Sep 16, 2020

There are simply not enough staff to carry out all the daily duties in aged care

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. 

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  1. Thank you Catherine Sharp and HelloCare for sharing the reality of what is happening in Aged care facilities. This was occurring in my last position in an Aged Care facility over 10+ years ago. The last position I held working in an Aged care facility . I also recall the wounds and leg ulcers and doing the wound round .Please keep raising the awareness of this issue , and I to hope it inspires improvements for staff and aged care workers . There is a saying in the Tradie world (Tradesmen) you can’t go to work and do the job unless you have the right tools . We need to be looking at how we can better support staff and make sure they are equipped with the right tool box .

  2. Aged Care should be the ones going out on strike for better wages and conditions. Where are the unions when they are needed for the Aged Care sector? All talk talk talk. If Aged Care were run by governments like our famous public hospitals we would have seen real change years ago. Nothing will ever change in this sector. Myself and others in the industry all agree that if we knew the conditions and even the wages before looking to work in the industry we would never have applied. Always had the belief that carers were respected and looked after but even this Corona Virus has become “the norm” and any gratitude from management is quickly dispersing. Just as short staffed as usual and expected to fill in the shoes of kitchen staff, laundry, Lifestyle etc etc. Now we have to wear not only paper masks all day and night but protective plastic shields as well. Label with out names. Family visitors have been caught out not wearing the masks when visiting behind closed doors while we low paid over worked AINs are forced to wear this blinding overheated garb when there is no evidence of the virus in our area and hardly any in the state!!

  3. I observed my mother in high care and there can be even more tasks than stated. Mum was burnt around the bottom due to pad left on too long and being fed so much roughage by my step father each day. At least double the staff is essential. Poor things. Bad situation.

    1. So sorry for your mum. There needs to be more supervision from the RNs incharge. This is half the problem. They are actually in charge of staff and are supposed to make sure the staff are doing their job properly. Particularly new staff.

  4. Sounds like Mrs Sharpe is a union rep
    Because no aged care facilities could even be open with two staff for the 40 residents she mentions.
    Staffing is based on what the government ACFI assessments detail not just the number of residents. aged care staffing is based on assessed care needs. If a resident is low care and can toilet and feed themselves why would a full time carers be fostered for that resident.
    Mrs Sharpe need to stop with the union ranting and base her comments on real assessed care need not just the number of resident.
    I woke in aged care and the worse staff are always the union care staff. Aged care is not a hospital.
    Fund ACFI correctly and more staff can be fostered on based on those residents assessed care needs.
    Frank the RN

    1. Of all the places that need staff to be in a union I would have to say the Aged Care industry is up there. I have never bothered with them but they are very good when something goes awry. Full of bias and often bullying from staff who don’t like their little world rocked when there are issues that are not dealt with within proper time frames. If at all they are dealt with. As a great Aussie carer of 7 yrs who stays back to assist residents when am staff are rushing to get showers done and where I could never go home unless I knew every one of my residents were cared for properly I find your comment unjust and unreasonable and possibly bias particularly if you are the RN you state you are. ACFI doesn’t make a difference when you have minimal staff and residents that can take 20 minutes or more to toilet when there are others needing your assistance at the same time. Even the independent residents are always independent on any given shift. Their needs are always changing from independent one day/night to needing assistance the other day/ night. I suggest you get on the floor and assist the AINs to get the experience you obviously need and get from behind your computer!

  5. did my nursing training2000 to 2002 in age care , then worked another 6 monts what i have seen and put up with still haunts me today, not enough staff and sometimes wrong staff just the tip of en iceberg

  6. ACFI has never given us more staff. It was always pushed down our throats years ago that if we all fill in the ACFI charts it means more staff for us! What a load of rubbish!! They actually cut staff shifts and hours at my place of employment. ACFI is the biggest con in the aged care industry. You can do all the ACFIs they want you to do but don’t expect more staff. You would have to have most residents on ACFI all the time not just once a year for behaviors and then hope all the new foreign staff actually know how to fill them in otherwise they don’t get done. Another thing that bothers me is the lack of supervision for new staff. We have mostly Nepalese and Indian at mine and the CMs are both of Nepalese and Indian culture. Which brings me to the truth about most aged care facilities. The bias. Unbelievable bias. When you have Indian and Nepalese working in a facility who are friends of the CMs it becomes a conflict of interest. Often they get the most work particularly on weekends over Australians who have been trying to get more hours. One of the staff has been caught on night shift sleeping while supposed to be relieving for others breaks with blanket and Indian food waffing around the ward. Yep! Sleeping on the job people. But nobody is game to say anything because of the relationship with others and CMs. So if someone falls during this time or a wanderer goes into another resident’s room who is left with the problem and the aftermath?

  7. Totally agree with above comments, ACFI is a joke and does NOT equate to more staff!,Not only are you expected to b dishonest in documentation, stating residents are worse than what they are it doesn’t change any thing !, in fact in one so called 5 star facility staff requested extra staff to help with work load in evening ,short shift and was denied manager stating the 2 rostered staff needed to help each other more and mayb staff could be taken from other levels, which then means those staff become shortstaffed!!!, makes complete sense , not,!? Hap p ens all the time , and most staff are not in unions!!, a lot are on visas and don’t say boo!, which has led to a lot of problems on t he floor, aged care needs a complete overhaul and owners, ceo’s made accountable

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