Quality Staff, Quality Care...

[danielle]

The primary determinants of good care for the aged are the quantity, quality, dedication and motivation of staff. There has been a steady deterioration in the quantity and the quality of staff since marketplace mechanisms became the primary structures for providing aged care. This is in large measure because government and business management ceased to value the skills, dedication and commitment of staff. The community followed.

The motivation of genuinely caring people has been replaced by a drive for profit and an emphasis on process and appearance as major objectives. The accreditation process has resulted is an excessive emphasis on the form of care rather than its substance. Largely as a consequence of the market focus the morale of staff has been eroded and a culture of genuine caring has become one characterised by apathy and indifference.

The accreditation and complaints mechanisms have not worked. This is not surprising in light of the patterns of thought within which the system was designed and the powerful market forces that it had to confront.

What the 2006 reforms to address these problems do is to impose more onerous impositions on providers of care, on staff, on the accreditation agency, on the police, and on the residents and their families. With the possible exception of increased training there is very little in any of the measures that is directed towards an understanding of why the aged care system is deteriorating. The situation is so bad that that some carers rape or abuse those they are charged to care for, others looking on do nothing, and management turns a blind eye. Without motivation and commitment a plethera of courses will fall on barren soil.

There is nothing to address the culture of money before care and the under staffing. Instead the government is encouraging more money-first companies into the sector and talking up the marketplace mechanisms which are at the root of so much of the problem. There is no sign that the government is prepared to even entertain the idea that the provision of aged care through market mechanisms is fatally flawed or that the possibilities of an integrated community service deserve exploration and trial. The new measures, which will push up the costs of care, may make the problems less visible and less confronting but I doubt they will do much to improve the broad sweep of care and give the elderly the sort of care they need and deserve.

[loumullen]

Danielle. You are bang on the money about the flawed system that now exsist. I had an interesting question put to me not long back by a carer, what do I get paid an hour to provide respite?. I replied $20, he replied with, where does the other $37 an hour go, paid for by the State government for me to go in the first place?. Now I didn't think past the point giving him the reticence asked of me by my employer not to get involved in such conversations with client, carer in the first place. He asked me if I would understand his point of view, I agreed given his need to talk out a possible problem he may have encounted. He said he had the trust in me to deliver the service, however the day before had an altercation over the phone with office staff member telling him the shower staff needed to change the morning time, he tried to explain his son's need for consistancy with asperger's, the reply over the phone was take it or we cancel the shower from the run. I asked of his knowledge for advocacy and he replied he was seeking assistance through Commonwealth Care Link.
The carer is not the first with such experiences dealing with administration side of service providers. In fact his experience is common. Nurses and carers working for providers are also handicapped having to deal with administration inaction. I recent attended a staff meeting with support staff mentioning our need to understand their needs and stresses and in future we need to organise times for dealing with our issues or those of clients, it was put to us to leave a note and someone will get back to us with regard. Excuse me, but I'm proving the actual sevice for in the first place. I couldn't help myself and replied: yep I'll leave a message in the pigeon hole and mark a reminder question on it so I remember days or weeks down the track what their talking about when they get around to phoning me for a time. Give me a break. Anyway a week later I had a problem and needed an answer so I went straight to the manager who was totaly amazed with why I was asking her a question I should be addressing support staff with. From that moment What has new meaning. Retribution by support staff was swift with no co car available for client transport I had that same week using instead my own car.

[Sally]

I totally agree. No wonder people like us have broken hearts and spirits. I cry more than I laugh, especially when I read what's on Aged Care Crisis. It seems that the higher powers and those in authority have very little regard for the elderly and for those who tear their hearts out caring for them !!
SHAME, SHAME, SHAME !!!

Sally

[Administrator]

Danielle and Lou - you may be mightily interested in an article written by Madonna King (Mornings Program - ABC Qld) who wrote an excellent column piece in the Brisbane Courier Mail this weekend - it has all the usual suspects, retribution, probity issues, accountability, an impotent (3rd reincarnation) of the complaints scheme, etc:

High time for change in aged care industry
August 09, 2008 12:00am

WHY weren't we outraged when we recently discovered that residents of one aged care home were found to weigh less than 25kg?

