The management at the nursing home I visit has decided that having a registered nurse on duty is a luxury it can no longer afford. 

They now think it is enough to have an RN on call. This one person, who does not need to be on the premises, is responsible for the health and well-being of 30 high care residents and approximately 150 low-care residents.

I am outraged - even though I know that this is the practice in many places. And even though I know that the Aged Care Act uses weasel words about staffing – more or less allowing anything, along as it is ‘adequate’. Who knows what that really means when it comes down to it?

It is hard to figure out why, when the care needs of those in residential care are higher than ever before, the staff cuts just keep on coming and coming. While it might cost less for one particular aged-care to employ fewer skilled staff, the cost to us all as a community is greater. Now every time someone coughs, or has a minor incident, off they go in an ambulance to the emergency department of the local hospital. And you can’t blame the carers for that. They are left carrying all the responsibility and don’t want to take risks and be found liable if things go wrong.

Then there is the question of giving out the pills. In the past, this has generally been regarded as a task that has required some knowledge of the medications, the condition or illness being treated and possible side effects. Recently, the Victorian Poison Information Centre reported on a study involving 97 nursing home residents and over 600 people living at home. It was found that there was a significantly increased rate of medication error in nursing homes. The report suggests that this is because of a range of staffing issues - such as carelessness, distraction, staff not following standard procedures or being unfamiliar with the patient.

It is not as if there are heaps of clinicians regularly visiting our aged-care homes. It is often hard to find doctors who will provide the care needed by vulnerable residents. This comment says it all.
‘GPs no longer visit RACFs with good reason, because there is no remuneration, because of the red tape and because their medication systems are just incompatible with primary care.’ 
People living in our aged-care homes need more care – not less. Where are the physiotherapists, the music therapists, the psychologists, the occupational therapists, the dieticians, the massseurs and the other allied health professionals who could greatly improve the lives of those we send off to nursing homes to live out their final weeks, months or years? It should also be noted that there is an increasing number of younger people in our nursing homes – who generally need very high levels of care.

How to account for this widespread devaluing of human life? All I can think is that being old and frail is a journey most of us have not yet undertaken and one we prefer not to think about.