Dear Mr. Ken Wyatt (Federal Minister for Aged Care) and Mr. Brad Hazzard (NSW Minister for Health,
One of the key clinical focuses in NSW Health hospitals is that of patient centred care, as targeted by the Clinical Excellence Commission also. Patient centred care encompasses an individual’s whole health and wellbeing, with health being defined by the World Health Organisation as: “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” [Preamble to the Constitution of WHO as adopted by the International Health Conference, New York, 19 June – 22 July 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of WHO, no. 2, p. 100) and entered into force on 7 April 1948].
In such context, I write to express my grave concerns over the ongoing care, or lack thereof, surrounding our elderly in the aged care sector. My first paid nursing job was as an Assistant in Nursing (AIN) in an aged care facility. We had many residents with dementia, chronic illnesses and physical incapacity who needed constant 24/7 care. There is currently no mandatory nurse to resident ratios in the aged care sector. Private providers of residential care are at liberty to decide the skill mix of their nursing staff and the accompanying ratio. The reality is: 2 nurses and 1 carer to 300 residents on a night shift (RN comment on Ratios for Aged Care Campaign 2018: www.morestaffforagedcare.com.au).
As nurses, we want to do our best and deliver quality care to each and every life that we are privileged to care for, yet there is simply not enough time without adequate staffing and skill mix competency.
I now work as a Registered Nurse (RN) in both the acute hospital setting and in private practice. I view it as my ongoing duty of care to advocate for the benefit of my patients. In the acute hospital setting, we are receiving patients with ever increasing health co-morbidities and higher acuity needs. What often stands out to myself and to my colleagues is the “state” that an elderly patient is admitted in. How can it be acceptable that an elderly resident from a supposed high-level care facility is admitted in a permanent foetal position, with bilateral lower limb atrophy, pressure injuries on their sacrum and hips, progressive weight loss, fungal growth in their mouth, and the only sound now uttering from them a whimper of the greatest fear? How can an elderly individual be left to deteriorate when such physical and emotional injuries are all preventable had there been better ratio and skill mix of staffing.
This letter is therefore an impassioned plea; a heartfelt plea for nurse to resident ratios in the aged care sector to be endorsed as law. Without it, the aged care sector continues to leave its residents in a state of neglect and abandonment. Many of these residents have proudly and selflessly served our country in wars. They have established communities, raised families, and built our society for what it is today. They have loved and deserve to be loved.
It is often said that empathy is a nurse’s greatest gift to their patient. It is through empathy’s eyes that we are hurting with our elderly. Their every pain is our pain, and their every discomfort is ours too. Our elderly deserve to live the rest of their lives in dignity and with the utmost respect. They need more nurses to be by their bedsides in the last home that they will know. Only with mandatory nurse to patient ratios can we deliver patient centred care.
Each elderly patient says to the lawmakers: “I have a right to receive safe and high quality care… provided with professional care, skill and competence”, and “I have a right to be shown respect, dignity and consideration…to me and my culture, beliefs, values and personal characteristics” [Australian Charter of Healthcare Rights, as quoted in: Australian Commission on Safety and Quality in Health Care (2011), Patient-centred care: Improving quality and safety through partnerships with patients and consumers, ACSQHC, Sydney].