When did it become acceptable to treat our elderly so appallingly?

Why isn't it a barbecue-stopper that a serious lack of clinical care and basic hygiene failures are routine events in our aged care industry? Are we so convinced that it couldn't one day be us sitting in dirty incontinence pads for hours, begging for a shower, that we don't consider it a priority?

Given the status the Rudd Government has afforded aged care since its election, it hardly seems to be at the top of their to-do list. Short of a public inquiry into the industry, it is unlikely to improve before our baby boomers swell the ranks of those needing care.

Minister for Ageing Justine Elliot's response to each new shameful episode is to ask questions, seek a review - and then move on. But tinkering around the edges will not help a sector that is so unaccountable and laden with problems that those who work in it vow never to let someone they know suffer the fate of those housed there now.

Of course, there are good homes; and even those that are dreadful attract caring and trained staff who try to do everything in their power to provide dignity to those with none. But the foundation for how aged care operates in Australia is wrong, and until the fundamental issues are addressed, it will continue to dominate headlines by lurching from one crisis to the next.

Elliot and her boss, PM Kevin Rudd, need to look at who is running aged care facilities, what staffing levels they adopt, how complaints are investigated and the retribution suffered by those brave enough to fight for change.

Let's look at ownership first. A strong argument exists for community-based care for our elderly. Or at least to ensure ownership is tightly regulated and monitored, if for no other reason than to ensure care, not shareholder profits, is the priority.

Complex company structures that exist now mean it is sometimes difficult to determine who might ultimately hold responsibility for the standard of care at a particular facility.

This was illustrated by a recent case where attempts were made to try to identify the provider of a particular home; all paperwork pointed to someone who had ceased being the owner 10 months earlier. That means, even when there is an ownership change, probity checks are not always undertaken. Shouldn't checks be made every time a home changes to new ownership so authorities can vet an owner's criminal background and business record? Intricately linked to the ownership issue is how a home determines its budget. And most business models would suggest an easy way to increase profit margins is to cut staff numbers.

Despite staff-to-person ratios existing in our hospitals and our kindergartens, none are mandated for aged care where dementia and high-care patients take chunks of a carer's time.

That means in Queensland there are complaints of one staff member for up to 20 residents, many of them high-care. In addition to issues of ownership and staffing, the complaints scheme hampers revelations of poor treatment or clinical care.

Accusations from insiders range from the elderly being punished for wanting to go to the toilet too often, to having their food confiscated because they do not eat fast enough. Families are resorting to all sorts of techniques to prove the lack of care. In one case, a family member put a dated note in a glass of water containing her father's teeth, to prove it was months since they'd last been cleaned.

Some homes are complained about repeatedly - and yet, to the families who feel the guilt of not being able to care for their elderly, they are falling on deaf ears. What makes that complaints process even worse, is the retribution being handed out in some quarters to those who dare complain from the inside. That means workers, laden with mortgages, are remaining tight-lipped about substandard care simply because they fear dismissal.

They also see instances where those who have blown the whistle have suffered for it - and that surely flies in the face of an open and accountable system where care dominates.

As our community ages, fewer and fewer Australian families will be able to cope without using an aged care facility. The standing of those who own them and the standard of the care provided within them should be the key focus of any government with a vision for the future. Our politicians should realise that one day they may need to enter an aged care facility. Surely this should be an added incentive to fix the industry's problems.

