In light of fresh allegations of abuse and neglect in aged care, we can only wonder why, in 10 years to 2015, systemic issues of elder abuse and neglect remain firmly entrenched in aged care.
The following snippets are a small collection only, of extracts of emails and letters sent to the Aged Care Crisis Team. These representations were part of a submission made to the Senate Community Affairs References Committee - Inquiry into Aged Care, in June 2005.
What staff and family members tell us:
Feedback 1. “…As a PCA8 or Nurse’s Aid, one doesn’t have a voice. You are considered quite lowly and no respect is given. So I decided to go to Uni and study to become an Enrolled Nurse (Div 2). I only lasted for half the course due to my disillusionment of the industry.
The class was supposed to consist of 22 students, but had 39. You were taught some things once and then considered qualified in that area. When we were sent to placement at a Nursing Home/Hostel, they were understaffed so us, the students, were left to shower, bandage and feed with no assistance or supervision. Because I’d had some experience, the other students would come to me for help and advice.
This is what they called training… The government have a lot to answer for…”
Feedback 2. “…there seems to be an influx of untrained and unsuitable staff who, because of the unemployment rules, take on any job because Centrelink tell them they have to. Companies want to take on Division 2 Trainee to make money, then ask them to leave when their traineeship is over, causing loss of trained staff. Many of the PCA10 trainees have come into aged care because they are not able to find employment elsewhere and companies are desperate for staff take them on with very limited skills putting the residents and other staff at risk…”
Feedback 3. “… Mum is in her mid fifties, yet it is not unusual for her to work double shifts and she routinely stays back two and three hours after her shift ends to catch up on documentation. In fact, although her official working hours have been cut back recently, the hours she actually spends at work have not. She is a highly dedicated nurse and does everything she can to give the residents the best care possible under very poor conditions…”
Feedback 4. “… it is difficult to "care" for residents with the present staffing levels. I burnt out within twelve months of commencing work in a Nursing Home, because of what I saw and as a result of not having the time to spend with people who so desperately needed me to just be there for them.
As a Nursing Home employee I treasure the time when I can speak to a resident, and listen to what they have to say. That only happens when they are naked on a chair, in a shower. This is their quality, one to one time.
I have 15 minutes maximum to get that person out of bed, often with a lifter, get them to the bathroom, shower them, dress them and transfer them into another chair. I also should have the bed made in that time. If someone needs to use a pan while I am in the shower, they have to wait. I can't leave the person I am with. Then we wonder why the majority of residents are incontinent. Most aren't when they are first admitted.
I am going to university to study so I can escape the tragedy of our nursing homes. They are a huge indictment on our society. I challenge anyone, who knows the reality of life in a Nursing Home, to say that they would like to spend the last years of their life in one.
We couldn't come up with a better way to strip aged people of all their dignity and humanity…”
Feedback 5. “… I am now in my mid 40s (a baby boomer) and for most of my working life have worked as a trained nurse (now no longer). During my initial years as a nurse, I worked as an untrained nursing assistant in the area of aged care, and I must say I found it difficult and depressing to say the least.
I witnessed many acts of brutality and cruelty from more senior registered nursing staff and doctors alike, but due to my low rank at that time (felt) I wasn’t able to do anything about it.
The thought of me having to rely on strangers to take care of my personal needs (like bathing and toileting), for me, is simply out of the question. My feelings would be the same if I were to ever need the services of a nursing home…”
Feedback 6. “As a nurse in an aged care facility, it is very frustrating to have a resident returned from a hospital visit of only a few days, return to us with pressure sores that did not exist before the hospital admission. Let me tell you - the hospital nurse/patient ratios are FAR less than what we nurses in aged care deal with. I was in hospital myself recently and the ratio was 1 nurse to 4 or 5 patients, compared with the ratios I work with at present 1 carer/nurse to a minimum of 12 residents on an afternoon shift. Sometimes it is more, if you are short staffed. Morning shift is worse because the workload is even heavier, and the night shift is 2 carers for 45 high care residents, with one RN Div 1 for almost 100 residents - this is a lot of responsibility for the RN Div 1. Not only is the RN responsible for the residents, but the care staff as well, and including the building itself.
