staffing

[mysticblue]

I have only been in the aged care industry for 5 months and its very sad to see that staffing is an issue here. we lose staff on a weekly basis. currently doing my cert 3 in aged care

[Administrator]

We constantly receive correspondence from family members of residents in aged care, and from the aged care workforce that this is the case. The reality is there are no mandated staff/resident ratios in aged care facilities across Australia - or minimum standards/skills or training.

[Snappo]

The issue of staffing is ongoing and very catch 22'ish. I am 60 years old, so have been in the workforce for quite a number of years. Aged Care is the ONLY area I have worked where we get 'no shows' on a regular basis. No shows are staff that simply don't turn up for work, no phone call, no nothing. Consequently, the staff who do work have to cover the no shows role as well. Aged care is hard enough performing your own role, never mind someone else's on top of it. There is usually no discipline for a no show, what can management do, sack them? This rarely happens due to the shortage of staff. They simply go elsewhere and are taken on gladly, as the next facility is also short staffed. While ever the pay is criminally low facilities take whoever they can get (within reason), then 'offer' them a course in aged care, they don't actually have to accept. Unless you have a love for our older generation, people go into aged care because it's easy to get into, and they can't find work elsewhere.

Most people have no idea what aged carers do, they think we just feed and change pads. The aged care certificate now covers a huge ammount of theoretical and practical issues. It is absurd to expect people to study for this, then pay them less than a shop assistant. It should be mandatory for people who work in aged care to have their certificate, and then be paid commensurate with the qualification. Until the government start valuing the elderly, and the staff who care for them, the whole process of ageing, and their care, will be sub standard. Role on when the current 'pollies' have the need for a facility and get a first hand look at what is dished out!!

[Sally]

That's the horrid, unfair part about it Snappo! The Pollies will get very well looked after when they reach that time in their lives! They and their cronies have seen to that!
HOW VERY INFAIR CAN IT GET?!!

[Sally]

Sally again. I meant to say UNFAIR.

[Administrator]

Hi there snappo - you're so right - people are completely oblivious to the valuable work that staff perform in aged care.

Would you like to elaborate and perhaps submit an article to the administrator (i can PM you an email address) if you like? It could be in the format of a 2 column table in MS Word document, ie, times on the left and a typical day/s duties/comments/description on the right....

[Administrator]

Sally, I beg to disagree - and here's why: When residents are old, frail, and unable to speak out for themselves (despite who they are), their frailty simply excludes them from having any control over their care. No-one should assume that if they have more stature, or perhaps money, that this will exclude them from bad care. Sure, the accommodation may look fantastic - eg, beautiful surroundings, lovely curtain fabric, plush carpet, specky bathrooms, even a menu written up by Margaret Fulton or perhaps Gordon ($%#@) Ramsay, but don't be deluded into assuming that the care will match the surroundings.

Remember, there are no staff/resident ratios in aged care - this is what resident's family members should be scrutinizing - the care of their loved ones and not the surroundings. In other words, never judge a book by it's cover...

At some point in most people's lives, they will need "care". And it's at this point where older and frail people face the reality of just how inadequate it really is, regardless of who they are.

[Snappo]

Hi,

Interesting exercise. The following is a composite of an average day for me in the brand spanking new, state of the art, aged care facility I went to with rose coloured glasses. I have since learned the hard way, that any facility, be it old or new, is only as good as the management and staff employed there!
I worked permanent evening shifts, from 2.45pm to 11.51(!)pm. You may also be interested to know that I am hearing impaired. I was alone in a 16 resident, combined high/low care dementia wing for the first 4 months. I was then given a second staff member from 5pm to 9pm (occassionally), then 3.30 to 9pm. (occassionally, when staffing levels permitted).

