The morning shift in aged care facilities is a whirlwind of activity, where every minute is fraught with competing priorities. As the sun rises, so do the demands on aged care staff: residents need to be roused from sleep, medication schedules need adherence, and confused residents may wander, requiring immediate attention.
On top of all this, call bells ring persistently, each signal an unknown quantity of urgency or need.
In this chaotic environment, one critical question arises: is it ever acceptable for aged care staff to leave a resident sitting on the toilet while they attend to a call bell request from another resident? To address this, we spoke with an experienced nurse who has spent decades in the field, offering invaluable insights into this challenging dilemma.
According to the nurse, the morning rush can make coordinating care incredibly difficult. “If you’ve got a resident who is a two-person assist, you need a transfer hoist and you also need a colleague to help.”
“Finding a colleague who can help in the morning can be a nightmare. They can be doing any number of things, including showering others. Meanwhile, while you are trying to transport this person, some other poor resident is forced to stay sitting on the toilet.”
The dilemma of prioritising care becomes apparent: should staff address the needs of a resident who has been waiting by the call bell, or should they stay with a resident on the toilet?
The nurse explains the difficult position this puts staff in: “That puts staff in a position where it’s like, ‘Well, what do I do? Do I go and see Mrs Jones who I know pressed her call bell 5 minutes ago, or do I stay with this resident on the toilet?’”
The answer is not straightforward. According to the nurse, each situation requires a careful assessment of the resident’s needs and safety. “You have to assess the individual situation. If you know you have a resident that is a bit more self-sufficient and cognitively intact, you probably have the option to say something like, ‘Do you mind if I leave for a couple of minutes to go and check on someone else who rang the call bell? So that I can assess that they aren’t injured or in desperate need for something and then make sure you follow that with the reassurance that you will be back shortly.’”
However, the situation changes if the resident on the toilet is at a higher risk of falling or other accidents. “If the person you’re assisting with toileting can’t sit safely in a commode chair and is at risk of falling forward or over the side, then it’s not appropriate to leave that person sitting on a commode chair or toilet to assist someone else. You have to weigh up the risks.”
In cases where staff are unable to remain with the resident on the toilet, the nurse suggests a few strategies. “First thing is to try and call a colleague and let them know that you’re with a resident who is on the toilet and you can’t leave them, and ask if they can assist the resident that pressed the call bell.”
Despite these efforts, the reality is that some colleagues might be unable or unwilling to help. “To be honest, there are some who say no just on principle or deliberately ignore your calls. It does happen.”
The broader issue is the pressure on staff, particularly those new to the role, who may feel compelled to prioritise call bells over the immediate needs of residents.
The nurse explains, “It’s common sense, but sometimes, sense isn’t as common as we would like. New staff, in particular, can feel a lot of pressure to avoid mistakes because the sector is so regulated. One bad mistake or multiple smaller mistakes can have dire consequences. It also impacts funding that the provider receives.”
One often overlooked pressure is the scrutiny over call bell response times. Families can complain if they see a long wait time without understanding the context, such as having to manage a fall or assist multiple residents.
“This creates a scenario where some staff—particularly new staff who want to make a good impression—can feel like, ‘I need to turn that buzzer off. If I don’t attend to that bell, I’m going to get in trouble. I’m going to leave that person on the toilet and they’re possibly going to fall off, but at least I’ve turned that buzzer off because then I’m not going to be in trouble.’”
So, how can this problem be alleviated? The nurse suggests that improvements in organisational understanding and support are crucial.
“It comes down to having an organisation that understands how things actually work on the floor in their homes and trains them to make those decisions without fear. It’s also about having a real team environment where people help each other. You’re trained to help your colleagues who, in turn, help you when the need arises. It starts with leadership and mindset.”
While there are no easy answers in the demanding world of aged care, a balanced approach that considers both immediate risks and overall care priorities, along with a supportive team environment, can help navigate these tough decisions. The ultimate goal remains providing safe, respectful, and compassionate care to all residents.
I think AI will help in many situations. Currently being trialled in SA.
Not detracting from human staff but a nice balance for comforting all round solutions.
Media reports that AI piloted in two aged care homes in Adelaide was scrapped due to 12,000 false alerts.
