Abstract:  This letter was sent to www.agedcarecrisis.com for inclusion on the website.  To protect the anonymity of the author, name and other specific details have been removed.

TO WHOM IT MAY CONCERN:

I am a an RN (Div 1) working in an Aged Care facility in Western Australia. We have (approx. over 100) number of beds divided into areas, one of which is a "locked" ward for residents with severe dementia. I have been at this facility for 2 years which has left me totally disillusioned with the whole Aged Care system.

I work in the "high level care" section of the facility, therefore I am aware of the need for strong advocacy for the residents in my care. Over recent weeks I have spent time researching the problems in Aged Care on the internet.  However, even prior to this, I was well aware that the Aged Care system is in crisis and has been for a long time.

The most abhorrent thing I recently discovered is that when the Aged Care Act was reformed in 1997 there was no legislation passed for minimum staffing levels - a dastardly crime perpetrated by those who drew up the new act giving open licence to Aged Care providers for abuse and neglect of the elderly and infirmed!
 
It has been said that "a fish rots from the head down".  Abuse occurs in exactly the same way! It starts with the Aged Care Act, which is then "interpreted" by the owners of these facilities for their own selfish pursuits, which is then handed down to the Chief Executive Officers, who in turn hand that down to the Directors Of Nursing (DON's) and Clinical Nurse Manager’s (CNM’s) - from there it is passed on to the Registered Nurses (RN's) and Assistants In Nursing (AIN's)…

And who is at the "bottom of the pile"?  The aged residents and their families of course!  People who have paid their taxes for many years, including the families who contribute to the financial and physical upkeep of their loved ones in the (misguided) belief that they are valued members of society.
 
Much fuss has been made about physical abuse in recent times, but there are many things that constitute abuse, which are perhaps more subtle, but non the less impact on the level of physical abuse and neglect occurring in Aged Care.

Working as an RN I am able to see the bullying that occurs from the "upper level" management - DON's and CNM's are told to cut staff numbers - this includes:

• staff cutbacks - RN's, AIN's, domestic staff (catering and cleaning) to reduce the wage bill;
• supplies (eg dressing materials, catheter drainage bags etc) are cut down to a bare minimum;
• food items are poor quality and "rationed";
• incontinence pads are obtained from the cheapest supplier and are "rationed" (and we are told this is called a "continence management program");
• bed linen is tatty, torn and short in supply;
• residents are denied services such as Physiotherapy and Occupational Therapy from within the organisation.

Then there are services denied from external providers, such as Speech Pathology, because it costs $60 per visit.

We have a Physiotherapist who works approx 3 days per week to cover xx number of residents, at present we have no Occupational Therapist (OT) on site, and 2 Occupational Therapy Assistants (OTA’s) for all these residents, however one of them works solely in the Dementia Unit (approx 40 residents) so one OTA is left to cover the remaining approx. 90 odd residents. 2 years ago there was a full time OT and 5 OTA's.

Residents left sitting alone in a room all day without any physical and/or sensory stimulation constitutes abuse by neglecting their needs.  Residents without regular access to Physio are left to sit immobilised and have their muscles shrivel away, which then leads to greater needs for care.

The AIN's with their limited training and hugely increased workload, are told they should be walking residents daily and doing passive limb exercises.

There are not enough AIN's to adequately and safely provide quality care. The Agencies are unable to provide AIN's to cover all the "gaps" in our roster.  This means we are working "short" most days - we try to get our regular staff to come in to work on their days off - this creates more problems, as those staff have worked short on their rostered days, then come in on their allocated time off to still work short.  Then the "upper level" management steps in and bans "overtime" because it costs too much. 

The "good" staff are leaving in droves - often due to conflict with the DON/CNM when they have spoken up about their disillusionment and they are branded "troublemakers" or "incompetent and inefficient" when they are simply being human and humane!

New staff are assured they will be "buddied" as part of their orientation - they are more often than not simply thrown in at the deep end.  Unfortunately, most of the AIN's have poor advocacy skills for themselves and are left to cope however they can.