Madonna King presents Mornings from 8.30am each weekday on 612 ABC Brisbane. madonnak@bigpond.net.au

[At Wits End]

I have said a lot about my outrage at Aged Care Facilities (ACF) that are not up to standard. And I have seen some horrible ones.
But I thought I would mention one ACF that is superb. Sadly it only offers low care. And although they continued to take my family member (FM) well beyond low care they eventually had to say that the next respite for my FM would have to be high care. And I agree that is appropriate.
However I thought I would share a little about how good this low care facility was/is. It has ten (yes 10) respite beds (rare I know) and a Board member for the facility Trust told me that they do cover all their costs for this respite. However due to rebuilding in progress now, the respite beds have been temporarily cut, and reallocated to permanent high care clients, while the new permanent high care area is being built. So Respite is not a loss maker, as most ACF will try to claim, when they scream like stuck pigs about their falling incomes.
Of course this Low care respite place is so popular that often the same people bob up again three months later, and the staff demonstrate respect and familiarity with all the respite clients. There are also two other wings for Permanent high and low care and a secure dementia area. But is still small by the standards of size for many ACF.
There is also a lovely well tended garden outside for all (who are able to) to enjoy. Or at least many can see this garden from their rooms. The garden has many older plantings, being over 100 years old.
It is owned by the community and therefore all profits are returned to improve the facility or make things nice for permanent residents and temporary guests(respite). The land and the funds to create it were a long ago legacy, with a proviso that the land can never be sold and it can only be used for aged care and run as a non-profit entity and be owned by the community.
Maybe because of the way it is set up they are able to do that little extra for the residents. Or conversely it perhaps underlines just how much profit is being siphoned off by owners of current ACF, no matter how they scream like stick picks at the alleged unprofitable state of their ACF.
The staff at this facility appear to all treat the clients with respect. There is a calm and positive atmosphere.
Bed linen is a good standard.
There is carpet on the floor in all the bedrooms. And there is carpet in the hall. Yes to mean owners of ACF - carpet can and does work.
Despite carpet at no time ever did i smell urine or worse.
a team of cleaners arrived each morning and went over all with a tooth comb
Whenever I have dealt with this wonderful ACF I have found that first there is no false insincere promises. What they agree to do they always do do.
I never saw a lifter present on the site nor any mention of ever using one. (maybe high care have to have them, I do not know - remember I am a novice at all this) but there was no lifter used at all in the respite area. Yes dedicated Respite only wing - fantastic and as it should be for all respite places.
My FM was always allocated two staff to assist with showering.
My FM was never just left sitting on a loo and left there unattended.
My FM was always allocated a staff member for the walk to and from the dining room
Only breakfast was served in the room - all other meals were in the dining room.
When activities were advertised as happening I noticed that at least four and sometimes five residents would already be waiting in the sitting area 30 minutes before, waiting for the Activity lady to arrive. And she managed a lovely range of different activities - and often she was joined by a second Activity person. Sometimes it was a memory discussion, sometimes a talk about things happening in the world. Sometimes a puzzle. It was always so fresh and not boring. I even sat in on a couple with my FM and I found it fun. If it was horrible they would not have been so Each Respite room is supplied with a large TV, a small fridge per room. A mini area with tea and coffee making facilities - cups, saucers, sugar, tea, coffee, an electric a jug and a toaster were made available in the mini kitchen (no stove and so sink ) but space for crockery. So every respite room had the above mini kitchen, a large bathroom, and a huge bedroom and sitting area per room. So civilised when visitors arrive. All rooms had two well upholstered guest chairs.
My FM was always provided with a pressure mat beside the bed. And it was always in operation when I visited.
Meals were lovely - never did my FM criticise the food. Food was cooked on the premises. The cook was willing to discus any preferences. He was very creative willingly would visit a resident to discuss anything important to the resident re the food.
The rooms were one person per room. There was a rule printed outside each resident's room that anyone wishing to enter the room had to knock, mention the name of the resident, and announce their name. I thought this was a respectful touch.
The decor was not what some 20 year old decorator thinks is appropriate for an older person
Instead the decor was quality, bright and cheerful and could have just as easily be decor used in an upmarket development near the sea for the young at heart.
There was also a lovely sun court. And the dining area was as if one was sitting in sunlight due to the architecture that let in a lot of light but not the heat due to how the windows were handled.
I could list more good things, but I thought you might like to know there are some good places out there. I have heard there is an impossibly long waiting list to get into this place for a permanent place. Why am I surprised? Not. I think people recognise quality
I always found the care given to my FM at this facility was absolutely perfect.

