When a person enters the latter stages of their life, variety and personal choice can be forced to make way for necessity due to diminished cognitive and physical abilities.

Upon entering aged care, many residents find themselves at a point where they require assistance for the most basic of tasks, which is why opportunities that allow residents to exercise personal choice become vitally important to maintaining a sense of independence.

Time pressures facing aged care staff have been well documented in recent years, with the Royal Commission describing growing workload demands as “a barrier to the capacity of workers to deliver person-centred care”.

The morning period between 6.30 – 8.00 am is especially busy in an aged care facility with staff often being required to receive handover, read care plans, and locate equipment before showering and drying a resident and then presenting them for breakfast.

Recently, HelloCare was alerted to the fact that the task of showering residents had become a point of friction between night-staff and day-staff during handover.

The majority of online opinion from aged care staff revealed that facilities were not asking night-shift staff to perform showers unless it had been specifically requested by a resident or due to excessive soiling.

However, instances where residents who routinely shower early decide to sleep in or refuse their shower had resulted in growing tensions that have escalated into abuse.

Rules regarding consumer dignity and choice that are outlined in Aged Care Standard #1 clearly illustrate that showering times should come down to the choices of residents.

But is attaining this level of flexibility simply a matter of skill and communication, or are there simply not enough hands on deck?

Skills and Communication

University of Sydney’s Associate Professor Lee-Fay Low is a well-respected researcher, dementia expert, and aged care advocate.

According to Dr. Low, adjusting rosters to incorporate a level of flexibility for both showers and mealtimes may be the key to lightening morning workloads.

“Our experience from facilities offering residents their preference for shower times is that rostering may need to be adjusted so that showers can happen when residents like. It meant that staff on each shift have fewer showers to get through within a set period of time, said Dr. Low.

“It does need to be clear to all staff which elders will be showered in the morning (possibly very early morning or later in the morning say after breakfast) or in the evening. Rosters will differ from unit to unit depending on the preferences of residents there.”

“As an aside, putting in flexible mealtimes (particularly breakfast) and flexible shower times together sometimes helps with the logistics.”

With over 25 years of experience as a nurse and educator, Consultant Gerontologist, Dr. Drew Dwyer, is recognised as an expert in the field of aged care.

Dr. Dwyer’s thoughts echoed those of Dr. Low, citing communication and leadership from skilled nurses as a pathway to flexible shower times that could then ease the pressures being faced by staff in the mornings.

“This task is completely flexible to the whole workforce, and when challenged, there should be clinical leadership applied by nurses to direct the flow of the timelines and resources,” said Dr. Dwyer.

“One of the skill sets placed in the hands of the staff is to identify the outcome of assessments undertaken between the nurses and the resident which will outline the timeframes and usual or preferred schedule that the resident has asked to be recognised and followed.”

“The flexibility lies in the skill of the staff to identify that they also have the choice to change the plan and to change the timelines or needs for showing. Once the staff has managed the showering assistance, the task itself can be flexible to all shifts and times.”

Many Hands Make Light Work

As with health care, quality in aged care has been proven to be directly impacted by staffing levels. Sadly, Australia still happens to have one of the lowest rates of staff presence in the world amongst comparable countries.

When compared to international staffing benchmarks, more than half of all Australian aged care residents (57.6%) are in homes that have 1 or 2-star staffing levels (1 or 2 stars represent unacceptable staffing levels).  

Of the remaining 42.4% of residents, 27.0% are in homes that have 3 stars (acceptable), 14.1% receive 4 stars (good) and 1.3% are in homes with 5 stars (best practice).

Although an added flexibility to mealtimes and shower times would remove the deadline mentality that currently exists, the question still remains as to whether this would lighten workloads or simply add pressure to other staff members?

While few would argue that more staff are needed in Australian aged care homes, Dr Dwyer believes that the current lack of funding is the biggest hurdle that stands in the way.

“The funding allocation in the ACFI is not enough to meet the daily care needs of most residents and this is one of the major issues,” said Dr Dwyer.

“In general I find that when the nursing staff has been able to plan the amount of care in the plan, the resources are adequately applied.

“When there is a complaint from stakeholders that staffing ratios are stressed it should be examined by the nurses who undertake the resource allocation according to the assessed care need.”

“It should be the nurses who are clinically leading the advice to increase staffing when needed. It should be management that takes this leadership and adjusts things like rosters and timelines in collaboration with nurses.”

Dr. Low also believes that the Australian aged care sector requires more funding in order to increase available staff hours, citing government subsidies, additional resident fees, and fundraising, as possible solutions.

Aged care funding has always been a contentious topic in Australia, as pleas for more funding from peak bodies are often met with questions about the lack of accountability and transparency regarding taxpayers’ money.

Hopefully, Australians will one day see an aged care sector that is proud to show where its money is going, and a government that is willing to provide enough money that will allow providers to ensure that resident choice and independence can be a top priority.

 

Photo Credit – iStock – Lisay

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