I am constantly in awe of the devoted AIN's, but unfortunately they are becoming few and far between.  For a period of 2 weeks last year I was asked to supervise "new" Cert 3 trainees (the organisation I work for is accredited for training).  They will literally take anyone who "comes in the door" - so needless to say I stated my views on this and declined a further offer to supervise any other trainees due to their gross unsuitability.  I was supposed to "ignore" the fact that some could barely speak English and therefore I was expected to fill in their work books for them and tick off all their competencies - even if they had no comprehension of what they were supposed to be learning. 

The fact that I voiced my opinion and refused to be a part of this process may have made me feel better, but it has not stopped the droves of trainees from overseas countries pouring into Aged Care, and I have been told that their residency visas will be granted quicker if they work in Aged Care.  If this is actually true, then what a great incentive that is!  Whether they work for "us" or one of the Agencies, they consistently turn up late or not at all, are often not adequately trained or experienced and I have put in complaints to one Agency recently to "ban" some of their AIN's from our facility, knowing fully that we may be once again working short due to an already acute lack of agency staff. 

Failure to adequately "vet" and train AIN's contributes immensely to the problem of abuse and neglect.

We have a former AIN at our facility who recently completed studies in Psychology and has returned to work as a "Counsellor/Educator". With all the "hoo hah" about Elder Abuse he ran a series of workshops for staff and asked me for my input afterwards. On that same day a notice had been put up in several prominent places stating that our bread order was 3 times higher than other facilities (who I might add have less residents), then went on to allege that this was due to staff stealing resident's food.

Also, another notice to all RN's that if any staff cancelled a 7am - 3pm shift, they were to be replaced by Agency staff but only from 7am - 1pm.(I have copies of these notices).  I pointed out to him that the REAL source of abuse was coming from the "upper level" management.  Staff are being accused of stealing from the residents and residents are being denied 2 hours of care when agency staff are booked for less hours. 

In fact, on a daily basis residents are being denied care due to staff shortages. 

When I complained about this several months ago I was told by our CNM that we are better staffed than lots of other facilities - my response was that I didn't believe that justified our facility dropping our standards down to their level.  Strangely enough, when the Accreditation team attended for 3 days recently, there were AIN's "coming out of our ears"!

I am lucky that I can "speak my truth" and not succumb to the bullying behaviour - our CNM quickly gave up reprimanding me for not doing my "RCS paperwork" when I told her that I was employed as a Clinical nurse and that my first responsibility was to ensure I attended to the Clinical care of the residents , secondly to the wellbeing of the AIN's under my supervision, thirdly to my fellow RN's and the "bean counters" came last.  I might add that all my previous nursing experience was in Acute care and Remote Area nursing, and I was given a 10 minute "orientation" from another RN on RCS documentation. 

After 2 years I am slowly getting the hang of it and it is incredibly time consuming.  I wouldn't mind so much if the paperwork actually reflected the appropriate level of care and staff required to deliver it for each resident.  Doing the RCS paperwork appropriately would directly contribute to abuse and neglect by me if I happened to prioritise it, as in order to maximise the claims for each resident I would not be able to complete my clinical work in the hours I am allocated for each shift I work. And as far as I am concerned, this includes attempting to meet the emotional needs of residents, and not just forcing pills into them. 

I have been told that before I started work at my current facility there used to be a Clinical nurse and another RN on duty in my section.  I am relatively fit and active for my age, but I am not a robot and I can only do the work of one human at any given time.  Other RN's that do succumb to being told that the RCS paperwork comes first are under great stress, due to inner conflict and torment over their priorities, not to mention being constantly reprimanded, and they usually leave (and sadly find it is the same elsewhere).  The AIN's have also been given more paperwork and other chores, while having their shift hours shortened.  They can only do the work of one human as well.

Our DON left a few weeks ago, due to the pressure exerted on her by the Regional Manager and CEO, and confided to me that she was regularly subjected to intimidation and verbal abuse from them.

In the interim, our CNM was left to cope with her own workload plus the DON's workload and she unfortunately left 2 days ago, also confiding to me that she was subjected to ridicule and abuse from the same sources as the DON was, and that she and the DON had been accused of "hiding" staff (ie; having more staff than were listed on the roster) because the wages bill was too high.

