One day this week mum found that the only carers available to her that morning were two 19 year old girls. She was aghast! How could they at their young age be expected to look after 28 elderly, including 4 who needed two staff to be hoisted to sitting, or to the toilet. Both had only been working as carers a short time, and had not done the morning shift in her section before.
They were lovely girls, she said, enthusiastic and willing, but that’s not the point. Admittedly they had been scheduled on with an older more experienced carer, but that person called in early unable to attend due to a sick child. The more experienced carer was not replaced, leaving the two young girls to manage the morning shift for 28 people between them. Mum feels more comfortable with mature women carers, as she can develop better friendships with them. She doesn’t have much in common with the younger ones, and building a friendship is important as carers are her main contacts on a daily basis.
When mum queried why there was no third person brought in to be part of this busy shift with the Director of Nursing (DON) a while later, she was told that all staff were getting experience across all the teams so they could go wherever was needed. The DON was proud of not having to resort to agency staff for some months. This sounds great, and very efficient from a provider’s point of view. You would want a team of well trained staff that you could move around as required. But is this what is best for residents?
This was not the first time a missing staff member had not been replaced. It had happened a few times lately. And mum is very aware of the impact on the staff where she lives as they already seem to be stretched to the limit. Whether its morning, afternoon or evening shift, being short staffed would make it extremely stressful for the carers and this has a ripple effects on the residents and the care (or lack there-of) that they receive. Unlike other jobs, some work cannot be left not done because they are short staffed. People still need to be fed, toileted, changed from or for bed, and rooms tidied. And that’s when things get forgotten, especially if its new staff.
Like the time a week ago when I was woken to a phone call at 4:30 am, with mum very stressed and asking me to call the front desk for her because the call button had been left out of her reach, and her walking frame was not left where she could get it. After edging along the bed to reach her phone she had been trying to call the office, but she could not get through. She desperately needed to go to the toilet. It turns out she had been inputting a wrong number on the phone in her panicked state and without glasses, with one digit incorrect. I called her back after successfully contacting the on duty nurse at the front desk, and I learned later that a male carer arrived after about 5 – 10 minutes.
She asks for a female carer, (she has a right to request a female to care for her) who they needed to get from high care. The carer who came was not familiar with her routine. By this time she has been sitting on the edge of her bed for half an hour, in her thin nighty, getting colder and more upset by the minute, feeling helpless and hopeless because she cannot do this for herself. She tried to explain the situation over the last half an hour to the carer, and then has to explain step by step how the carer could assist her with her toileting. The carer complains that she is not happy. It is true, she tells me later, I cannot be happy to please her, especially in this situation.
Once back in bed it takes her half an hour to warm up sufficiently to be able to sleep again, but the upset about the bell not being put within her reach, and being told to be happy warrant a report to the DON the next day. The bell not being placed within reach can be put down to inexperience, but that’s not an excuse. There will be more and more inexperienced staff as they are moved around to ‘get experience’. For people like mum what she needs is consistency of staff who become familiar with her routine, and the alternative of moving staff around will mean they provide care to her infrequently, and are not likely to remember her routine. This means she is less likely to get the care and assistance she needs, and there is more chance of her again being left unable to access care via her bell when she needs it. I may get more calls such as this in future.
Reporting this situation is not likely to change anything however, and it is possible that things could get worse. With the government withdrawing money for more complex cases such as mums, combined with the inbuilt incentives for providers to encourage dependency as it gets them more money and more profits, embeds a systemic imbalance between money and quality of care. Staff and clients will be more and more squeezed to maintain profits, in the opinion of industry analyst Michael Pascoe. See and listen to Aged care staff set to pay for government crackdown.