Nov 26, 2024

“I Spent My First Shift Crying”: Nurse of 30 Years Reveals She Was Unprepared for Aged Care

As an experienced nurse and educator, Sarah (an alias), has spent decades training personal care assistants (PCAs) in aged care and disability.

Yet, despite her extensive teaching background, her practical exposure to aged care was limited to working in a rural hospital with an attached aged care ward.

When she decided to take on a few night shifts at an aged care home in Queensland, Sarah believed she understood the landscape. Instead, she was met with stark realities that were both shocking and heartbreaking.

“I went in thinking, ‘I know what this will be like,’ but I was in for a rude awakening,” Sarah admitted. Her initial shifts challenged every preconceived notion she held about aged care. What she encountered was a system stretched thin, riddled with inefficiencies, and often prioritising appearances over meaningful care.

The aged care facility where Sarah works is marketed as high-end, with room prices reaching $750,000. However, she quickly realised that the luxurious veneer masked significant shortcomings.

“You’d think for that price, residents would get excellent care and a dignified experience,” Sarah said. “But they don’t even get tea in proper cups. They use plastic ones, while the nice crockery sits untouched in the cupboards. It’s ridiculous.”

This emphasis on preserving appearances extended to other areas of the facility. Empty rooms were kept locked to ensure they stayed in pristine condition for potential new clients, even while family members of terminally ill residents slept on the floor using couch cushions.

Sarah recalled, “When I tried to get a spare bed for a relative, I was told it wasn’t allowed and required approval, which could take days.”

Overwhelmed and Understaffed

Sarah’s introduction to the role was equally disorienting. Promised several buddy shifts to help her adjust, she found herself thrown in as the sole registered nurse (RN) for 150 residents by her third shift.

“They told me, ‘You’re an experienced RN,’ and left me to it,” she said. Of the 150 residents, 100 required high care, but Sarah was still responsible for responding to the needs of the remaining 50.

Her first night on duty was chaos. “I think I had three falls that night,” she recounted. Equipment that could have mitigated these incidents, such as floor sensor mats and call buzzers, was either malfunctioning or unavailable.

The lighting in the main building couldn’t be dimmed, so staff resorted to draping blankets along door bottoms to block the glare and allow residents to sleep.

Adding to the challenge, management mandated that staff check every resident every 15 minutes due to faulty safety equipment. “We had one carer per floor looking after 30 residents. It’s utter madness,” Sarah said. By the end of her shift, she was in tears.

Perhaps most distressing was the facility’s approach to basic care. Continence pads, a necessity for many residents, were rationed.

“If a resident exceeded their quota, staff had to pinch pads from someone else,” Sarah said. For a time, management switched to a cheaper brand of pads, which often leaked, causing residents further discomfort. While the original pads were eventually reinstated, rationing remained.

Training opportunities for PCAs were virtually non-existent, despite their critical role. “I was told to spend five minutes here and there to train carers, but even that was frowned upon,” Sarah explained. Carers who wanted formal training, such as administering medications, were expected to fund it themselves.

Exploitation and Fear Among Carers

The staff Sarah worked alongside often endured questionable employment practices. Many PCAs were paid for double shifts but not at overtime rates, and some received two separate payslips from different companies for the same work. “It’s a way to avoid paying proper overtime,” Sarah said.

Most troubling was the treatment of migrant workers, many of whom were nurses in their home countries. “They’re scared to speak up because they’re on working visas,” Sarah said. “They’re spoken to like servants by management and even some colleagues. It’s really terrible.”

A Broken System

Sarah’s experiences illuminated systemic issues that she believes perpetuate poor conditions in aged care. One moment that stood out was when the facility appeared to undergo a sudden transformation.

“I noticed residents using proper tea cups and other improvements being made. Then I found out we were being audited,” she said. The facility had been given advanced notice, allowing management to temporarily address issues without making lasting changes.