I have no direct criticism of our previous DON or CNM, as I am aware of the problems they encountered, and they did what they could under the circumstances.  We now have no DON or CNM. 

I had the opportunity to meet with the Regional Manager and the CEO's "cohort" earlier this week, related to the alleged physical abuse by an AIN, and I put forward my views on the abuse and neglect of the elderly directly attributed to the need and greed for extra profiteering by the corporation who own our facility and several other facilities in WA and other states.  I informed them that we were often short of staff, to which they replied that we were in fact overstaffed.

I then asked them to explain to me why I had one less AIN on my shift that morning and also had one less AIN on my shift the day before, and that if they checked the DON's communication diary I documented each time we were working short - sometimes 2 AIN's short, and so were other shifts.  Needless to say they were both speechless and looked most displeased with me, and I left the office disappointed, but satisfied that I had my say.

So how do I stay sane through all this and why do I stay?  Good question!  I am not at all "religious", but I use the "Serenity Prayer" on a daily basis and sometimes on an hourly or minutely basis while at work!

After 31 years of nursing I have a highly developed "nurse's sense of humour" which is a great coping strategy, but does not solve the problems at hand.   I am very lucky to work with some delightful colleagues who share my passion and conviction that some day someone (or something eg; GOD for those that have that belief) in a position of greater power than my "mortal" self will intervene.

I am writing this after much deliberation and inner torment. I am doing whatever I can to empower myself and the staff I work with to TRUST that we are all doing our best for the residents every single day, regardless of the circumstances, and we need to appreciate ourselves and our values, regardless of the attitude of disdain from the "management sytem".

I am truthful with the families of residents who have genuine complaints, and I encourage them to speak out, but they fear that this will be misconstrued as a criticism of the staff.  For the most part, the relatives are very appreciative of the care given, and when they express this to "management" the "management team" interprets  this as a "pat on the head" and therefore does nothing.  Yes, there are also relatives that are acutely critical and abusive towards staff members (usually due to their own sense of inadequacy and powerlessness to be able to personally care for their loved ones themselves) but unfortunately when these people report to "management" their complaints are used to threaten and intimidate workers, leading to more stress and anxiety in the workplace.

I know the problem is ENDEMIC.  I talk to other RN's and AIN's who come to work with us from various Agencies - they assure me it is actually MUCH worse in other facilities.  Am I supposed to just simply say "OK, well I won't complain about our facility then".  I have no idea who is going to read all of this. 

I have expressed my views in writing on the routine "satisfaction" surveys put out by my employers - 90% of the staff I work with say they have put forward strong views as well (due to the surveys being "anonymous"). 

However, I have seen the published results of these surveys which claim that overall 90% of the staff are very happy in their workplace! I have expressed my views verbally to many people who agree with me, but stay silent.

I have friends who work in other professions (some are RNs in Acute Care) who are horrified by the lower wages paid to RNs in Aged Care.  I am horrified that AINs are paid an insulting wage for the care and devotion they provide to our elderly. 

Why are our elderly so undervalued in our society and treated as though they are lepers and/or parasites, and why are those who choose to provide care (including family members who provide care at home) also undervalued?

So who can we trust to look after our elderly?

If you are reading this, be aware that you may have a loved one in care and you may also need this yourself one day.

Will we end up with trained robots looking after us on a production line?

OR perhaps (shock, horror) drug addicts who are paid with cheap cocaine/other drugs because it might be easier to obtain than paper money, which seems to be such a precious commodity for the owners of aged care facilities?

OR will our government implement a radical euthanasia law to totally wipe out members of society who are deemed "unproductive"?

I will keep a copy of this correspondence, and will encourage others to do the same as I have done. 

There is nothing to be feared by telling the truth, and unless the truth is told nothing will ever be done to create change.  Speaking up now absolves me of any sense of further perpetrating the Aged Care crisis by remaining silent.

Yours faithfully,
Anonymous.
28 June 2007