Nina Martin
Wonder why a nurse was asked about the duties of personal care staff, which are not nurses?
Interesting. Call bell pressure has become a priority in the Aged Care where I work. But as the article indicates sometimes it is not possible to answer a call as you attend to someone on the toilet who needs supervision plus your colleagues may be attending to a resident who requires two people. Everyone an be on the other side of the facility. And you can’t ring the emergency bell .Who else can answer that bell. It could be the RN who may be with a doctor, physio, attending a fall etc or maybe they just don’t answer bells. It happens. The EEN is doing meds and cannot leave their trolley. So who assists? Also what I find happens is that you attend a high falls risk resident but you often do not turn the call bell off immediately as you need to get that resident to a safety position first, be it the toilet. chair , bed etc It takes time and the bell continues to ring, management ask why? Because RESIDENT SAFETY is the top of all priority. Management need to get to the floor and see what actually happens, better still, indulge in doing part of a shift to reach out to what really happens on the floor. It happens in the PM shift too not just AM. The most unfortunate position is when you are with a high risk falls person on the toilet who will get up if you are not there and a call bell rings and they are also a high falls risk, probably already up and on the move. What do you do? Firstly don’t blame the staff! RN, DON and CCC access what is going on on the floor!
This is a “damned if you do / damned if you dont” situation that happens daily.
The pressure to attend to “everyone” at the same time is ridiculously overwhelming with current staffing ratios & unrealistic expectations by residents, families and government agencies.
Mornings are not the only “high traffic” times, it is often forgotten that basic human needs by the many, is the main contributing factor
a) residents waking from 4am onwards, when night staff are already attending to regular comfort rounds and staffing is at a minimum
b) pre-breakfast demands to be assisted is at its highest, with many residents insisting their need supersedes others;
c) breakfast itself is demanding with many residents requiring delivery of meals, assistance with meals, supervision & assistance in the dining room and often staff are also required to assist with meal prep and service itself
d) post-breakfast is the next rush to complete personal cares not already attended to
> while staff attempt to afford themselves the luxury of a toilet/meal break for themselves (therefore less staff on the floor to assist residents or answer call bells)
> this also includes the needs of additional toilet assistance that is a result of breakfast
e) this leads straight into “Moring Tea” rounds of room service, room assistance and dining room assistance
f) now lunch is looming with staff required to have completed the morning cares, take their breaks & be back on the floor in time to now assist residents back to the dining room for lunch with many needing toilet assistance first
g) Lunch is a repeat of breakfast….. returning residents back to their rooms for more personal cares
h) maybe by 1.30pm there’s a bit of a break where staff are required to complete all related documentation for each resident for the day, usually with reduced staff as some shifts finish at 1pm while a couple remain to 2.30 or 3pm….and don’t forget the call bells
* Dont forget, these staff are also required to change/make beds; clean/tidy rooms; attend to laundry/rubbish runs; supervise/special residents with challenging conditions/behaviours; and still be available to lend an ear to residents or family’s; encourage, reassure, comfort, entertain and SMILE, then…..
i) the next rotation comes on at approx 2.30-3pm do basically do it all over again in reverse
At the end of it all, the Royal Commission did nothing to assist staff provide the care they wish to give and staff certainly do not get paid appropriately for the work & care they give. There’s just more pressure to tick the boxes the Commission created with more & more disheartened & tired staff.
The above still doesn’t even address the registered staff and care managers pressured roles in all this, while supervising / caring for their staff (I haven’t even mentioned the other important staff – Lifestyle, Catering, Cleaning, Laundry, Maintenance)
It’s a vicious cycle of never ending dissatisfaction as our populace lives longer, demands more & cares less because its always someone else’s responsibility.
At the end of the day, this service is a business, so WHO are the winners here?
JUST GIVE US MORE STAFF & PAY and YOU’LL FIND WE WILL STAY
I would have thought you could leave a person on the toilet. Still, while I was a student doing placement in a nursing home many years ago, I accompanied a staff member to assist a resident to the toilet and left her there to give her some privacy and make her bed. The resident became confused and tried to get up from the toilet herself resulting in a very serious fall. Now I would be very reluctant to leave a person alone.