When a person enters the latter stages of their life, variety and personal choice can be forced to make way for necessity due to diminished cognitive and physical abilities.
Upon entering aged care, many residents find themselves at a point where they require assistance for the most basic of tasks, which is why opportunities that allow residents to exercise personal choice become vitally important to maintaining a sense of independence.
Time pressures facing aged care staff have been well documented in recent years, with the Royal Commission describing growing workload demands as “a barrier to the capacity of workers to deliver person-centred care”.
The morning period between 6.30 – 8.00 am is especially busy in an aged care facility with staff often being required to receive handover, read care plans, and locate equipment before showering and drying a resident and then presenting them for breakfast.
Recently, HelloCare was alerted to the fact that the task of showering residents had become a point of friction between night-staff and day-staff during handover.
The majority of online opinion from aged care staff revealed that facilities were not asking night-shift staff to perform showers unless it had been specifically requested by a resident or due to excessive soiling.
However, instances where residents who routinely shower early decide to sleep in or refuse their shower had resulted in growing tensions that have escalated into abuse.
Rules regarding consumer dignity and choice that are outlined in Aged Care Standard #1 clearly illustrate that showering times should come down to the choices of residents.
But is attaining this level of flexibility simply a matter of skill and communication, or are there simply not enough hands on deck?
University of Sydney’s Associate Professor Lee-Fay Low is a well-respected researcher, dementia expert, and aged care advocate.
According to Dr. Low, adjusting rosters to incorporate a level of flexibility for both showers and mealtimes may be the key to lightening morning workloads.
“Our experience from facilities offering residents their preference for shower times is that rostering may need to be adjusted so that showers can happen when residents like. It meant that staff on each shift have fewer showers to get through within a set period of time, said Dr. Low.
“It does need to be clear to all staff which elders will be showered in the morning (possibly very early morning or later in the morning say after breakfast) or in the evening. Rosters will differ from unit to unit depending on the preferences of residents there.”
“As an aside, putting in flexible mealtimes (particularly breakfast) and flexible shower times together sometimes helps with the logistics.”
With over 25 years of experience as a nurse and educator, Consultant Gerontologist, Dr. Drew Dwyer, is recognised as an expert in the field of aged care.
Dr. Dwyer’s thoughts echoed those of Dr. Low, citing communication and leadership from skilled nurses as a pathway to flexible shower times that could then ease the pressures being faced by staff in the mornings.
“This task is completely flexible to the whole workforce, and when challenged, there should be clinical leadership applied by nurses to direct the flow of the timelines and resources,” said Dr. Dwyer.
“One of the skill sets placed in the hands of the staff is to identify the outcome of assessments undertaken between the nurses and the resident which will outline the timeframes and usual or preferred schedule that the resident has asked to be recognised and followed.”
“The flexibility lies in the skill of the staff to identify that they also have the choice to change the plan and to change the timelines or needs for showing. Once the staff has managed the showering assistance, the task itself can be flexible to all shifts and times.”
As with health care, quality in aged care has been proven to be directly impacted by staffing levels. Sadly, Australia still happens to have one of the lowest rates of staff presence in the world amongst comparable countries.
When compared to international staffing benchmarks, more than half of all Australian aged care residents (57.6%) are in homes that have 1 or 2-star staffing levels (1 or 2 stars represent unacceptable staffing levels).
Of the remaining 42.4% of residents, 27.0% are in homes that have 3 stars (acceptable), 14.1% receive 4 stars (good) and 1.3% are in homes with 5 stars (best practice).
Although an added flexibility to mealtimes and shower times would remove the deadline mentality that currently exists, the question still remains as to whether this would lighten workloads or simply add pressure to other staff members?
While few would argue that more staff are needed in Australian aged care homes, Dr Dwyer believes that the current lack of funding is the biggest hurdle that stands in the way.
“The funding allocation in the ACFI is not enough to meet the daily care needs of most residents and this is one of the major issues,” said Dr Dwyer.
“In general I find that when the nursing staff has been able to plan the amount of care in the plan, the resources are adequately applied.
“When there is a complaint from stakeholders that staffing ratios are stressed it should be examined by the nurses who undertake the resource allocation according to the assessed care need.”
“It should be the nurses who are clinically leading the advice to increase staffing when needed. It should be management that takes this leadership and adjusts things like rosters and timelines in collaboration with nurses.”
Dr. Low also believes that the Australian aged care sector requires more funding in order to increase available staff hours, citing government subsidies, additional resident fees, and fundraising, as possible solutions.
Aged care funding has always been a contentious topic in Australia, as pleas for more funding from peak bodies are often met with questions about the lack of accountability and transparency regarding taxpayers’ money.
Hopefully, Australians will one day see an aged care sector that is proud to show where its money is going, and a government that is willing to provide enough money that will allow providers to ensure that resident choice and independence can be a top priority.
Photo Credit – iStock – Lisay
Night staff should never be bullied into showering residents. There was a time when RNs, CMs and management bullied night staff into showering up to 7 residents of 68 residents and only 2 staff working horrible conditions and workloads at the time. We all decided enough was enough and stopped it! Early shift were so bloody miserable. And yet they had so many more staff in the mornings. The bullying of night staff still goes on but only the really bad incontinent residents get showered. Which is not very often. What AM staff don’t realise is how exhausted you are by 5.00am in the morning g when residents begin to wake and Dementia resident’s behaviours begin and take up all your time in the early mornings not to mention the computer work we are expected to do for so many and so little staff working night duty. It is dangerous to expect night staff to shower anyone as the tiredness alot of us experience is detrimental to the safety of the residents and staff alike. You can only expect that all Early staff begin their shifts at least half an hr earlier to get ahead of their busy workload.