[industrystandard]

I would be very concerned for staff and residents alike if lifters were not available in both high and low care areas.

While carpet in aged care facilities is aesthetically pleasing, there is an abundance of evidence to show that resistant organisms like MRSA, and even viruses, like norovirus, survive in carpet. Regular cleaning will not remove resistant bacteria. Gastroenteritis and infections caused by resistant organisms can have devastating consequences for the frail elderly.

[Snappo]

Agree totally with the lifters. With 'aging in place', they are indispensible. All staff (should) attend a manual handling course every 12 months to upgrade knowledge and skills in this area.

Carpet is nice, but there are many reasons not to have it, particularly in an ACF. Apart from various viruses, etc, carpets also harbour mites that can bring on asthma attacks and exacerbate emphysema. Carpet is also not too good in dementia specific areas due to incontinence episodes and such like. Sometimes we have to forego on the aesthetically pleasing, for the hygiene, and ultimate health, of the residents in general.

[At Wits End]

I guess my post just demonstrates my ignorance on these matters.
Perhaps that place I love (place A) chooses to accept clients in low care respite who do not need lifters, yet. And if they needed a lifter I am sure the high care area would be able to provide one. I hate the look of lifters, but accept that they can be required. And that staff must be protected from ruining their health by inappropriate manual handling practices.
As far as cleaning I do recall, at (place A) that had carpet on the floor and in the corridor (place A) that cleaning staff came through every morning and were meticulous in the extent of the cleaning of each room. They used a powerful floor cleaner and the place smelt wonderful and fresh every morning following cleaning and that continued all day. There was Glen 20 in each bathroom. And I could see that the cleaning satff wiped down all the surfaces every day with disinfectant. At (place A) the standard of cleaning was 100 times better than the last vile high care place (place X), (used once only and only for respite)
Place X did not seem vile at the outset. But ably demonstrated how poor the management was when one was faced with so many horrid things happened.
And filth such as faeces on the floor, skips overflowing with towels with faeces on them, that were not promptly removed from the corridor. And urine and faeces on the corridor floor and in the bathroom, that were not promptly cleaned up by the carer staff. There were no actual dedicated cleaners. The carers had to care and clean. Impossibly unjust load on the carers. And I think this doubling up of staff could lead to infection of the clients.

So urine stayed on the corridor floor at (place X) until one could find a carer to come and clean it up. When I did find a carer she said she would clean it up when she got time. And one elderly woman using a walker then walked through it while the carer went to find a mop.
Then I was shocked to see that the carer did not apply anything but the mop to the urine and just gave it a swish across the urine to mop it up. Does that mean that germs could still be on the floor and on the mop? I do not know. I do know. I could smell the urine in the corridor after the carer took the mop away.
And getting dried faeces removed from the floor of bathroom, and off door frames and shower curtains took even more time. I asked a carer but she never came back. so then I told the RN and she was more bothered that I had raised it with her than the fact it was still on the floor.
And (place X) had no corridor hand washing facilities for staff. No hand gel to disinfect hands. Public lavatory at (place X) only had hard soap for hand washing so I kept hand disinfectant gel in my purse, for these occasions.

If it helps i do recall that (place A) had carpet with a very low tight pile. Not like domestic home carpet that one can run one's fingers through. ..So perhaps some manufacturers make carpet that is hospital grade. Because I also recall that two really excellent private hospital i know also have this same type of carpet with a very tight low pile, in all their rooms for clients. And all the carpets in (place A) where spotless. And the place was not new.
However I will accept that carpet can hide bugs I never dreamed of. Thank you for that advice, I learned of things I never knew about.

