Imagine being in a deep, restful sleep, only to be jolted awake in the early hours of the morning by a staff member insisting that you must get up for a shower. You are disoriented, exhausted, and have no choice in the matter. For many aged care residents, this is not an occasional disruption – it is a daily reality.
In some aged care facilities, residents are being forcibly woken as early as 5 AM to be showered – solely for the convenience of staff. This practice is not just unethical; it is a form of institutional abuse that violates the dignity and autonomy of some of the most vulnerable members of society.
The justification for this practice varies. Some facilities have long-standing routines that mandate residents be showered before breakfast, while others enforce it to lighten the workload for morning shift staff.
Regardless of the reasoning, the outcome is the same: residents are deprived of their right to sleep and their basic autonomy is disregarded.
Sleep deprivation is well-documented as a serious health concern. Research from the University of New South Wales has already highlighted how another common aged care practice – repositioning residents every two hours to prevent bedsores – can cause severe agitation and distress, disrupting natural sleep rhythms.
The researchers describe this ongoing disruption as “unintentional institutional elder abuse.”
The Australian Journal of Ageing has published findings demonstrating that disrupted sleep patterns in aged care settings contribute to behavioural and psychological symptoms of dementia (BPSD), including agitation, aggression, and increased confusion.
Given that a significant proportion of aged care residents live with dementia, it is imperative to adopt care models that promote natural sleep cycles rather than disrupt them for arbitrary routines.
Physically, sleep deprivation can lead to weakened immune systems and slower recovery from illnesses, making elderly individuals even more vulnerable in aged care environments.
According to the Sleep Health Foundation, adequate sleep supports cardiovascular health, metabolic function, and overall quality of life. When residents are woken prematurely for showers, their body’s natural circadian rhythm is disrupted, leading to grogginess and increased fall risk—a particularly serious concern in aged care.
Many aged care workers argue that they are simply following procedures. Some report that they are pressured to complete tasks as quickly as possible, fearing backlash from the morning shift if showers are left undone.
In an online aged care worker forum, one worker candidly admitted: “We have to wake them up. Thought it was the same for all facilities. Always has been in my 15 years of nursing. Wake up, shower before breakfast.”
Another stated: “If not done, day staff would complain to the manager.”
But while staff shortages and high workloads are legitimate concerns, they do not justify mistreating residents.
The fundamental issue is that the system prioritises efficiency over person-centred care. If staffing levels were adequate and care minutes properly allocated, there would be no need to wake residents at inhumane hours.
Some aged care providers are already moving towards more ethical, resident-focused models of care. Facilities implementing the “homemaker model” allow residents to wake naturally and shower when they feel ready, rather than adhering to a rigid schedule designed for staff convenience.
One aged care worker described the benefits of this approach: “Residents can cook their own toast and make their own coffee in the dining room. Staff assist them as they wake up, rather than forcing them into a one-size-fits-all routine.”
This model fosters independence, respects personal preferences, and aligns with basic human dignity. It is their home – we merely work in it.
Aged care reform must address the cultural shift required to eliminate these outdated and harmful practices. In countries such as the Netherlands and Denmark, aged care models prioritise individual autonomy, with residents deciding when to wake, eat, and bathe.
Studies from the European Journal of Ageing suggest that such approaches result in higher satisfaction among residents and lower stress levels among staff.
Australia has made great strides in recent years, with fewer and fewer homes opting to wake residents for showers. However, there needs to come a time when this practice is no longer an option at all.
The question is no longer whether we should change this practice, but why it is still happening in the first place.
Sound great I worked many years in care here and the UK, and yes we shower before breakfast but for one nursing home in the UK and it worked well
I did night shift and the frist word out of the morning shift coming was how many are not coming in day
I had an interesting conversation recently with a facility manager who said that HCA’s often speak of “a good worker” or “hard worker” and unpicking that meant that it was someone who got all their “tasks” completed in their shift, including showering people etc in the morning shift. My feedback is that there is 24 hours in a day and there are no written rules or guidelines that state that everyone needs to be awake by 7 and showered and dressed by 9-this is such an antiquated way of working and does not out the person first..similar views are held that all people should be in bed by 8.30 as it convenient for staff..I believe some of this is driven from managers and how the managers measure what a successful or good day looks like and also a benchmark that care staff measure themselves and others against..if we measured a good day by promoting meaningful engagement, focusing on supporting emotional needs as opposed to tasks, then imagine how much happier everyone would be..