Reflecting on her 30-year career, Sarah expressed frustration at the lack of progress in the sector. “When I first trained, I was told this was what aged care was like. After decades, a Royal Commission, and countless promises, it’s still the same. It’s unbelievable.”

Despite the emotional toll, Sarah continues to work two shifts a week, driven by her concern for the residents. “I’ve wanted to leave many times, but I know my leaving won’t change anything,” she said. “I try to do as much as I can for the residents and support the carers, but it breaks my heart.”

Sarah’s situation is set to change in a few months, and she plans to resign. Until then, she remains a witness to a system that, in her words, is “piecemeal and deeply flawed.”

“I saw this job as an opportunity to understand aged care better,” she reflected. “I was told that this is what aged care was like 30 years ago when I first did my training. It’s crazy to think that after all that time, money and a royal commission things still haven’t changed in some places.”

“I look forward to resigning in a few months when things in my life change, but until then, I will just work my two shifts a week and do my best. ”

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  1. I worked in aged care for a few months after I completed my cert III in Aged care. I found exactly the same things. This was like me writing it. There was NO time to give the residents the care they needed and deserved. It was so distressing I also had to leave as I was not sleeping and could not watch it any longer. God forbid my parents have to go into care. I am sick just thinking about it.

    1. 100% agree with you. This is exactly how most if not all work. It’s the reality of aged care. It’s not possible to fix it. Looking at it from the outside and not being a resident won’t show the truth of it. You have to live it by being a resident or a resident family watching it.

  2. This is not all aged care facilities. Ours is the same, whether there is an audit or not. We are a stand-alone facility with no big brother or sister to bail us out. We have a labour agreement, sponsor staff & do our best every damm day & i am sick of articles like these portraying all facilities as functioning like this.

  3. There is a duty if care for this RN to report this treatment and conditions to the Quality and Safety commission or similar asap.

  4. Sadly, these sorts of experiences have been going on for decades. As an RN of almost forty years, I can say I have seen very few providers that I am proud to say I have worked for them and that they deliver quality care and services in the residential space. Nurses of our era are leaving in droves and never looking back, lots of experienced professionals are leaving and not that many are entering aged care as a career. Even now with the new Aged Care Act and strengthened quality standards I am not convinced things will improve. In my day you could sit and have a chat and a cuppa with an older person and really make their experience a positive one …………………..not these days. Very sad.

  5. This is sad to hear, but I suspect more common than we all realise. Someone with Sarah’s commitment would be an asset to the company I work for. We are not for profit and put everything in to providing good quality care and support for our residents and staff are valued. Yes, compliance is important but improvements must be sustainable. The workforce is fragile enough without added stress and cost-cutting. Plastic cups? How can that be beneficial to quality of life or finances? I really feel for her 🙁

  6. No, nothing has changed and it goes back even longer for me. I am now 81 and have sworn that I will never enter aged care where our elders are treated so badly. Why aren’t there older nurses like myself who could go in and talk to the residents, find out what is really happening for these people who should be getting first class service.? Why are many retirement and aged care on the stock exchange where business and profitability is the driver? It is a disgrace that not only our elders are treated this way but nursing staff are being used as scapegoats and also treated badly. What is needed is strong supervision from authorities, proper training for staff, residents treated as your own mother and father and finally, Value for money

  7. This story is 100% accurate. It’s probably even worse than that. This was my experience with my mother recently in aged care for almost 3 years. If you haven’t worked in aged care or had a loved one there, you cannot know the full extent of what is happening. The deficiencies are well hidden until you uncover them by having something bad happen to your loved one. The facility looks nice on the outside but rotten on the inside. It’s a frightening reality for everyone’s future. No matter how much a general manager of a facility wants to change the culture of it, he/she is fighting an uphill battle. I really cannot adequately describe our experience in aged care when Mum was there except to say that I can never unsee what I saw and I now am damaged inside. I had no idea what happens in aged care facilities before Mum went into one. It’s not an exaggeration to say that my mother’s (and mine) experience in aged care has left me with a mild form of PTSD. Every time I think of those 3 years and what happened to Mum, I feel sick to my stomach. She was in a better quality one with a very switched on and caring GM. I shudder to think about what goes on in a lower quality one.

