Not enough nurses in the nursing home – a daughter’s letter

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Ensuring safe nurse-to-resident ratios in Aged Care will make a huge difference to the lives of many nurses, residents and their families. Tell us your aged care story here.

To whom it may concern,

My name is Belinda, I am a single mother of two and live with my adult intellectually handicapped cousin who I am carer for.

I was also caring for my mother, who survived a stroke after having life saving surgery. It was hard doing it on my own but I managed because of the love I have for them. One day my mum decided she was going to put herself into a nursing home because she didn’t want to be a burden on me any more.

I accepted my mother’s wishes and she went into an aged care centre in western Sydney. Beautiful, clean, hotel-style living, no dirt, no messy smells, it is lovely. Mind you, it took me 12 months to accept that, but I did in the end.

My mum has been there for five years and we have always said the nursing staff is so good but there are not enough of them. And for five years we have been told they are adequately staffed.

We’ve seen residents come and go – you become close to them and their families and watch their everyday struggles when they get to the point that they can’t feed themselves, walk, talk or interact with others, till one day you don’t see them any more and later find out they’ve passed away.

Today there are 30 residents in the High Care ESU Unit and four nurses. Now my mother is at the stage in her life where she can no longer walk, she talks differently, granted because of the stroke, she has only two fingers she can barely move, but she still has her wits and sense of humour.

I have now put my 100 percent caring for my kids and cousin on hold to go every day to help feed my mother, because four nurses is not enough for 30 high care residents. Six of the residents need to be fed because they can’t feed themselves. Then you have someone wanting to be toileted. Some people still need to be showered. One nurse is supposed to be on the floor at all times.

Now forgive me, but there are a few family members of other residents who have asked the same thing and every time I say to them what is told to me – they’re adequately staffed.

So recently while I have been there for sometimes four to five hours a day, I’ve discovered that 30 residents in the High Care Unit are not adequately staffed with four nurses.

If you spent a couple of days out here and saw for yourself, I would 100 percent guarantee you would say the same thing. Between 6am and 1pm is the busiest time where the showers need to be done, beds need making, feeding and toileting where some residents need two nurses.

Sometimes it gets so frustrating for the nurses they take out their frustrations on the residents.

The point is even the nurses have said we are too busy and you’re going to have to wait. Now when you’re in a nursing home and need to go to the toilet, you can’t wait, when you gotta go, you gotta go.

By the time the resident gets to the toilet there’s a mess to clean up, which then takes up more time for the nurses.

I was always under the assumption that when you go into a nursing home you’re supposed to be cared for to the point you feel safe and loved. I guess I was wrong. Everyone knows when you go into a nursing home it’s the end of the line and they should be able to live out the rest of their days feeling happy and safe and secure. When some get bullied, it makes them feel less of a person, humiliated.

The hot meals that are made for them are cold by the time a resident who can’t feed themself gets fed.

I’m talking about all nursing homes – I’m just using this one as an example as I’m having this disturbing experience in it.

Why is it all hush hush when we talk about this subject at meetings?

Who says how many nurses work?

Is it the fewer nurses that work, the more money for the decision maker?

Who and how do you work out how many residents equals one nurse?

Do any of the decision makers even have a loved one with a disability in a nursing home?

If there are nurses that are off, whether it be sick, injured, holidays, whatever, and there is only one fulltime nurse on and the rest are casuals who have no idea how to do everything, then that one nurse is under a considerable amount of stress because she has to go help the casuals. I have witnessed this with my own eyes.

Something needs to be done about this situation. Not all elderly people that go into a nursing home need just one nurse, some are so badly disabled that over time they are in need of two nurses, like my mum. And most of the time now she is missing out on the activities or late because there is not enough staff or time to put her on and off the toilet.

And if this is happening to my mum I can only imagine how it would be for the others.

I am a loving and caring person and it breaks my heart to witness this every day and if I don’t speak up for all the residents and nurses, what hope do they have?

Thank you for taking the time to read my letter. I hope something changes so that these elderly people who have no choice but to spend the rest of their days in a nursing home can feel safe and happy as they are paying a lot of money for what is supposed to be great care.

Sincerely, Belinda

If you have an experience you’d like to share, please get in touch here: nurseuncut@nswnma.asn.au. Whether it was something that occurred in a single shift or about you’re entire career so far, we want to know.