Based on the hospital nurse ratio's one has to wonder how they cannot give adequate pressure area care required to avoid pressure sores…”
Feedback 7. “… I work in an aged care facility as a nurse/carer. It is a lovely facility but it has many problems. I specifically see problems in the delivery of quality and best practice care to residents.
I get very frustrated working along side people who call themselves carers who do not have experience, and some have no formal training/skills. Unfortunately, the government let aged care facilities employ such people. I believe the elderly deserve to be looked after respectfully and with dignity, but the delivery of care falls short by most facilities when employing staff who basically 'do not know what they are doing' and do not have the passion and dedication to perform and deliver quality care…”
Feedback 8. “… I have been a personal carer for several years now, and for the last few months working in nursing homes.
I care deeply for my residents and treat every one of them as I would my own grandparent and I am disappointed that many people believe that Personal Carers (PC's) are careless or abusive. I guess there are people like that out there, but given that where I work I am pressured to carry out the ADL's with speed... (aim for 15 minutes/ resident), I am not surprised that residents are injured at times.
I have been instructed through communications (at my work) that if we cannot fulfil our tasks in the allotted time, then maybe we should not be working here (place of employment). We are short staffed and apparently 'under funded'.. something I find very hard to believe, but that is what I am told.
On average, each employee would stay on the shift (unpaid) for up to half an hour just to complete tasks and make sure that the residents are comfortable. All my work colleagues are compassionate and caring individuals. It is the management and owners of the nursing homes that need to be accountable for the funding they receive.
My understanding is that as long as a nursing home meets the accreditation standard, they continue to get funding to be spent in whatever way they choose. We bear the brunt of abuse, a career that very few others would choose to pursue and get paid very little for a job very few of us would swap for another career. We don't work for the money.... we work for the love of our elderly citizens.
Would someone please help us, to help our elderly live out their remaining years with dignity and comfort?”
Feedback 9. "… I have in the past had expressed concerns about the level of aged care but have not been heard. I worked in a large aged care facility for the best part of a decade many years ago and not a great deal has changed. In the industries where accreditation is implemented I see fundamental flaws. I see agencies given accreditation status in aged care and child care facilities and I often wonder how they achieved this standard. The only way accreditation will work is if spot accreditation is applied. A set schedule for the process only provides the organisation the opportunity to dress up the "facade" for the occasion. It is a farce and always has been. I could tell you many a story about accreditation!"
Feedback 10. “… have just left employment with a categorised Low Care Hostel employed as a PCA. Over the 6 months I was there, I was a silent partner in out and out deception regarding accreditation:
- I was told to complete 18 months worth of bowel assessments before (accreditation);
- the staff were hand-picked for the day the on spot review happened (the roster was changed to accommodate this);
- the residents who may of spoke of concerns where sent on a bus trip to local RSL for the day (a first I might add ), unbeknown to them the accreditation team were coming in;
- the ratio of staff was upped for the day; and
- the menu changed to something very palatable the residents did not normally receive.
Of course, the home passed with flying colours. I was lucky in the respect I was not stopped and asked any questions, saving me an ethical dilemma, due to the fact 3 weeks earlier, had been rushed through my medication competency - to the extent I arrived for a shift at 6am and found I was giving medication out, and at 9.00am the R.N arrived and then signed me off for 3 previous supervised medication rounds that had not happened.
I was working that day with one other carer who had no experience in aged care and had only worked one shift the evening before. She (no buddy shift/no competency passed) walked in and had to shower 9 residents before 8.00am and burst into tears when faced with a colostomy bag. (The poor woman had called 2 days previously on the off chance looking for domestic work and had been employed on spot as a carer.)
