Should Aged Care Staff Leave a Resident on the Toilet to Answer a Call Bell?

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.