Personal care workers are the backbone of the aged care sector. Not only do they provide emotional support and care to older people living in residential aged care, they are also increasingly being asked to perform a range of more technical tasks that require high levels of skill and training.
One such task that has come to HelloCare’s attention is stoma care, including cleaning of the stoma and changing of stoma bags.
A quick ‘snap poll’ of more than 100 readers on our Aged Care Worker Support Group showed that of 107 respondents surveyed, 76 per cent (82 respondents) said they have been changing stoma bags but have not been provided with formal stoma management training.
This result reinforced a theme that has emerged in the Support Group over recent weeks – that aged care workers are performing stoma care without formal training to do so. While some have received formal training, some have learnt how to perform the role ‘on the job’.
One member of the Support Group said the person with the stoma themselves had shown them how to clean and change the equipment.
Some HelloCare indicated they felt they were performing a role they were not properly skilled for.
A stoma is an artificial opening that allows faeces or urine either from the intestine or from the urinary tract to pass. The end of the intestine or urinary tract is brought to the surface of the abdomen to form the stoma (opening).
A stoma is the result of an operation that removes disease or relieves symptoms. It is usually moist and pinkish-red, and sticks out slightly from the abdomen.
Lauren Hutchens, Health Services Union, NSW manager of the aged-care sector, told HelloCare that stoma care is part of the role of an aged care worker but there isn’t a large amount of training for them to support them in undertaking that role.
HSU members say they are shown how to perform the task, and the expectation is they will then take on that role.
The Cert III needs a review and be brought up to date to reflect the real world practices in aged care, Ms Hutchens said.
There is no accredited training that guarantees personal care workers have the skills for stoma management, Paul Gilbert, Assistant Secretary of the Victorian branch of the ANMF, told HelloCare.
Cleaning of the stoma and changing bags is only one aspect of stoma management, said Mr Gilbert.
Assessing risks is equally important, and must be performed by a highly trained registered nurse, he said.
Carmie Walker, CEO of care training and worker placement organisation, Vative Healthcare, told HelloCare her organisation does provide stoma training as an add-on unit to its Certificate III courses.
She said stoma care is “just part of the job” of a personal care worker in aged care, but she echoed Mr Gilbert’s concerns about risk assessment. Many aged care workers are trained to clean the stoma and change bags, but they may not understand the risks. For example, they may not recognise a problem when something goes wrong, she said.
Personal care workers are taking on more complex tasks in other areas too, including the management of tracheostomies, urinary devices and PEG feeding, Ms Walker said.
With more personal care workers and fewer nurses on staff in aged care homes these days, the drift in the scope of personal care workers’ roles could indicate that more complex tasks are being delegated to personal care workers as a cost cutting measure, note researchers Suzanne Hodgkin, Jeni Warburton, Pauline Savy, and Melissa Moore from La Trobe University in a submission to the Royal Commission into Aged Care Quality and Safety.
The drift in the scope of practice of personal care workers to include more complex tasks “raises questions about the role, supervision and training of personal care workers.”
Working in aged care is virtuous and physically demanding, but it is also becoming increasingly complex and this must be addressed, not only in training and accreditation, but also in pay and recognition.
Image: yacobchuk, iStock.
This is so true Age Care Workers are asked to perform the more clinical task with a small amount of training or shown once. I myself have done a lot of outside study and training to get the information but very little acknowledgment or accreditation is giving. I one year I spend over $1000 upskilling myself, will little acknowledgement from managers.
Nursing Attendants should not be working outside their scope of practice. I remember administering morphine mixture when I was a Nursing Attendant in charge of an entire hostel by myself overnight. There was nobody to check the drug with me and before that shift finished the smoke detector went off after the toast caught fire (because I was assisting a resident to the toilet) and finally a resident was found on the floor of her room (having been there all night). This is the horror show that is Aged Care. If Nursing Attendants are going to do nursing work they are going to have to be registered, trained and paid and have insurance in case something badly goes wrong. Sadly Aged Care providers are happy to shift risk to individual workers but when there is an accident or a complaint you are on your own. Being home alone as a Nursing Attendant on night shift is not a good place to be.
I too was shown how to clean & change stoma bags as a carer and was just expected to do it with no questions asked. I was a cert 3 as well constantly being asked to do duties out side of my scope of practice. Even now I am have been moved to another department promised a qualification that was over a year ago. To be told your doing great just keep doing what your doing with no formal training.
I believe strongly that due to the fact support workers to a large amount of nursing care the courses should reflect it and that change the qualification to certificate III in Nursing Care, Certificate IV in Nursing Care The people that want to do less in their qualification should be support workers and be qualified as such but those who perform wound care, stoma care, assist with Medication, apply uridomes, provide catheter care plus a multitude of other tasks, that require training, should all be classified as nurses and be registered as such.
Surely if untrained carers are performing tasks that should at least be overseen by an RN the facility requiring untrained workers to do this as part of their normal duties places itself at considerable risk if anything is to go wrong. Their insurance could be voided and families could sue if their loved ones are adversely affected.