I was lucky that day, as no incidents/accidents occurred. When I queried the fact I was not conversant with the medication I was giving to the cognitively impaired (as per regulations), and (asked) ‘when would education happen for that’, I was told ‘you have a MIMS11 in the clinic, read that’.
My next shift as the Carer giving out medication was over the long weekend, no R.N is rostered on for 4 days, and unfortunately for me she also was not answering her phone or mobile so I had to make my own judgement calls re PRN medication12. When I brought my concerns up, I found they were not addressed - leaving me no choice but to leave before they fabricated a reason to get rid of me as happened to previous staff members.”
Feedback 11. “…Speaking with other relatives today, there are still ongoing issues. One resident asked to go to the toilet and was told to wait until after she had finished her breakfast. Staff did not return and she soiled the bed. It seems they are still not adequately staffed, either quantity or quality…”
Feedback 12. “… A nurse wheeled Mum into the disabled toilet and went away. The nurse then went off duty. Unable to see any buttons (blind) Mum called out until her voice was gone. She was found 3 hours later at meal time by a staff member searching for her..”
11 MIMS – A handbook containing medicine information from Australian pharmaceutical companies 12 PRN Medication - the name given to‘when required’ medications. PRN medications are defined by the Australian Pharmaceutical Advisory Council (APAC) as being those which are ordered by a medical practitioner for a specific person on that person’s medicine records and when the registered nurse, using clinical judgment, initiates, or delegates to an authorised enrolled nurse, when necessary. The administration of PRN medicines must be recorded on the person’s medicine record (APAC 2002). Staff should record the times and dosage for which that medication is administered on the resident's medication chart and record why the medication is given and the outcome (for example, pain relieved, resident settled) in the progress notes.
Feedback 13. “… Lack of surprise inspections: I worked in a Nursing Home, which was privately owned for nearly two years. In this time the proprietor sacked over 18 D.O.N's (Directors).
Food for residents was locked with a padlock in a fridge because the owner felt we might steal her milk or margarine or jam. So, hungry residents couldn't get a snack after 7.30pm when kitchen staff went off duty. We once had two chickens to feed to 30 residents because she wouldn’t purchase more food. If we ran out of stuff, we had to buy milk or bread for the people.
Sure, we complained, and complained about so many things you could never believe. Nothing ever was done. All in a very affluent Melbourne suburb too!”
Feedback 14. “… Self regulation is a joke. Why would a proprietor, who most often is an absentee landlord with no emotional bonds with the patients, expend extra money if he does not have to? Philosophically how many people invest in aged care homes to provide good quality care as the first objective? Surely the main objective is to make a profit. The two are contradictory.
How many inspections take place at "dinner time" at 4pm when the bread and butter and cup of tea are handed out with nothing else until 7am the following morning?”
Feedback 15. “… This home has had sanctions placed since and one of the biggest flaws was that they have one qualified RN on each shift and sometimes none at night time. When my husband spoke with the RN on Sunday, the RN had no idea that MIL13 had been sick. The report on the accreditation stated that often care assistants were in charge of residents and did not report illnesses back to the RN's (Registered Nurse). She was showing signs of flu and maybe the assistants didn't think it was bad enough - who knows.
The doctor had not been called for her. My MIL (Mother in Law) was just under the impression that that was the case as she had commented on her unwell feeling to the staff. When we bought it to the RN's attention, a Dr was arranged for the next day. Unfortunately, the infection had already hit the brain causing hallucinations and 4 days later, despite antibiotics, she had deteriorated enough to be admitted to hospital with pneumonia.
The poor RN's have way too much responsibility - medication records, changes in resident’s health/appetite, etc and often don't get to actually spend time with the residents. If they had, they might have picked up her illness and acted upon it earlier.”
Feedback 16. “… Due to staff shortages my mother (totally blind and with dementia) had several bad falls, one when she fell out of bed suffering bruising, cuts, and a broken collar bone and resulting in extensive hospital treatment. The relieving staff member was unaware my mother was blind and forgot to put the restraining sides up on her bed".”