2.45. Handover, often interupted by residents.
3pm. Check on the whereabouts of all my residents, I need to know where they are and that they're safe. Afternoon teas for everyone, resident's family members also, if they are there. Residents from the high care wing wander over and go into the rooms of my residents causing behaviour issues. These issues can take the form of either verbal, or physical aggression, which I, alone, have to deal with. I cannot take the residents from the other wing back, as we cannot leave the wing unattended!! I can only hope that the EEN on duty will come in to see how things are and take them back for me.
3.30. I attempt to carry out regular toileting programms, but I have a lady who is shadowing me constantly, she just wants to be with me, holding my hand and feeling wanted. I want to give this to her, but can't, as I need to toilet a male resident. I sit her gently down then move very quickly away, hoping she won't find me. She doesn't understand about 'personal space', and will follow me into the male resident's room unless I'm quick enough. One toileted, but as I leave his room, I see another female resident, who is a compulsive eater, going into another resident's room looking for food. She does this constantly and has to be redirected. She is often not happy about this and can become aggressive. I move onto the next person to toilet, but my 'shadow' has found me again, and another resident is shouting because another resident is in his room using his bathroom, they come to blows and I have to separate them. He has a lock on his door, I ask him to please use it. I also have a family member wanting to discuss an issue with her husband. I tell her I won't be a moment, I have to sort out the yelling. While going to do this, I notice that one of the residents is very wet, far more so than would be expected if the morning staff had toileting them prior to the end of shift(!!). So, sort out the yelling, try to 'lose' my shadow, toilet, clean and change the wet resident, then go talk to the family member.
4pm. The EEN comes over to see how things are progressing, great, ask her to take the high care people back to their wing, and please lock the door so they can't come back. Take this opportunity to clean up the afternoon tea things in readiness for dinner. Go around the rooms and put out the night pads and pyjamas in readiness for bed preparation. Redirect a resident back to his room as he 'was just going to get his car'. Toilet 2 more residents, one of whom has been incontinent for faeces. Throughout all of this, I am trying to redirect my shadow. This is what I really hate about the job, she needs attention, which I would gladly give if I had the time. But all I can do is constantly sit her down and offer her drinks, at least she is getting a good 'fluid intake'!! There is nothing for her to do, the television holds no interest for her as English is her second language, she is rarely taken to 'activities' as she will wander off and the activites are held in an open area.
4.30 Ask the EEN if I can have a 15 minute break, sometimes possible, sometimes not, depends on how busy she is. Assuming I manage to get it, I go, with great relief, and have a coffee.
4.45 Start taking residents to the dining room for dinner at 5pm. Low care are fine, but high care need to be taken by the hand, or guided with their wheelie walkers to the table, sat, and pray they will stay sat. During this time the kitchen is unlocked, so I must watch our compulsive eater constantly or she will go into the kitchen and eat anything in sight. Care has to be taken as to where residents are sat as some simply don't get along.
5pm The meal trolley arrives, cutlery, serviettes, and drinks are placed before each resident. Soup is served, our compulsive eater is presently happy, but our shadow is verbalising loudly, and upsetting the other residents, I don't have time to placate her as the meals need to be served, I can't do two things at once (amazingly), some residents need to be encouraged to eat, some need to be fed. I make a pot of tea, clear the tables, then serve everyone a cuppa. During all this, I have residents trying to leave the table before eating their meal, I have to try to keep them there, some finish sooner than others and want to go back to their room, they need assistance, meanwhile the shadow doesn't want her meal, you take it away, then she wants it, you return it (you may be interested to hear that I am getting palpitations just writing this, remember, I am alone). The EEN comes over to give out medications, a little relief for me. I am able to take residents to their room knowing there is someone there to watch the others.
6pm Load the dishes into the food trolley, clean up the kitchen, check all residents are safe and clean, toilet where necessary, ask the EEN if I can go on my meal break.
6.30 Blessed relief, half hour break, do the wee I have been hanging onto. (Incidently, I had several UTI's due to the fact that there was no one to relieve me (pun not intended), when I needed to go to the bathroom).
7pm. Back on duty, the EEN leaves and I get supper for everyone, clean up the kitchen after, then starts bed preparation. The first is a male resident who is unable to weight bare, so I use a stand up lifter, toilet him, night pad, change him into his pyjamas, brush teeth, then settle him into bed. Assist my shadow to bed, get hit, spat at and scratched for my trouble. When I leave her room, she is content, comfortable and happy.
7.30 Buzzer goes, it's a resident who needs assistance with toileting, assist him, then get him into his pyjamas, and brushing of teeth, settle him in bed. Take another male resident to his room, he is to be an evening shower, manage to divest him of his clothes, get him under the shower, he then, for reasons known only to him, becomes extremely aggressive and has me baled up in the bathroom (I am alone, no support). I stand mute, and wait for the blows I expect to follow. Fortunately, he contains himself, but I am unable to rinse the soap off his body, he goes to his room, dries himself and then puts his day clothes on again, despite me having put his pyjamas on his bed and folding his clothes up, placing them on the chair. I am not going to argue with him at this stage! (I, again, have palpitations).
8pm Assist 3 lovely ladies with bed preparation, p.j's, pads, teeth cleaning, and settle them into bed. EEN comes over to do medications, she is busy and unable to offer me any assistance.
8.30 Assist a male resident, who has a very set bedtime routine or he becomes extremely confused. Toilet, teeth cleaned, pyjamas, settled in bed.
8.45 Buzzer goes, it is the first male resident I put to bed. Go to check on him and he is distraught. He says he has 'just fallen off the wall'. This is a very real issue for him, so I take 45 minutes to talk him through it, make him a cup of tea, then settle him into bed again. I hear screaming!! Rush out and a male resident has a female resident in a headlock and is dragging her along the corridor. I have no idea what set this off, other residents are aggitated and also start exhibiting behaviours....prioritise.... first, and foremost, is to stop the female resident being strangled, I approach them and tell the male resident that's it's fine now, everything is OK. He says 'are you sure?', I reply yes, and he (thank God), lets her go, then allows me to take him and sit him in front of the communal television. I then go and check the female resident, take her to her room and calm her. I then go to the other unsettled residents, gently redirect them to their rooms. I then run like the clappers, through the courtyard, into the high care dementia wing, and ask staff to come over. I am a mess, shaking, palpitations. Staff come over and tell me to go have a break for 10 minutes, I do, happilly.
9.30 Back on deck, now I have to attempt to get our aggressive male resident to bed, I never know if he will be compliant, or become aggressive. He is still sitting in the chair I sat him in and dozing. I approach him gently and ask him if he is tired, would he like to go to bed now, he says yes. I take him to his room and verbally encourage him to put his pyjamas on, he refuses, all I can manage to do is get him to take his shoes off, then he gets into bed and settles (Thank you, Lord).
10pm. It is now time to attack all the paperwork and computer work. I start, but a male resident gets up and is wandering, I take him to his room, toilet him and settle him back in bed, Go back to the paperwork, but he is up again within 5 minutes. I, again, try to settle him, and while I'm in with him a female resident gets up and goes across the hall to another residents room and uses the bathroom, waking her up as well. I now have 3 to settle, meanwhile the paperwork is waiting. The buzzer goes off!!! I attend the resident who needs toileting, settle him, settle the other three, then try the paper work again.
10.35 I manage to get the bowel charts done, everything else must go begging as night staff is here for her handover. The male resident gets up again. Settle him, quick check through the wing to make sure everyone is in bed and comfortable. Give handover and leave at 11pm, 9 minutes over my allotted day. I am exhausted, I do this 5 nights a week.

