Feb 27, 2023

Aged care leaders: should they be spending time on the floor?

If you take a close look at the greatest leaders throughout history, the one common theme that links these people together is the shared understanding that what you do has a far greater impact than what you say. 

It has become abundantly clear that aged care facilities are struggling to meet the needs of those in their care, and whether you blame that on shrewd business tactics by some providers, a lack of Government funding, or a bit of both, the end product remains the same. 

Although conditions may not always be ideal, those that hold management positions within aged care facilities wield some of the greatest influence pertaining to the quality of care that residents receive. 

Gerontology Consultant, Nicole Smith, spent a number of years managing aged care facilities.

Throughout her tenure, she made a conscious decision to spend four days of each month on the floor to work alongside the nurses and carers that she managed while performing the same tasks as they did. 

Nicole sat down with HelloCare and shared her thoughts on what facility management can do to positively influence the culture of their workforce and how changes in the selection criteria for management roles can have a big impact on care outcomes.

“I started out as a disability carer at the age of 18, but I didn’t get to university for nursing until I was 26. But I have had a vested interest in people for as long as I can remember,” said Nicole.

“By the time I started managing aged care facilities, I realised that the higher up I started to go in terms of job title, the more disconnected I felt from the issues that staff on the floor were facing, so I lobbied those above me to give me four days out of every month working on the floor.”

 While Nicole had a great relationship with staff beforehand, the initial reactions to Nicole picking up a mop and cleaning the floors were more shock than admiration. 

“When I started mopping floors again, the staff actually tried to take the mop off me because they felt I shouldn’t be doing that in my role. Which is not the mindset that I wanted staff to have,” she explained.

“Of course I wanted to help, but in reality, getting out on the floor stemmed from wanting to build a culture of teamwork with staff and letting them know that we are in this together.

“I changed pads, I mopped floors, I did med-rounds, and I got a chance to really understand how well we were doing our jobs by spending more time alongside residents, and this had a great effect on the spirit and culture within our facility.

Leaders or Followers?

There are a number of different aspects to managerial positions within an aged care facility that go far beyond the realms of overseeing the workplace practices of staff.

Managers are often expected to juggle a number of important responsibilities on any given day ranging from conflict resolution and general people management to the intricacies of meeting targets, staying on budget and dealing with issues related to occupancy.

As part of her role in staff recruitment, Nicole is called upon to gauge the suitability of prospective aged care facility managers.

“I check a lot of resumes in my current role, and If I come across a resume from a Director of Nursing that is solely focused on their budgeting skills, and meeting targets, I throw it in the bin,” said Nicole.

“I don’t want to see a spreadsheet of financial accolades, I want to hear about their goals for delivering person-centered care and I want to hear about their ideas for potential programs for people living with dementia.

“If they don’t have that, I am not interested.”

 Although Nicole acknowledges that candidates need to have a wide range of skills in order to be suited to a management role, she also believes that there are some qualities that should hold a lot more sway than others which are not always at the top of the list for providers when recruiting. 

“I think there should be emotional intelligence testing for those entering management positions in aged care, because aged care should not be about who has the most qualifications on paper,” said Nicole.

“ideally, it should come down to who has the most heart – and then you work backwards from there.

“I think that there are a lot of people in the aged care industry that take these roles for six months who collect their big pays and then leave because they don’t suit the role.

“But then, these same people get another job in the same role somewhere else and you end up with a cycle of managers in the industry who can manage spreadsheets and meet financial goals but aren’t necessarily great at ensuring their residents are having the best experience.

“We need to investigate new ways of employing leaders, because at the moment, the majority of aged care facilities only have bosses – and the current climate shows that this is simply not working.”

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  1. Nicole Smith has hit the nail on the head stating;

    ‘Personally I think Managers that don’t get out on the floor regularly are incapable of getting the big picture’!

    What a woman of common sense!

    Words can’t convey the ongoing years of frustration of trying to communicate with Managers who are disconnected with the reality of the issues that Nurses and carers face daily!

    1. I agree with what you say . for example I can say the when I was a care manager I went out on the floor many times a week and even assisted with showers however my up line RM[aged care facility had changed hands one year prior] asked me what I had been doing so I told her “showering “and was informed this was not in my job description. I informed her that I felt it was and shortly after my work performance was completed and my marks were very low and in fact 3 weeks after that I resigned {after 39 years of working in that facility ]

  2. Having knowledge of how management works in the aged care system, I noticed managers rarely spared time to go on the floor . Maybe a brief show of the face ,but that was about the level of involvement. To rely on staff to report on day to day work by staff is just wrong. How can a facility manager even begin to know her residents and most important the staff who work in difficult circumstances.

  3. One of the fundamental reasons why Aged Care Managers do not spend time with, and talking to, their residents is because residents are not considered particularly important to the careers of Managers.

    Unfortunately a large number of Managers view residents as a problem and the families and carers of residents as an even bigger problem that must be avoided.

    In some Aged Care businesses the “pecking order” is residents at the very bottom, staff who provide hands on support to residents are near the bottom, supervisors are above them and Managers are so important they only talk to other Managers and Directors.

    I look forward to the day when residents are recognised as the most important people in all Residential Aged Care Facilities and the staff that provide direct support to those residents are recognised as the skillful, hardworking people that many of them are.