Feedback 17. “…Are you aware, to reach Accreditation nursing homes have to tender an application, at the cost of thousands. Nursing Homes have to be accountable for care given, we have to prove we do what we say we do. Hospitals do not have to do this…”
Feedback 18. “… My grandmother, a dementia sufferer was often put in the humiliating position of being left on a commode chair in full view of other patients and their families.
She was harnessed into the chair by a piece of cloth tied around her waist to the arms of the chair. One day she wriggled down and was trapped by the cloth around her neck. Had it not been for one of the other residents, she would have choked.
She was admitted to hospital, bruised and very ill. She was left too long without supervision…”
Feedback 19. “… My mother was in a nightmare of a nursing home....a broken walker that no-one knows how that came about; items that go missing never to be returned; a lady that empties her bowels in my mother's room - faeces all over her things.
I complained to staff and management. I was told they don't have enough staff or money to look after them properly. If it was the RSPCA, they would have closed them up!”
Feedback 20. “… My mother in law had lots of falls and was often there for some time as the nurses rounds are only every few house through the evening and she seemed to manage to fall between checks. One morning I found her on the floor at 8am. Never knew how long she had been there. She had a dislocated shoulder. The ambulance took hours to come as she was not an ‘urgent case’.
I do really feel for the staff though the good ones are just run off their feet. and most do care it is just the insufficient funds for good care and supervision…”
Feedback 21. "… The domestic staff were doing most of the caring with only one qualified nurse for 65 patients. My mother was often left to sit for hours, on a vinyl chair, not properly clothed or covered. One day she fell off this chair and broke her hip. She was sent home from hospital 48 hours after her hip replacement and untrained domestic staff were used to bathe and move her. Within two days .her hip had dislocated. This happened again - twice. Once it was dislocated for nearly a week but the doctor had not been called.
A physiotherapist was supposed to train staff, but the one nurse there told me ‘she didn't have the time’.”
Feedback 22. “…We actually verbally discussed our concerns regarding the medication with both the DON (Director of Nursing) in January and the Managers/Owners on several occasions during February and March. They were meant to "look into it" and get back to us and we heard nothing. After several discussions with the pharmacy, we informed the Compliance part of the Department who after investigating our comments, strongly advised us to place a formal complaint. It was only after this that something was done by the nursing home. The fact that we had not put our concerns in writing, gave the owners a chance to claim that we went straight to the department.
The home does have a written communication book to write concerns but part of the assessment found that none of these were being followed up…(we are concerned that there is no) proof that they have received the complaint…”
Feedback 23. “…I'm more concerned about their "sneakiness" in not providing information when requested and lying about what is going on in the facility (missing medication) and only supplying information and admitting the truth when the Department became involved upon our complaint. This leads me to wonder what will happen after their sanctions are lifted and the department is no longer watching…”
Feedback 24. “…Nurses in a hospital setting have little or no understanding of aged care and how to manage any person over 70 years of age.. We hate sending our folk to hospital, they return with pressure sores (very little are known in a nursing home setting) their behaviours have usually exacerbated and are out of control, they are malnourished and to put it bluntly - are worse than when they were transferred for a said 'acute illness'... It just makes me sad, angry and quite disgusted that elderly people nearing the end of a good life are enforced to go through this debilitating treatment…”
Feedback 25. “…My 88 year old mother, highly educated, has just been dumped by a hospital in Sydney into a respite facility without any further plan in place. Whilst she has minor cognitive impairment she does not have dementia - yet the private facility, operated by a religious charity, is insisting that we take out power of attorney or they apply for guardianship and insist that I am responsible for all form filling in. I contacted a legal service who told me this is incorrect and she is fully responsible as she has full legal capacity. The emotional pressure and emotional blackmail employed by these places and by the hospital social workers has been nothing short of immoral and they are willing to treat the elderly like children and take away their rights just to ensure their money comes in. The system is broken, completely. The aged are treated like cash cows, toddlers and nuisances instead of with respect …”