Danger at night

People are usually stunned to learn that there are no set staff/resident ratios in aged-care homes. They simply assume that frail people in care will be treated like other vulnerable individuals – for example like those in hospital or very young children in kindergarten and day-care who receive the protection of mandated levels of staffing.

Then tell them that some homes have only one or two staff members on duty at night to care for - perhaps 100 residents - and the shock is magnified many times over.

So what are the night staffing levels in our aged-care homes - on average? How would we know?

Prospective residents and their families are not generally told about staffing issues – even though these are highly significant when choosing a home. There is no compulsion for proprietors and their managers to do so and it is not usually in their interest to disclose.

If we go to anecdotal evidence, then the way in which residents are cared for at night appears to be very risky in many instances.

In 2006, Choice Magazine published a guide to choosing a nursing home. The general advice, resulting from their research, was that we all need to plan early for our future care needs. Within that story, there were several accounts from people with family members in care.

One man stated that, at his wife’s home, there was one person on duty at night to look after 80 residents. How not to be shocked!

Things seem to be no different now. Perhaps they are even worse.

Take this recent account from an experienced nurse who finally resigned rather than work in conditions dangerous to both her and the residents in her charge.

... I was the Div 1 working alongside a PCA for a 40 bedded nursing home and across the corridor there are 110 residents which 2 PCA's are in charge of. I have overall charge of the whole unit approx 150.

After the initial shock of being just run off our feet from beginning to end I decided to speak to the manager and explain that I felt that it was dangerous and my registration was at risk.

I felt that we needed more staff at night and that having 4 staff for 150 was too much. The facility had people with dementia wandering around continuously.

To top it all I had to go over the other side every night (one time 15 times!) if the staff needed me for whatever reason..."

Then there is this comment …

... Our 'low care' facility has around 60 residents. On paper, we have 2 staff overnight, but 1 of them is, more often than not, flogged by the high care N/h. Over half of our 'low care' residents are actually high care, but our staffing levels have dropped.’

At one Melbourne home, four staff are expected to care for 188 people at night.

What is it about night time that makes it OK to slash staffing levels to extreme levels? Certainly many residents are asleep. But often wandering residents still wander, people are still at risk of falls during the night, people become ill and medications still need to be administered.

Those residents who have been sent off to emergency departments of hospitals (because there is no skilled staff to care for them at the home) are often returned late at night. And, as we have so sadly learnt with the Quakers Hill Nursing Home disaster, fires can be started in the early hours of the morning.

And, dare I say it, some residents who are unable to sleep might like a spot of human companionship and comfort from the staff who care for them!

Recently, questions have been raised about the increased numbers of deaths in nursing homes in South Australia over the past 5 years.

It is not clear what has caused this spiral in the death rate in homes. But one thing is sure – having staffing levels as low as the ones described above creates a dangerous situation for the vulnerable people in care.

Proprietors of homes and others claim there is a need for "flexible" staffing and that mandated staff/resident ratios prevent that from occurring.

But there comes a point where people are just not safe.

And having one person to care for 80 vulnerable people or more is well past that point.


#5 Kathy 2015-05-14 20:48
My mother's facility are so low on night staff, they had time to call an ambulance but not me, when my mother fell and broke her ankle. I awoke to a call from the Hospital, letting me know they had my mother and were taking care of her injury! The facility told the hospital - again not me(or the family) that they could not take her back and provide the increased level of care provided - i.e. supervising her moving about with a cam boot on! The happy ending is that she is now in a different home with staff who are more than happy to look after her!
#4 Pauline 2015-05-14 20:47
You can ask all the questions you like when looking at a prospective nursing home but the answers you will be given are usually not the truth. I was told that the staff to resident ratio was about 1 to 4. In truth, it was 1 to 30. I was told that my mother would be placed on the toilet every 2 hours. She never was and with the staff ratios - it would have been completely impossible for staff to do this. I asked if my mother would be able to have a bath. Yes, definitely. She never had one. I asked if they would make sure she had her teeth in when she ate her meals following previous experience at a nursing home. Mostly, she had her teeth in because they were not taken out to be cleaned for days at a time. What I find really sad is that these nursing homes blatantly lie to you because they know you are completely vulnerable and have limited options. It doesn't matter if you find out once the resident is admitted because there is nothing much you can do about it. Complaining certainly won't help as it will only make things much worse. It's very hard to move a resident as you have to go through the whole process again and who do you believe? It's very hard to put an elderly person through another move. Sometimes it is worth it and you will find just as we did the "HEAVEN" of all nursing homes and blissfully wonderful and caring people. The trouble is that it is like finding a needle in a haystack. You would think with all the millions of dollars in taxes paying all these Aged Care bodies, that someone would be accountable for this absolutely atrocious and greedy aged care system that puts profits before the welfare and wellbeing of the elderly - but there's not. No one is accountable nor responsible.
#3 Heather 2015-05-14 20:45
Who pushes the staff implementing the assessments for ACFI?? I know from my past experiences that the private proprietors push and push to gain more funding.. Lies are written up for funding and yet when the assessers come out to check paperwork, they are PASSED !!!! Come on and get onto those that commit fraud, and are reaping the benefits. Also, Div2 nurses who are endorsed are used to the limit, and carers DO NOT get pulled into line enough. An influx of immigrants has hit Australia, and majority seem to be heading into aged care. This is not on, as they are unable to understand the Aussie traditions, or the English language. This is where communication is lacking, and incidents DO occur. I am not alone in my grief of exploiting our older Aussies. wE NEED TO BE ABLE TO SPEAK UP AND BE HEARD.
#2 Rozanna 2015-05-14 20:44
2/2: While the industry allow owners to build facilities that fool clients into a false sense of security with the bells and whistles and bricks and mortar nothing will change. The aged are a silent minority. Entering aged care is usually foreign to the client and the family. I have always encouraged people who were looking for a home to go during meal times, ask about quality improvements and resident meetings and what activities they offer. More importantly, ask about their staffing and staff ratios and how many are on during each shift and what their staff turnover figures are. These questions will definitely get some dodgy looks from quite a few places but those who are working honestly and trying to raise the benchmark will appreciate the questions and directness.
#1 Rozanna 2015-05-14 20:43
1/2: In 1997 John Howard destroyed aged care. Until then aged care was funded under a system that dictated not only staffing ratios i.e., how many RNs, carers etc. but also allocation of funds to non-nursing items. Whilst this system was not without its fair shares of faults the current system lends itself to abuse through the total delineation of roles, duties and accountability. I have spent over 25 years working in this industry and finally left it after years of watching it implode upon itself as a result of being over-regulated in some areas and totally unregulated in others. Aged care is at a point where you were unable to spend time with clients. Everything now is dollar-driven. Paperwork is verbose and ambiguous with care plans designed to looked good and tick all the boxes using the correct terminology to keep funding (and your job) for another day. All the while totally stressed in the fact that if you went above 'X'% in category changes it would spark another departmental visit to assess your accreditation status; or there would be an accreditation visit with an assessor out to prove a point (not all, only a few) and you would have to battle there; or the owners who decide you're still not earning enough money and can make more – not far removed from a Brothers Grimm story of spinning gold from straw. So you put in more hours and get more dollars and feel like Oliver when you're asking for more staff '... more please sir'.