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Inquiry hears about heavy workloads and inadequate training


Residential aged care staff often have heavy workloads and work unpaid overtime to finish all their duties on a shift, the aged care royal commission has heard.

On Wednesday, the Royal Commission into Aged Care Quality and Safety heard evidence from a panel of aged care staff including two assistants in nursing, a registered nurse and retired diversional therapist about their experiences of caring for residents with dementia.

Registered nurse Elizabeth told the inquiry it was not uncommon for staff to come onto their shifts early and work unpaid overtime to ensure residents were cared for.

“I was working in an aged care facility where we did half an hour… unpaid overtime every day and that was so we could have the handover. And … we would be doing up to four hours overtime a day, just trying to manage care for people,” Elizabeth told the inquiry.

During some shifts, staff were expected to take on more than their own workloads, she said.

“If somebody doesn’t turn up, then you actually have to do your work, their work and that’s just bad luck,” Elizabeth said.

Suzanne Wilson, an assistant in nursing at a 150-bed facility on the north coast of New South Wales, said she did not get to leave on time after most of her shifts.

“If there’s a resident we’re halfway looking after you don’t just leave, you stay there and you finish caring for them,” Ms Wilson said.

Fellow assistant in nursing, Susan Walton, who works in a 100-bed facility in Illawarra, said she never got to complete all her duties during a shift.

“If I’m on a floor with 40 people, I don’t have a cleaner, a laundry person and kitchen staff, I have to do all that, plus answer call buzzers, attend to people that are on the floor, pain, you can just imagine, you can never get it done,” Ms Walton said.

It results in some residents missing out on their care, she said.

Ms Walton said she also started her shift half an hour early to allow time for handover.

Maggie Bain

“We have a problem with handover between shifts. We don’t actually get to see the registered nurse for a handover when we start our shift. They’re busy getting a hand over from the registered nurse before for 100 residents,” Ms Walton said.

Elizabeth said handover in aged care was “your bread and butter” but that important information wasn’t always provided from one shift to the next.

“You need to know what is going on for the residents so you can then provide effective care. And if you don’t get a proper handover, you’re working blind,” she said.

Retired diversional therapist Maggie Bain, who was responsible for assisting residents with dementia to participate in activities, also said handover was extremely important but was lacking.

“There is not enough time provided to read notes all the time. It’s very important because we need to know if a person has different changes to behaviours or different changes to their physical self.”

Staff need more training

Elsewhere on Wednesday Dementia Centre head of clinical services Associate Professor Stephen Macfarlane said staff education and training on dementia and behaviour management was inadequate.

“If the majority of your workforce are personal care attendants and the requirement is for them to complete a six-week course in aged care, it doesn’t really give you much opportunity to gain any understanding about what dementia is, let alone to understand the complexities of how to assess somebody with problem behaviours to determine their cause,” Professor Macfarlane told the inquiry.

“If we’re not equipping our aged care staff out of their training institutions with the necessary skills to at least have an understanding of dementia, you’re almost setting providers up to fail,” he said.

There should be mandated minimum training on dementia for all aged care staff in caring roles and it needs to include modules on behaviour management, Professor Macfarlane said.

“Knowing about the training curriculum of nurses, I’m not convinced that having completed a nursing degree, necessarily gives you any particular expertise in dementia, simply by virtue of being a nurse,” he said.

“There should be specific modules with an educative focus on how to manage problem behaviours from a psychological environmental and social perspective rather than perhaps education that reinforces behavioural problems as being something that it’s the doctor’s responsibility to sort out, because most doctors will then only have the tool of a prescription pad available to them.”

Issues attracting the right staff to the sector is a contributing factor to the quality of care provided, Professor Macfarlane said.

There are two types of people who work in the sector, staff who are passionate about the aged care and those who may not have been able to get a position elsewhere, he said.

“With people with passion, you get both quality and safety. With people who are just taking the job because it’s all they can get, you’re not getting either really, despite them both having the same qualification,” Professor Macfarlane said.

The hearing continues this week.

To stay up to date on the latest about the Royal Commission into Aged Care and Quality go to our special coverage. We will also be issuing regular Royal Commission Roundup reports which you’ll receive in addition to your weekly e-newsletters.

