Aug 18, 2020

PJs to dinner? That’s okay if it’s a choice

 

If a resident wishes to come to dinner in their night clothes, they are well within their rights to do so. However, a HelloCare reader is concerned that staff cuts at the aged care facility where they work are forcing busy care workers to make the decision on the resident’s behalf, because it saves them time.

Person-centred care means residents should be at the centre of decisions made about their care. The new Aged Care Quality and Safety Standards require that all aged care providers put the consumer at the centre of all decisions.

But amid the pandemic, staff shortages, and even staff cuts, our reader is concerned staff do not have time to deliver the care residents desire.

We take a look at person-centred care as it relates to wearing night clothes to the dining room, discuss where this conversation started, and outline some simple steps to achieve person-centred care ‘on the go’.

Person-centred care is the goal

A couple of weeks ago, a personal care worker wrote to us about a resident who comes to dinner in her nightdress and dressing gown. It was causing problems in the dining room.

His comments sparked furious debate, with nearly 250 readers expressing their views.

Most said their aged care facility always takes the person-centred approach. They said that if a resident wishes to come to dinner in their night clothes, then they should be enabled to do so. Aged care facilities are homes, and residents are entitled to do as they please, within reason of course.

Many said daily routine items, such as showering and dining times, are often included in care plans, and this could include details such as whether or not a resident wishes to wear their pyjamas to the dining room.

Some readers said their facility regularly took residents to dinner in their night clothes and that it was comfortable for them, while others said it was degrading and had a policy of only changing residents after dinner.

One reader suggested that it might be preferable for residents with fragile skin to minimise the number of times they change clothes in order to prevent injuries.

Time constraints can clash with person-centred care

A number of readers conceded they struggle to implement true person-centred care due to time constraints and staff shortages. 

Though well aware the new Aged Care Quality and Safety Standards require the consumer, the resident, to be at the heart of decision making, sadly, a number admitted that that wasn’t always possible for them. 

Decisions about shower time, and when to dress for bed should be made by the resident, they agreed, but in reality, this wasn’t always achieved in practice and they sometimes made decisions based on what was possible given their time constraints.

Saving time vs person-centred care

HelloCare has since spoken to the personal care worker who wrote the initial post, who revealed this is his concern.

He has no problem with residents coming to dinner in the pyjamas, but he was not convinced carers were asking the resident what their preference was. He suspected they were dressing residents in their pyjamas before dinner to save precious time.

The personal carer said staff cuts are resulting in residents being brought to the dining room nearly an hour before dinner is served, and left there, unattended, watching television but otherwise unoccupied.

Where once a personal carer was supposed to be in the dining room at all times, for breakfast, lunch and dinner, this was no longer possible due to the fact there were fewer staff available, the care worker said.

Left to their own devices, a resident who came to the dining room in her night clothes became the target of unwelcome advances by other residents, the reader said.

The reader, who wishes to remain anonymous, said personal care staff are “there to take care of the residents, but also to learn about their background, and get to know them as friends. 

“When you come to work, when you walk in the front door, you want the resident’s eyes to light up when they see you because they are happy to see you, and vice versa,” he said.

In the carer’s experience, most residents who wish to get into their pyjamas in the afternoon, like to eat their dinner on a tray in their room, or those who shower in the afternoon will get into comfortable clothes for dinner, and have night clothes set out so it’s easy for them to change into before bed.

Problems occur when residents are left with nothing to do before dinner, and with nobody around to monitor the situation, they said. Residents are being “dumped” in the dining room, they said. “It’s tantamount to elder abuse.”

“It’s our job to look after the residents, but it’s not happening.”

Achieving person-centred care on the go

Aged care staff are often rushed off their feet. This fact has been well-established by the royal commission, and other investigations of the aged care system. It is something we hear from our readers on a daily basis.

So how can aged care staff deliver person-centred care when they are so busy?

It’s certainly not easy, but the Victorian Department of Health offers some simple guidelines to help achieve ‘on-the-job’ person-centred care

  • Use a person’s preferred name.
  • Refer to the unique details of the person’s life.
  • Use verbal and non-verbal communication to begin tasks for people that they can then complete on their own.
  • Use verbal and non-verbal strategies for people to see their immediate needs or requests will be met.
  • Request family members’ input into their relative’s care. Communicate with family members as valued participants in care.
  • Do not act as if a person with dementia cannot hear or is not present.
  • Use non-verbal behaviour to show respect for a person’s individuality. 
  • Make sure verbal statements support feelings of belonging and self-worth. 
  • Do not use statements that dehumanise, threaten or show disrespect.
  • Organise activities that refer to people’s past social roles.
  • Organise activities that meet the person’s individual needs.

Please feel free to share your views and comments. We know this is a topic that is important for many of you.

Image: Mediterranean, iStock.

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