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 have 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).
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).
The 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 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.
Well done to all aged care staff – I truly admire you. I know the workloads you have every shift.
Catherine Sharp is the Founder and CEO of The Wound Centre®. The Wound Centre® provides wound care/infection control/pressure injury prevention/management and education through the free Wound Centre® Visit website: www.thewoundcentre.com.