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6 Responses to Inquiry hears about heavy workloads and inadequate training

  1. Kerry May May 20, 2019 at 4:35 pm #

    Massive workloads for PCW’S including showering, toileting, giving out/dishing up meals making/ giving out cups of teas, making PCW’S give out the medications totally disagree with that they don’t know what medications they are giving or side effects of certain medications only reason facilities have them giving them out is because their wages are less. Lots of documentation and often work short staffed facility I work at refuses to use agency staff expect us to work short staffed if they can’t replace the shift and this definitely compromised resident care and causes the staff lots of stress and anxiety.

  2. Anonymous May 21, 2019 at 7:20 pm #

    As an Rn working in aged care for a number of years, i have never finished on time, usually at least 1 hour at the end of the day, and half an hour before the start of the shift, so that I can get my work load done, and I am very good at time management. There is just not enough staff, and as our elderly have more medical conditions, their care becomes, more and more complex. Then dealing with relatives is a huge issue as well.

  3. Sally Learmonth May 22, 2019 at 6:30 am #

    I have only worked in my one facility where the staff member in charge of leisure activities was expected to be at handover. I’d like to see a change, for residents benefit and their improved overall care. Thank you Ms Bain for raising this matter. If these staff positions were government funded, the benefits to the residents would be enormous. Too many staff members who are passionate about caring in this ‘field’ are leaving due to burnout. It is time residents were respected, treated with dignity across the spectrum. It is time. It is time residents came first. Time for residents to come before profit margins. Time for compassion, empathy, dignity and decency towards our elders to reign. It is time. Sadly, we live in an age of entitlement. Sadly, we don’t respect our elders as we ought. Sadly, training doesn’t seem important; is considered too expensive, unnecessary by owners and management. The time for change is NOW. It’s time for radical change of attitude. It’s time. It’s a national disgrace that our many our elders have been mistreated, belittled for so long. It’s time. Time to continue to break the silence and bring matters out into the light. I am personally grateful the Royal Commission is doing so. It’s time.

  4. Maggie McNab May 22, 2019 at 1:36 pm #

    As a Carer of a loved one who went through the whole experience of long term disability, ageing, illness, hospital, respite residential care, home care package, and having worked in the health field from an admin point of view, I have found listening to the Royal Commission to be an amazing eye-opener. I have gained so much knowledge of the magnitude of the problem from so many different points of view.

    The reason I have had the opportunity to listen to it all, is because my loved one passed away at Christmas.

    Of main concern is, the staffing levels and training and so many other issues. And a huge concern of mine is that those who need to follow this Royal Commission the closest, those involved in the funding, management, and those involved in the care, are too damn busy to “listen and learn”. The information gained, the submissions and recommendations of the Commission should become an essential part of “on the job” training – for all levels of staff involved – definitely including “Management and Owners”. The Care workers are not trained enough (through no fault of their own), not appreciated enough, and certainly not remunerated enough.

  5. Helen Stanley May 23, 2019 at 7:41 pm #

    Staffing levels are a major concern. If staff ring in sick quite often they will not be replaced, or replaced with a shorter shift.
    If we have empty rooms we sometimes have shifts cut shorter because we have less residents. They don’t consider that the workload is not lighter. Many of the residents still needing care need x2 carers, sometimes x3. In that case we have to borrow a carer from the nursing home. We are rushed every single minute of our day.
    Yes, we come in early, leave late. We are not praised or thanked. We are told you are not covered if you hurt yourself. If computer work is not completed then we have to explain why. I love my job and have worked in this industry for many years. It appears now to be all about the money and not the residents

  6. Mary Rankin May 27, 2019 at 10:19 am #

    I hope that some answers and plans can come out of the Royal Commission to take us into the future, the recent findings that about 50% of surveyed aged care homes in this country are not turning a profit is incredibly worrying. Who is going to invest and build new nursing homes if they re not a profitable business. The staffing levels we all know are too low now, and still they can’t make a profit, if staff levels go up as they should and good ratios come into play then without adequate funding from government or consumers a great majority of these businesses will go under. The biggest cost to these businesses is staffing, and staffing needs to increase, but where will the money come from? The taxpayer? The Consumers or their children?, who already believe it is too expensive and are losing a great deal of their inheritance. Some financial sustainability needs to be found, they are still a business that needs to make a profit, even not for profit need to make a profit!

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