I am not surprised to read that Australia has one of the lowest staff ratios in the world.
What a disgrace in a country this wealthy.
I am not a fan of public shaming but this would be absolutely appropriate in this instance.
The time has come for real change, too many of our elderly have spent miserable years in understaffed and under funded aged care facilities
I am disgusted as well as ashamed.
More nurses with qualifications in aged care would be a good start. In pursuit of creating a home like environment providers have seen this as an opportunity to employ a workforce that is semi-skilled with undertaking activities of daily living such as hygiene care and toilet assistance without understanding why that assistance is required or the best way to provide it. Assessment is a skill that underpins the care provided. You need appropriately qualified staff to do this and these people are not accountants and lawyers.
It is right that the resident have a choice when to shower. I am in a house with 15 residents 6 all press their buzzers at 7 am for a shower, so I have to decide who goes first and ask others to be patient. As the resident worked out 6 showers to do between 7 am and 8.30 am as well as a bed made and to start breakfast that is about 11 minutes per resident, the resident’s words “bloody ridiculous. Yes, residents have a choice but when the same resident buzzes for a shower while saying I know you are doing hand over but it is my right. More staff is needed on all shifts not just am shifts.
So true Rosemary. Amazing isn’t it that with all the information and media attention, past and present governments are no closer to fixing the problem. Even with Coronavirus effecting some nursing homes nobody has made a difference to the care and safety of our most vulnerable. Funny how the government can find all the money in the world to make sure the general public and other businesses don’t suffer during a pandemic while aged care homes still did not employ more staff in preparation for a possible outbreak in a facility. No more extra cleaners or nurses. In fact they have actually cut AIN’s hours at my place of employment. This is after hiring so many new foureign AINs. Cannot blame these guys for working other jobs just to make ends meat! Then you have the issue of them contracting a virus in their other job and bringing g it to a facility!!
Early morning in an aged care facility just as an example:
The first thing [all] people want to do when they wake up in the morning is to go to the toilet. But there is not enough time for two carers who have arrived on duty at 0700 hours to take 20, 30, 40, residents to the toilet all at the same time.
Let’s say there are 55 residents in a ward. Many are woken at the crack of dawn (although I don’t know why they are woken at all.) I believe they should be allowed to sleep and wake up naturally. Some can walk, go to the toilet and wash their hands themselves, but there are many who wear incontinence pads and they need their pads to be changed before breakfast. Many are faecally incontinent and changing pads requires care staff to devote a lot of time to clean them up properly (or even to shower them before breakfast).
Many residents will have hearing aids. Care staff has to make sure the aids are clean and batteries are working / changed / tested before they are inserted correctly into residents ears, before breakfast. This can be difficult when residents have dementia because they may become resistive and lash out at care staff (often hurting them).
Dentures have to be cleaned and given to residents, or put into the mouths of residents who cannot do this for themselves. Most if not all, residents have full or partial dentures and these too have to be inserted before breakfast..
Then there are dependent, immobile, residents who need total assistance from at least two or three care staff using a mechanical lifter after they have had their hearing aids and dentures put in and pad changed. Lifting these residents out of bed and into a wheelchair to push them into the dining room takes time and I repeat, when residents have dementia they may become resistive and lash out at care staff (often hurting them and themselves).
Breakfast may be served at 0730 hours but the kitchen closes at 0830 hours. Many of the 55 residents need their food cut up for them and some need to be fed (if they have lost the use of an arm following a stroke for example). It is completely unrealistic to think that two care staff can safely manage all the tasks I have mentioned for 55 residents.
This routine of toileting, pad changing and hand washing, is repeated before every meal. Then at night hearing aids and dentures have to be removed and cleaned. Toileting, pad changing and hand washing, is repeated.
In over 20 years of nursing I have worked across all shifts, & while I agree that night shift is tiring, it is hardly a difficult or busy shift to do. Morning shift is, by far, the busiest shift, & when facilities are not required to have a mandated ratio it will always be rushed & stressful for the staff who work mornings.
Our facility has asked night shift to attend to a few of the more routine tasks, like ensuring all dentures are spotless, checking on hearing aids, making sure any equipment that requires charging is plugged in, refilling pad caddies & checking to make sure residents have enough toiletries on hand & setting up the dining room for breakfast service. You would not believe the complaints the care manager received from night shift about adding to their tasks.
In order to help everyone see the situation from a new perspective, staff were challenged to “swap” roles for a few shifts to see what it was like. It was completely voluntary but staff were asked to work a shift they don’t normally work to give them a better idea of how it works. As you can guess, every morning staff worker volunteered to pick up a night but not one single night shift worker volunteered to try a morning shift. None of them were willing to have a go at a morning shift. On a side note, afternoon shift were happy about that because they were concerned about the sh*t show that would greet them if the night staff attempted a morning!
I agree that showers should not ever be undertaken by night staff (unless the resident requests it or has soiled themselves to a point where a shower is the only option) but asking night staff to take on some of the smaller routine tasks to ease the burden on mornings is not an unreasonable request.
What if a resident is asleep when you approach them for a shower when they are an early shower should you still be waking them up to have the morning staff happy
Whilst so many aged care homes run at a negligible staffing level there will continue to be problems and neglect of our elderly.
Night shift staff shouldn’t be required to shower residents unless absolutely necessary. but they could help ease the tasks of the next shift.
Why is it that so many aged care homes are reticent to divulging their expenses, staffing levels? Divulging this information could see homes given more funding and ensure more confidence in aged care.