As the second round of the Royal Commission into Aged Care Quality and Safety gets underway in Adelaide this week, an anonymous aged care nurse reveals to Insight the haunting consequences of cost-cutting at the facility where she worked and others like it.
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Over the years, the conditions in private sector aged care have become diabolical. And I would know – aside from a brief stint as a nurse in a hospital, I’ve been working in aged care homes since I was 14 years old. I was offered a part-time job as a personal carer on my second day of work experience. But last year, I stepped away from an aged-care nursing career I loved because the stress of cost-cutting pushed me to the brink of a mental breakdown.
It’s not just staff who are feeling the affect of cost-cutting. It’s the residents we care for – or cannot care for, as it were.
Party pies and sausage rolls are not a proper dinner. Shampoo and toothpaste are not ‘luxury’ items. Waiting hours for pain relief, medication, food or assistance going to the toilet is not the standard of care one should expect when they’ve payed up to $600,000 for a room in addition to 85% of their pension for the rest of their life if they can’t pay up front. But when there’s only one nurse and a handful carers for a facility with 150 residents, residents have to wait – even if they can’t hold on that long. I have even heard of staff being asked to wash bandages and reuse them to save on dressing costs.
At nighttime it was even worse. It was just one nurse and two carers. To put that into perspective, at a public hospital – where they have mandatory staff-to-patient ratios – there is one nurse for every seven patients overnight and one nurse for every four patients during the daytime.
At nighttime, there were no doctors. There were no management staff. No administration staff. No wardsmen. No maintenance. No hospital co-ordinator. The nurse would take on all these roles. It was beyond ludicrous. It was outright dangerous. With only one adequately trained professional on shift, it meant personal carers were often tasked with administering potentially lethal medications like morphine. These personal carers had as little as one day’s training on how to do this. If there was any error when the nurse was assisting the carer to administer meds, it was the nurse in charge who was disciplined and threatened with de-registration and job loss.
What the public don’t realise is that the definition of ‘adequate’ is left to the discretion of the provider.
Here is an example of what it was like trying to work on a desperately understaffed night shift. There was a bedbound resident who was quite a heavy woman. A physiotherapist determined that fewer than four staff working together to manoeuvre the woman would risk injury to the staff. Overnight there were only three of us. Consequently, this lady was left in the same position without changes to her continence pad from 9pm at night to 9am the following morning. This went on night after night after night. To be left in the same position for 12 hours put her at risk of pressure injuries and infection from sitting in a soiled pad for hours. Instead of employing more staff to work the night shift, management tried to persuade the physio to change her plan to say that only three people were required to assist this woman. How utterly disgraceful. All we’re asking for is the working conditions to do our jobs safely.
Aged care providers save money by claiming that their staffing levels are ‘adequate’. What the public don’t realise is that the definition of ‘adequate’ is left to the discretion of the provider.
The Palaszczuk Government has committed to implementing mandated staff-to-resident ratios in Queensland’s public facilities as they have done in Queensland’s public hospitals. But I don’t know of a private aged care provider in Queensland that does not have the horrendous conditions I’ve written about above.
Providers know we gain our dignity from our work – so they think they can get away with paying an undignified wage.
I am angry that I had to choose between doing a job I know I’m good at, and my sanity and financial stability. We do this work because we care. And aged care providers exploit this. No one goes into aged-care nursing because of the money. Providers know we gain our dignity from our work – so they think they can get away with paying an undignified wage.
I would always claim my overtime, but I was never paid for it. I was actually called into the office once by an acting manager and told to stop claiming my meal breaks and overtime because the company could not afford it. That particular provider reported a $40 million dollar post-tax surplus that year.
The Australian Nurses’ and Midwifery Federation has conducted research to prove that an investment in quality staff-to-resident ratios can actually save providers money in the long-term. When there are staff on hand, small problems like tending to a wound get solved before they become bigger, more expensive problems like infection.
In my opinion, aged care providers are no better than the big banks. They both charge people for services they don’t deliver. Until we see appropriate investments in ongoing staff training, mandated staffing ratios, and a dignified wage for staff, then incidences of poor care and even elder abuse will continue to plague the industry I love – and probably affect someone you love.
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