This doesn't include palliative care that is often expected of us due to 'aging in place'. Two hourly turns, bed baths, trying to 'push fluids'. Often there are showers after residents are incontinent and a wipe over with a washcloth simply isn't enough. This is manageable if there are enough staff on board, but, despite my constant asking for help, I was told it was a 'one person wing'. Ludicrous.

[industrystandard]

so I use a stand up lifter

On your own?

!!

[Administrator]

Hi there Snappo - thankyou for sharing and going to the trouble of putting together an excellent account of your work day - suffice to say that we're gob-smacked.
Little wonder that aged care workers are leaving in droves...

[Snappo]

Yep. on my own. In fact, it was during the usage of the stand up lifter (alone), that I suffered a severe tachycardia event, sufficiently worrying for the DDOC to call an ambulance and take me to hospital!! One of my questions I asked the DOC, in an email to her when I was asking for help, was "How come, if this is a one person wing, we have 2 x assists and stand up lifters?" Another little anomoly of our state of the art aged care facility, was that every nurse station has a computer (everything is done on a computer, except the stuff you hand write, then that goes on the computer too!!!). This sounds wonderful, except very few knew how to use them properly (myself included), and we, naturally, had no training in them. Everybody in the facility, to my knowledge, had an email address. It appears though, that the DOC was above this, and wasn't on the internal email system. I didn't find this out till months after I actually sent the email to her. This is no excuse though, as the DDOC knew I had 2 x assists, aggressive residents, palliative care. She would tell me that IF I needed help (how can this be an 'if' with 2 x assists?), to call the EEN. Often the EEN was busy, and unable to come for some time. The resident cannot sit for prolonged periods of time in a wet or soiled pad, or be left to fall asleep in a wheelchair (at least, MY residents can't), so I use a stand up lifter alone, nobody cared, so long as the work was done. Incidentally, it was just 2 weeks after the tachycardia event that I suffered a heart attack!! Both incidents happened at work whilst alone and stressed. $16.20 an hour??? Geez, mate...........

[Administrator]

Snappo - don't know how you manage to do this...

[Snappo]

Hello Administrator,

Me either!! I continued because I thought that maybe I was lacking. I had my time management skills questioned!! I told them it wasn't anything to do with time management, it was to do with the inability to be in 6 places at once!! Went down like a lead balloon!! I can't even think of what I did there now without getting angry and, amazingly, get palpitations. Their total lack of concern for their staff, not to mention their residents wellbeing, is stunning.

[Administrator]

Well - I can honestly say that I am constantly amazed at the level of detail and feedback that ACC website collects. Just when I think I've heard it all, and mind you, the pollies call these types of things "isolated incidents". We receive so much correspondence like yours, and a whole lot worse, that it is difficult to comprehend just what will it take for the government of the day to improve the care of elderly and frail people in care, and to support staff who work in such a tough environment.... I'm going to see if we can publish your article on the ACC website to give people an understanding of just how tough it is for such hard-working carers!

[Snappo]

Hi, I look forward to that. I stand by everything I have told you, with witnesses if necessary. I also have plenty more shifts I could share with you!! I so hope some good will come of it. Thanks.