  4. I am fortunate enough to Manage a lovely small facility and spend a a significant portion of my day tending to the care needs of residents, assisting staff (when needed) and liaising with families. This part of my roll brings me so much joy that I never want to leave.
    Thankfully the privately owned business has a wonderful ethos of genuine care and collaboration and all staff are hand selected for the qualities that they bring and their ability to fit in with the culture that is already in place.
    I tell all of my staff that they are working for the residents and that our collective goal is do our best to make the last 1% of each individuals lives as good as possible. It’s simple and extremely effective.
    I appreciate that this is not going to work in every facility, although I want people to know that it is possible.

    Great article
    Thank you for sharing

  5. I have had to bite my tongue and count too 100 before writing this.
    Why is it that an assumption is made and accepted that blanket covers whole sections of persons & roles. My managerial responsibilities include an enormous amount of time on the floor liaising with residents and NOK, GPs & allied health, staff in all departments and constant phone calls.
    My colleagues and I are screaming for more time to do “our” work which is constantly being piled up, because we are on the floor….and noone else can attend to our duties, which results in long days & weekend catchups just to stay sane.
    It’s bad enough to be kicked in the guts by the public and government, now our own want to slap us down too….When will this all end….

    1. yes Debbie, I agree with what you say, there is no one else to do our “managers” role, but others who can do the rest. I wear the hat of manager/RN in an 11 bed facility so there is no option but to be on the floor. This last year has seen me shredded as I have attempted to take the journey set by the govt with new standards as well as caring for residents who have increasingly high care needs and end of life palliation too. Staff, residents, clinical care, admissions and the never ending documentation. My head spins. But I KNOW each one of those who live at our facility as well as knowing the staff too. rewarding.

    2. 100% relate Debbie. No one else can do the work that is my responsibility, so when I work on the floor it increases the already huge amount of time I spend working after hours and on the weekend. Absolutely it’s important to know the floor, to know your staff’s issues and capabilities. But this industry is one of the worst for knocking it’s managers, very discouraging.

  6. How right you are Nicole ! Speaking as a retired village manager, that disconnect you mentioned is very real. The higher you climb the ladder, the further you move from the real reason that you loved the position in the beginning…..

  7. Perfectly said .. all management should reconnect and discover the heart of care. That being said .. I have always advocated that no matter what the business or industry is .. the heartbeat of all is found in the trenches and reconnecting is and will always be key!

  8. I SO agree with this! My parents are living in a senior independent living residence, with assisted-care across the street. The Executive Director (too much “Title”, in my opinion) manages both. She is NOT involved with the residents on a personal basis in any way, shape or form. Any action she takes is either directed from higher up or, in cases she COULD control, she often just makes arbitrary ones. Or, as in my case, it takes phone call after phone call, meeting after meeting, threat after threat, to bring a fair action on her part. I am not one to complain or browbeat or cause trouble until push comes to shove. But when it comes to now having to advocate for my 86-year old parents, this daughter has now turned into a Mama Bear. In addition to not be a “people person”, I have seen many instances where her business acumen could use attention, also. Things could be run much better. And now, I am just about ready to write my letter to Corporate. I’ve had more than enough. Too much money from the residents goes into this living situation but they are not getting back what they pay for. The staff, for the most part, are sweet, caring folks. But they can only perform up to the levels they are permitted from their superiors. Enough is enough. I thank this writer for this article on a manager to be applauded for doing the job the RIGHT way. And now I am even more motivated to write my letter! Thank you!

  9. I totally agree. Facility Managers without a nursing background should also not be allowed. Clinical Care Managers who don’t do a daily round should also be given a ‘shake up’.

    RNs are going to work to ‘nurse computers / care plans /ACFI .

    The ‘New’ standards were launched with ‘Person centred care’. Haha

  10. Thank you for this great article – this has voiced the very core of the problem from a family members point of view.
    I could write screeds to back up my sentiments. Briefly though I had a mother who spent the last three years of her 102 years in an aged care facility. Management changed after the first year and from there on the decline in ‘care’ was awful. Not from the Carers, cleaners, dining staff, most nurses but from management.
    Whilst I understand covid added to the problems, just talking to other friends and families who had their mother/father in similar situations, management seemed to be the main difference between aged care facilities.
    I hope that Nicole is ‘heard’ – a pity there are not more who think as she does. Thank you Nicole.

  11. I think it’s wonderful idea for higher management to spend time on the floor as a carer or nurse, but not as an extra, but maybe to fill in when someone’s on holiday or to fill a shift that quite often goes unfilled and makes it hard for staff to cope. We often have to do double shifts, so it wouldn’t hurt for management to come on the floor after there works done and do an afternoon shift. They often know that’s we are staff down, but they just pick up there bags and go home without even blinking an eye.

  12. I agree with what Nicole was discussing about. I been working in aged care for 15 yrs & I have worked with several managers. Some of them stayed in the comfort of their office staring in the computers or doing only paper works. Some residents complaint that they dont even see them. I remember, one RN told me, she hates working on the floor, that’s why she wants to be a manager. Now, she is our Resident manager. Guess what? We’re always short of staff because what she did was, she recruited most of the staff who used to work with her in the previous facility. She shuffled the rosters, changing the dedicated way of staffing which was very effective. The result, many staff loss their on going dedication and love for the job because there is an on going favoritism in the work place. Many senior staff members resigned whlie others, decrease their hours of permanent shits. Now, there is always a shortage of staff on the floor. Another problem that I observed is about the migrants who came with student visa, studied nursing just to get the permanent residency, but when they finished they are not effective nurses because they’re not there for the job. It is very frustrating because sometimes I have to tell them what to do or how to do things since they don’t have experience on the job, and worst is they are lazy to do the heavy jobs on the floor. But because they are friends with the manager, they get away with it. How frustrating is that?

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