I think it is nothing to do with organisations adopting the Homemaker of care which has mixed research results on its success.
Why not go back to what will ensure quality of life, independence and wellbeing, what seems to have been forgotten “person centred care”
Ok, that’s great… but what happens when a resident is no longer able to make decisions about having a daily shower, or even every 2, or 3 days?
What about when it’s been 3 weeks, but the resident doesn’t remember and their skin is starting to react, they’re getting sores, but they still don’t want to have a shower?
I understand everyone should be consulted about the time of morning they wish to get up and if and when they wish to wash, and their rights to have individualised care which is safe and right for them… but where does the Duty of Care of a organisation, caring for people with high care needs, come in? How does this work in memory support care when residents are no longer able to make safe decisions for themselves?
Residents are coming into long term care facilities with higher physical care needs, less mobility, higher frailty and a lot lower cognition – all owed, I believe, to the general stigma and media hype of being “locked up in a nursing home until they die”. I feel this article neglected to approach this side of the equation and a lot of nursing home facilities are in the same predicament…
I think this is one of the questions anyone going into residential care needs to address. For people seeking quality for their loved ones, to ensure that they are treated as autonomous people rather than tasks to be completed is their right. If you’re not ready to rise at 5 am (and not many are) then your wishes should be respected.
I recently attended the funeral of a friend who had been an aged care resident for many years and her nursing staff and the manager of the facility attended and explained that they were part of her home and that each resident is regarded as part of the “family”. They had come to say goodbye. That is what most people would want from a care facility and doesn’t suggest a regimented harsh routine that forced someone who was gradually losing her grasp on reality to march to the beat of their drum. There were days when she did not get showered until the afternoon and as long as her hygiene needs were attended to she was allowed to call the tune.
My friend had chosen her own care home and she chose well.
The same unintentional abuse is waking up the elderly for early breakfast. My mother always had restless nights at home so was not an early riser. When she went into aged care, that pattern continued. She used to have her eyes closed in the early morning when breakfast was brought around. Staff would feed her with her eyes closed in the bed. When I showed concern about feeding her not fully alert I was told “it’s ok because she can open her mouth for the food”. No concept whatsoever about the potential for aspiration pneumonia. There is so much wrong with timetables in aged care facilities. We know staff are under time restrictions with too few staff and too many jobs to do but surely, a better way can be found.
I recall when I was a student having very heated conversations with the nursing managers about just this type of abuse. It was all about “proficiency”. A high percentage staff were rostered on from 7am for a four hour shift, after that skeleton staff were employed, plus students (unpaid I might add). When a 102 year old lady just wanted to sleep longer – I was told to get her up and get her in the shower. As a student and unpaid, I was working all day, so I refused to get her up and I showered her later that day – she was so happy.
I always thought I would not pass my course and would receive a bad review, but I did and now own my own home care business where we really do put the consumers first.
No resident needs to be woken and turned if they are on an electric bed. The research was done many years ago to prove that tipping the bed up 11 degrees and then lowering it back down every 2-4 hours will take pressure off of points. And this only takes one nurse. This can be done without waking the resident.
When a person enters a Facility they fill in a Care-plan listing their personal care requirements, diet and personal care. Most clients want a shower in the morning which would mean a smaller amount in the evening would be required. Some clients claim “I haven’t done anything today so I am not dirty and requiring a shower”. We remove their right to decide not to shower every day, they may only require a ‘personal wash’ instead. Yes, it may require the same amount of time but it is their ‘home’. Client Driven Care is the claim of Aged Care, needs to be put in to practice and if not it needs to be reported. The funding may be tight but don’t make claims that you aren’t prepared to fulfil.