Aged Care
Missed care widespread in nursing homes
Inadequate staff numbers are the most common reason for missed care, a survey of aged care facilities shows.
Only a tiny proportion of aged care nursing staff believes that staffing in their facility is always adequate.
This is shown by a “Misscare” survey of 3,206 RNs, ENs and AiNs from the aged care sector.
Designed by university researchers, the survey was part of the National Aged Care Staffing and Skills Mix report recently released by the Australian Nursing and Midwifery Federation (ANMF).
The Misscare survey asked staff about the interventions they believed were being missed and the reasons why they were missed.
The survey found that all types of nursing services and personal care interventions were missed at least some of the time.
Only 8.2 per cent of respondents indicated that staffing was always adequate.
Just under one-third (30.6 per cent) identified staffing levels to be adequate 75 per cent of the time, while more than a quarter (27.2 per cent) viewed staffing as adequate half the time.
Staffing levels were viewed as never adequate by 14.2 per cent of surveyed staff.
The types and frequencies of missed care were consistent across 24 hours and were not influenced by shift times.
A majority (76.8 per cent) of respondents indicated they could not request additional staff. Only 10 per cent indicated that extra staff were provided when requested.
With more staff, less care is missed
Where nurses were able to request extra staff when needed, less care was missed.
Employees in private-for-profit facilities were significantly more likely to report difficulties in both asking for, and receiving, extra staff when compared to both government and private not-for-profit facilities.
Tasks that were reported as most frequently missed across all shifts were assisting residents with toileting needs within five minutes of request, and answering the call bell within five minutes.
The interventions that are least frequently missed are some of the more complex care tasks undertaken by nurses.
They included providing stoma care, maintaining nasogastric or PEG tubes, suctioning airways, measuring and monitoring blood glucose levels, and maintaining IV or subcutaneous sites.
When an RN was not available on-site during the last shift, staff expressed less workplace satisfaction.
Lower levels of staff satisfaction with their current job, lower levels of workplace teamwork and reduced intention to stay in their current job were all associated with an absence of a RN in the workplace.
The absence of an RN also had a direct correlation with reported care delivery, with higher levels of missed care reported when an RN was not on-site.
Only 8.2 per cent of respondents indicated that staffing was always adequate.
Staffing levels were viewed as never adequate by 14.2 per cent of surveyed staff.
A majority (76.8 per cent) of respondents indicated they could not request additional staff.
Only 10 per cent indicated that extra staff were provided when requested.
Pain management, falls among missed care issues
Episodes of missed care due to understaffing and too few RNs are relatively common in nursing homes, says registered nurse and TAFE teacher Diane Lang.
Diane worked as an aged care assistant in nursing for 10 years before doing a nursing degree. She now teaches Certificate 3 aged care workers at Bega on the NSW south coast.
She says delayed pain management due to an RN not being available is a widespread problem.
“Also, people who suffer falls but can’t be assessed by an RN are whisked off to hospital. That places a greater burden on the public hospital system and the resident is thrust into a confusing, noisy environment, which increases the risk of delirium-related behaviours.
“Residents get chest infections when they aspirated from eating improperly because an RN was not available to assess their swallowing ability.
“Untrained staff are not usually able to assess changes in cognitive behaviour or detect the fact that someone has a mild TIA (mini stroke).
“Medications are sometimes missed or not given at the correct time because there are just not enough staff available to give 30-40 people their medications in the allotted time frame.”
Diane says residents miss out on adequate meals when there are not enough staff to feed all residents in the allotted time.
“In an effort to get everyone fed, staff often feel the quickest way is to rush the person by forcing food before they have finished the last mouthful. Sometimes people go without a meal as it is removed before staff can attend to them.”
Diane says that with the distinction between high and low care facilities now eliminated, more and more people are staying longer in what used to be low care places with hardly any skilled staffing.
“As soon as they have any episode at all they are rushed off to hospital and taking up a public bed.”
Aged care is grossly underfunded
Diane says the national aged care report points to gross underfunding of aged care.
“The current federal government has cut funding to aged care to such an extent that nursing homes will cut staff numbers even further.
“Aged care should be getting more money, not less, with greater accountability to make sure additional funds go to increased staffing.
“The elderly have been paying taxes their whole lives and deserve to be treated with respect and dignity – not as commodities which is how many of them are treated now.”
Diane said residents were often “lonely, depressed, and totally dependent on someone else to care for them”.
However, if the report’s findings were implemented, “they would actually get respectful and good quality care towards the end of their lives”.
“And nurses who enter that profession are less likely to leave after 12 months due to exhaustion.”
“The elderly have been paying taxes their whole lives and deserve to be treated with respect and dignity – not as commodities.” — Diane Lang