There is simply not enough staff to carry out all the daily duties in residential aged care facilities. Not having the necessary number of workers to care for the elderly means essential care is missed.
I will start by describing a morning in a RACF that I don’t believe has ever been documented in any detail. Just as an example: The first thing (all) people want to do when they wake up in the morning is 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.
Many are woken at the crack of dawn (although I do not know why they are woken at all) to be showered. 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 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 must 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 sets of 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 20, 30, 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 even 10 residents.
This routine of toileting, pad changing and hand washing, is repeated before every meal. Then, at night, hearing aids and dentures must be removed and cleaned. Toileting, pad changing and hand washing is repeated.
I am an aged care, wound care, Registered Nurse (RN). I have been in about 300 RACFs and many private homes since 1997 to see residents with wounds and advise on clinical care and infection control. I have watched them working. I have fed residents when I see that two staff simply cannot get around all the residents who need to be fed (and we wonder why some are malnourished).
I have discussed this with RACF managers and doctors in one Division of General Practice. I have expressed my overwhelming concerns to them. I have written to the Royal Commission about staffing levels. I spoke at the Royal Commission hearing in the Darwin Supreme Court last year — on another aged care matter.
I am so frustrated because I feel ‘ratios’ need to be discussed in the context of what care staff must do each shift. They cannot get everything done. Dentures alone can take 20 minutes to remove, clean, re-insert in one resident’s mouth when they have dementia.
Catherine Sharp wrote these words in response to a HelloCare article about staff ratios. You can read the original article here: ‘Will Aged Care Staff Ratios Be One Of The Outcomes Of COVID-19?‘ Ms Sharp has been a nurse for more than 50 years, and is now a wound specialist, consulting widely around Australia. She has visited more than 300 aged care facilities over the course of her career, and has in-depth, first-hand knowledge of the pressures facing aged care staff. We have republished her comments with her permission to demonstrate the huge challenges that aged care workers face every day. We hope to raise awareness of this issue, and, by doing so, we hope to inspire improvements for both workers and aged care residents.