Dear Minister Roxon
Saturday, 17 April 2010 08:50  |   Print page:Print

The following letter was sent by a concerned daughter whose mother currently resides in a nursing home, to Minister for Health and Ageing Nicola Roxon, in an effort to raise their concerns about lack of staffing ratios and skilled staff working in aged care, as well as the lack of care. As well as providing a first hand view of these issues, the author has also provided some practical views on resolving those issues:

Dear Ms Roxon,

I am an Occupational Therapist with extensive experience in the care and management of elderly individuals. My professional skills and personal experience allow me to comment with some authority on some of the current problems existing in the nursing home management of the elderly.

My elderly mother who has dementia has been in a nursing home for a number of years. Over this time I have needed to be constantly vigil to ensure that she gets the correct care and good nutrition. On two occasions I have prevented her from dying of drug toxicity.  The professional staff were incapable of observing this and acting appropriately.

The daily care in nursing homes is largely delivered by foreign students who have very limited English language skills and a very low level of training.  A new staff member is often trained by the existing staff who are so poorly trained they don’t know they are passing on the wrong information.

Do we have so little care and respect for our elderly that we allow people to walk in off the street, manually handle and make clinical judgments about their welfare?  The most vulnerable people in our society are nursing home residents with dementia.  These people are not able to make their needs known, if hurt they are often unable to react.  I have observed that incorrect manual handling of  an individual is often the cause of iatrogenic injury to that person.

Currently there is little or no continuity of care for residents in nursing homes.  One reason for this is the lack of sufficient and permanently employed registered nurses.  One Registered Nurse cannot adequately care for the complex clinical needs of 40 or more patients.  Time is not invested in the individual resident and it is left to the less trained staff to observe and report on a residents well being.

The constant changes in staff and the use of staff from health care agencies contributes to the lack of continuity.  Agency staff  who do not know the residents, often display a lack of skills and interest in the job.

Proposed solutions to the current problems in aged care:

The most important factors in the nursing home care of the elderly are providing continuity of care by competent staff and  making sure the resident has an advocate.

1. 

An increase in the ratio of registered nurses and semi- skilled staff per resident.

The provision of high quality care in health is always dependent on having  the correct number and mix of human resources.

An increase in human resources will facilitate the provision of continuity of care.  Nursing homes need to develop a culture which values their workforce, so that staff feel they have some recognition for the job they do and that it is relevant to the organisation.

 
2.

Improve the formal training and competency of staff working in nursing homes. 

The current level of training and practice by staff  in these facilities is not providing the residents with high quality care.  Improve on the job training and supervision of these carers.  Among other things I have observed carers blowing on the residents food to cool it off and shoving large spoonfuls of food into the residents mouth barely giving time to swallow.

 
3.

Require private agency staff  to demonstrate a high level of competency before they are let loose on our elderly.

 
4.

I am suggesting that funding to nursing homes should be tied to the employment of a permanent allied health professional whose role includes the following:

  • To act as a resident advocate.
    This is particularly important when the resident is unable to satisfy their own needs or does not have any visiting relatives or friends.
  • To teach Occupational Health & Safety on the job
  • To teach and supervise Manual Handling of the Elderly on the job
    The employee in this position  should be familiar with all areas of the residents care and treatment and have the knowledge and skills to change the care as needed.
     
    For many reasons this person should  be a health professional but not a registered nurse or activity person.  

    Allied health professionals have a broad training and a more holistic approach to the management of people in their care.

 

The development of private aged care facilities where the payment of large bonds and high daily care fees is leading  to inequity of care for the elderly.  Soon we will have two levels of aged care in nursing homes one for the rich and one for the poor.

I am compelled to write this letter because we owe it to those people who are now in nursing homes and to ourselves as future nursing home residents to at least strive to provide excellence in aged care.

Please do not reply to this letter by referring to accreditation standards, spot checks etc required for the accreditation of nursing homes because these are just words on paper which have no resemblance to the functional daily care of individuals in nursing homes.

Concerned daughter who wishes to remain anonymous.