutes because he and one of the residents both love racing cars. The domestic who knows exactly which pie someone used to buy from the local bakery and goes out of her way to get one because she knows how much they enjoy it. The kitchen assistant who remembers that someone likes their tea in a particular mug, or the receptionist who knows which relative rings every Sunday and notices when they do not.

Those things can look small, but they are not small to the person receiving care. They are the moments that say, “I know you”, and not what your care or support plan says about you.

I've seen more meaningful interactions happen with these people. Not because someone has been told to create a “person-centred moment”, but because a relationship has developed naturally and somebody has taken the time to remember what matters.

For people receiving care, so much of life is organised around other people, meals and medications happen at certain times, support and appointments are planned, so these unplanned, authentic moments become so much more important, and the person is just that, a person, someone who has something valuable to contribute to a conversation.

Kitchen teams, domestics, laundry staff, maintenance and reception often get to know people in a completely different way because their contact is ordinary and unforced. A domestic may know how someone likes their room, a kitchen assistant may remember the food they grew up with, and maintenance may know more about someone’s old hobbies than anyone realised simply because they have stopped and had a proper conversation.

I probably appreciate these roles more because I have had to step into them myself over the years. I have ended up in the kitchen on Christmas Day, picked up a mop and bucket, and done the admin when there was nobody else to do it. I found some of those jobs harder than nursing, caring or being the manager, mainly because they were so far outside my comfort zone. It gave me a much better appreciation of just how much work goes on beyond what we usually think of as the “care” side of the service. Those roles are not in the background. They are part of what keeps everything together.

People receiving care do not stop being interested in ordinary life just because they now receive this support. They still want to talk about football, cars, baking, gardening, music, grandchildren, holidays, old jobs, the weather and all the other things that make up a normal conversation. Quite often the person who gives them that conversation is not a nurse or care worker. It is the person fixing the wardrobe door, changing a light fitting, bringing in the post or clearing the breakfast things away.

Those relationships can be incredibly important because they are not always built around a care task. They happen because two people find something to talk about, somebody remembers what was said last time, or a familiar face takes a few minutes to stop.

That knowledge can be so useful too. Someone who sees the same person every morning may notice when they are quieter than usual, have stopped asking for something they normally enjoy or simply seem different. They are not there to make clinical judgements, but knowing someone well can often be the first clue that something has changed.

What I would not want is for us to recognise the value of these relationships and immediately turn them into another responsibility. The point is not to make domestics, kitchen teams or maintenance staff do more. It is to recognise what they already bring to the service and make sure that, when they do notice something or know something important about a person, we actually listen.

CQC reports pick this up too. In recent assessments, inspectors have highlighted services where staff knew people well, understood their preferences and routines, and adapted support around the individual. At Burlington Hall, relatives described staff knowing very specific personal preferences and forming distinct relationships with people. CQC also noted that staff knew people well enough to notice changes quickly and act on them. At Maristow Nursing Home, staff were able to talk confidently about people’s needs and preferences, including food preferences, and the kitchen stocked foods people specifically liked.

That is exactly the point. Knowing somebody well is not just a nice extra; it is part of good care. And the people building that knowledge are not always the ones with “care” in their job title. Residents do not care what somebody’s job title is. What they remember is how that person makes them feel, whether they stop and talk to them, whether they remember the things that matter, and whether they treat them as an individual rather than a task to get through.

That is probably why some of the strongest relationships in a service are with people whose role sits outside direct care. To the resident, they are not “maintenance”, “domestic” or “kitchen”. They are the person who knows about the racing cars, remembers the pie, notices when something is different and treats them like themselves.

Care homes are people’s homes, and the people who make them feel like home are not only the people providing direct care.

A lot of my work with providers is about governance, quality and improvement, but this is also what person-centred care in care homes looks like in practice. Good systems are important, but they should support the human side of care rather than squeeze it out.

If you are reviewing culture, quality or what genuinely person-centred care looks like across your services, I can help with that too.