    1. I’m there with you and the PTSD that still haunts me seeing my mother in a aged care setting. I’m an intensive care nurse so it killed me to see the very basic care mum received from inexperienced carers…. so I went in everyday to give and provide her the care and time she deserved. Still my heart breaks at the lonely nights she must of experienced buzzing and waiting for long periods of time …. thinking if anyone was actually on shift.

  8. Actually, MOST aged care facilities ARE like this. It’s the nature of the beast. They cannot be any other way. So, yours is good? How about the other many hundreds that are not good? Yours being good does not help them.

  9. Sarah’s story reflects the reality of the aged care sector, where the hopes raised by the Royal Commission to address key issues remain unfulfilled. Staffing levels need to be increased to ensure that staff can provide the person-centred care that elders deserve. It’s important to offer decent wages and to eliminate the internal bullying that occurs amongst staff in many care settings. I moved from London, UK, fifteen years ago, where I had a career in housing management. I had never encountered workplace bullying until I began working in residential care in Tasmania.
    People need to realise that the welfare, comfort, and safety of the residents are paramount, and that cannot be achieved when one member of staff is responsible for 30 sometimes 40 residents.

  10. yes, it makes a mockery of the star rating system which we are told we can trust. Audits should be conducted without notice and more frequently than every three years. It seems all the government promises are token gestures which without constant monitoring and higher penalties for non compliance will never work. they would rather turn a blind eye to profiteering and lack of care than take true responsibilty for looking after our seniors in their needful last years.

  11. I had the same experience as Sarah and she is 100% correct – especially the luxurious veneer masking significant shortcomings, it’s an understatement to be honest. The standard of care in many ACF’s is an absolute disgrace and an insult to the dignity of these older people, it is heartbreaking but there will never be any change because the entire system is driven by the almighty $$$$.

  12. this is a terrible situation no doubt but has a very proud registered nurse and operator of an RACH for over 40 years this reflects one facility, which may be one of a larger organisation, and not the many more facilities that take pride in offering dignified consumer focused care to the residents they care for. Do I think the royal commission was successful in weeding out bad practises or more importantly acknowledged the majority of quality care provided, no I don’t, at its very core it caused bad operators who are still in the industry to cover their tracks more.

  13. Not surprised to hear of Sarah’s experience, I find it odd that she had such little experience working in Residential Care after training carers for so long!! It is also incredibly frustrating and upsetting that the new Aged Care Act has passed through parliament with very little provision in it for compulsory training. Carers need to have a minimum Cert 3 qualification due to the very complex and multi-faceted nature of resident needs. Older people are staying at home longer, therefore entering aged care when their needs are much higher. Carers more than ever require training to equip them with the knowledge and skills to do their job according to the hight standards set down in the legislation. Providers much more interested in their profit margins than setting aside money for training their care workers. While a very much awaited pay rise was welcome, it is still not enough to promote a better quality of care. Watch this space, quality of care will not improve without robust and practical changes at ground level, how do you expect untrained, partially trained or poorly trained carers to look after residents with complex needs?? doesn’t make sense.

  14. Pads have always been rationed, nothing new there. Nothing in Aged Care will change no matter what is done! In some Facilities You may have enough Staff but some are lazy and don’t look after the Residents properly and sadly there have been some Nurses who are supposed to do observations and document on a Resident that has fallen and make them up! They believe that as it is so hard to get R.N’s into Aged Care They won’t get sacked… They are right.

  15. This is so sad and this is why I don’t want to go into Aged Care, in any form. I’d rather not be here!
    The Federal Government has a lot to answer for in aged care. It won’t be until they need it themselves to realise how thoughtless and selfish they are.