[Snappo]

At Wit's End, I was interested in your reply, not because of carpets v linoleum, but your part concerning carer's cleaning. Elsewhere on this Forum I had asked about this as they brought it in recently at my place of employment. It lasted around 4 weeks!! It was just impossible for staff to care, and clean at the same time. An impossibly huge workload, nothing was done satisfactorily, cleaning interupted to attend to residents, care interupted to attend to cleaning. It took the might of the resident's families, complaints to various government bodies, the removal and replacement of various 'management' and, sadly, the loss of many, many great care staff, to make them realize that they were asking the impossible.

We are now left with staff who were employed solely because they would clean, no experience in aged care, no qualifications, minimal English, so now the care still suffers, the documentation suffers, we failed accreditation because of this, all to save a few lousy dollars on cleaning staff. We now have to drag ourselves out of the mire we are in and try to regain our credability, try to become the great facility we once were. When will people learn that aged care is not about profit!!

[Heather]

I am new to this. But the cleaning bit interested me. I was visiting a place recently and stayed a while with my friend's mother. So I saw the staff I thought were the carers. But later i saw the same staff carrying around cleaning stuff when they came into the room to clean. Meanwhile my friend's mother was asking the carers for something when she saw the carers. So then the carers left the cleaning trolley unattended and went to help this old lady. It seemed a dirty concept to be cleaning one moment and then care the next.
The place was horrid.
Part near the front door smelt of urine. Bathroom, see below, smelt of urine.
I went to put my gift of toiletries in the bathroom and shrunk back. The floor was horribly dirty. But my friend told me not to put the toiletries there or they would go missing. What a horrid thought that you cannot even have your own toiletries in your own bathroom. The bathroom was shared. With someone on the other side.
These places are supposed to be 'home' to the elderly people but this place did not seem much like anyone's home.
I can recall at the hospital everyone was encouraged to put gel on their hands. But no gel in this place.
Then there was this altercation that we could hear/see in the corridor with a very old lady and a two carers.
The old lady was telling the two carers 'I can't understand you'. The two carers talked back quickly, in (almost) English, to the old lady and guess what, I could not understand either carer either. Then the old lady got upset and said 'I don't know what you are saying', then the two carers got frustrated. Does the industry not ensure that any carer speaks English in a voice that is easily understood or does that not matter? Neither of the two carers had what I would call sufficient English. And when things got worse with the old lady they talked in their own language which only made the old lady more upset.
I was visiting this place with a friend to see her mother and I left feeling not too positive about these places. And eventually my own mother may have to go into one of these places, but not one like the above, if I can help it.

[Snappo]

There you go, I rest my case!! Pretty sad, huh. This is called 'multi skilling' and is in the same category as 'adequate staffing levels'. If I had been your friend, I would have put in a formal compaint. The place you are referring to would have complaint forms, probably accessible from reception, or the shift supervisor. We encouraged residents and family members to complain long and hard, family members also attended the residents committee meetings and voiced their concerns. They also complained to various aged care departments sufficiently often enough for them to come in and see for themselves. The place was a mess, OH&S issues such as carers attending residents whilst trying to clean, cleaning trollys left unattended, buzzers left unattended as the carer couldn't see, or hear them from the depths of a toilet bowl. Then the issue of documentation, since staff were being employed because they were happy to clean and, trust me, none of the long term carers were happy to do this after studying for various aged care certificates, under going dementia training, etc. and working in the field for many years, then expected to roll over and become cleaners, and the majority of the new staff had very minimal English speaking skills, documentation was simply not being done. Even the basics, like personal care charts and bowel charts went begging. Lack of this sort of documentation will definitely not get you through accreditation!!

Our staff complained bitterly, refused to clean, risked our jobs and were bullied, but we stood fast through the fiasco. The ones that remained during all this were the staff that loved the residents and cared about them. It wasn't about the staff, it was about the quality of care that our residents were receiving. In the long run, we prevailed, new management took over, carers returned to caring, cleaners were employed, and staffing levels were reinstated. Now we have to fix the mess that the last management left us with. Tell your friend to complain, and keep complaining, till something is done about it. The place sounds horrible.