  16. I share Sarah’s experience. As an RN I spent many years working in palliative and aged care. I also did education, training Cert 111 and Cert 1V, Medication Management etc. Also I am a lawyer who worked in advocacy for disadvantaged people, particularly retirement village and aged care residents. Everything Sarah says is true. Reluctantly I had to place my 99yo mother into residential care. It was extraordinarily expensive and the care was less than acceptable. My mother passed away in less than ideal conditions despite me being there most days and complaining to management on a number of occasions. Unbelievably her crisis meds were withheld until I arrived and demanded that she receive meds to relieve her pain and discomfort. I was treated with indifference and disrespect despite being polite in all communications. This was an extra care facility with a good reputation.

  17. I nursed in aged care for 20yrs but due to health issues I retired 15yrs ago. E erything Sarah came up against was just as bad back then. Regardless of royal commission and promises for improvements it has only got worse. It breaks my heart for residents especially dementia ones . I am 70yrs old and have a brain tumour.our but I would never go into care

  18. No, things have not changed nor will they. As mentioned by others this is an accuracy accounts of an Not for Profit aged care provider’s functions in one of their large facilities in Adelaide. It is so accurate in the terms or the issues and problems at this facility
    I thought the Royal Commission may have resulted in some improvement but No. The Government is also at fault with an inefficient Aged Care Quality and Safety Commission. Some Aged Care Providers appear too have “protective status” from the Commission and its staff.

    The Aged Care Reforms and the New Act will have very little effect in fixing the ground root problems. These issue will unfortunately continue for an unseen period of years

  19. As a past educator in Aged Care amongst other things it gives you opportunity to tell the students what aged care is the real world to the glossed over view of text books.
    Being an aged care nurse I have a sound knowledge of the field.
    Yes in some places continence aids are ratio to 3 per day and the room they are stored in only 2 nurses have the code for the door.
    It doesn’t stop there with short cuts for dressing of wounds and at times the family are asked to supply the dressings.
    Staff ratios has never changed but the roles have
    Rns used to do the medication rounds and now pcws and endorsed nurses do them leaving a short fall of staff to hygiene the residents.
    The residents deserve to have quality time spent with them but instead they get rushed care.
    After the Royal Commission there was a knee jerk reaction with Drs and a lot of residents were taken off certain medication immediately when they should have been slowly withdrawn hence a lot were going through withdrawal symptoms.
    There have been a few other things that have changed but no facility addressed the main issue and that was resident to staff ratios.
    Because more is expected of staff in aged care facilities we have seen a huge amount of staff leaving the industry. The emphasis is on paperwork and not the residents. There is no time to do the care and the required paperwork so the hygiene is done pretty darn fast.
    If aged care is to improve, ratios need to be seriously looked at as this is key to good care and wages need to reflect what we do.

  20. Sarah’s experience in Aged Care is completely accurate & true. I worked in this industry for seven years as a Business Administrator & the people trying to cut corners in Aged Care had never worked hands on in any facility. They were & still are pen pushes without a clue of what the needs are for our Aged. Can you imagine having to wear incontinence pull ups that leak, & do not allow the elderly any dignity. Care homes that cut back on such things should be totally ashamed of themselves. And that is just one area where they keep cutting corners. There are staff cut backs, food cut backs, lifestyle cut backs which are for activities & entertainment for residents just to mention a few problems.

  21. I don’t believe any amount Royal Commissions will fix or change Aged Care. It remains the Poison Chalice for any Minister’s portfolio . The reality is the shifts are spent , providing there is adequate staff, ensuring residents are clean, dry, fed, watered, medications given and residents kept safe. Anything achieved above this is a bonus. Our nursing staff had so much clinical work put on to us, we were told by our clinical manager we would not have time to speak to the residents, just go to their rooms, give their medications and leave, no time for conversation etc. we were required to enter a lot of unnecessary clinical data, possibly to do with funding. It was at this time I decided to resign and I have not renewed my nursing registration.

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