More information on aged care staffing:

18 COMMENTS

  1. I have worked in the aged care industry for nearly 7 years now and can vouch that every nursing home is understaffed. It is a struggle to provide even basic let alone quality care to residents with the current staffing levels of roughly 2 assistant nurses to 20 residents and 1 registered nurse to maybe 40 residents. It is heartbreaking seeing residents’ calls for help go unanswered day after day as there is simply no one available to help them because staff are already busy helping someone else. I encourage families and friends of residents to contact government representatives and to alert the media to our elderly’s plight. What is going on needs to be exposed and investigated. We need a Four Corners report/A Current Affair and newspaper and magazine coverage.

  2. Belinda, the Government sees the ageing population to be a burden and will not allow for more funding to go towards staffing issues. It has been like this for years & makes me sick with worry after working for 17yrs as an Aged Care nurse that my now 72 year old mother will one day want/ need to go into care… I fear it will still be the same then.

  3. Past and present governments are only concerned with their leave entitlements and packages and ripping off taxpayers. They’ll be in need of these services one day.

  4. I totally agree with the above comments. I was an RN in Victoria working PM shifts, in which there were 92 residents. I fear for the Aged Care carers as they are understaffed and of course, contrary to what management says, most residents miss out. I could go on and on but thank you for this.

  5. Belinda, you are a very caring person. I see that you are torn between looking after your children, handicapped cousin and your elderly mother in a nursing home. My mother was in a nursing home and despite the fact that it was very good, it was not perfect. Today, now that they don’t have to have a registered nurse on at all times, they seem to be worse. My father was also in a “very good” hostel and then nursing home. It was not perfect either. You could say that imperfections in both nursing homes were the immediate causes of their deaths. I don’t know what can be done about institutional aged care.

  6. I have been a PCA for a few years in a nursing home in Melbourne, during the last year our situation has been terrible – for morning and afternoon shifts we had to work short staffed, it means one staff member less than normal! In normal situations the number of staff was not enough, now we have to work like robots – morning shift only 7 PCAs looking after more than 60 residents including high care, low care and dementia and in the afternoon shift the situation is more terrible, only 5 PCAs for the same residents!
    No time for hygiene, feeding and looking after them. Sometimes it takes 10-15 minutes to answer the residents! The residents mostly are hungry and thirsty but there is no-one to help them, when I go back home I am totally destroyed and I feel shame about the situation, I cannot believe that we live in Melbourne! But it is true we live in Melbourne!

  7. If it was legal to photograph some of these residents, saturated from shoulder to knee, infected dressings, pressure area breaks, the lack of linen & gloves, the meagre meals (1 Party pie & a drop of sauce) etc etc. And have a site where the public could see what goes on behind closed doors, the public would be horrified. Some homes insist on computer ACFI funding, staff state they have done certain things to obtain funding for the organisation, even though they don’t do it. If staff do not complete the ACFI funding they are reprimanded. Some organisations are making a killing but nothing is going back to the residents. Do the Aged Care Accreditation people care – NO!

  8. Belinda, I know exactly what you’re talking about. The staff where my mother-in-law was were excellent and did their very best but some days it wasn’t enough. My mother-in-law passed in the nursing home and I can’t fault them for their care that day.

    It is time the powers that be open their eyes and get out into the retirement/aged care communities and see for themselves what really goes on.

    I send you a hug because being the person who fills the gap and who loves that person isn’t easy. You are doing a good job. Xx

  9. Absolutely agree. I am a cleaner in 2 different aged care facilities and am generally there from 6-12 and I have seen it time and time again. Nurses rushing around and residents calling for help and these calls go unanswered for long periods of time due to the fact that there is just no one to go to their aid.

    And these nurses mainly take it on the chin because what else can they do?

  10. Finally, we have the answer for aged care:

    Friday 2nd December, 2016
    The Australian Nursing and Midwifery Federation (ANMF) has released the National Aged Care Staffing and Skills Mix Project. The project is the first of its kind in Australia and has collected evidence relating to the need for a staffing methodology that considers both staffing levels (the right number) and skills mix (the right qualification) for residential aged care.

    The comprehensive project developed an evidence based complexity profile, tested the elements of care associated with the resident profiles, determined what care interventions were being missed and confirmed the need for, and structure of, a staffing model for residential aged care.

    The key findings are:

    Residents should receive an average 4 hours and 18 minutes of care per day – compared to the current 2.84 hours which is currently being provided;
    A skills mix of Registered Nurses (RN) 30%, Enrolled Nurses (EN) 20% and Personal Care Worker (PCA) 50% is the minimum skills mix to ensure safe residential care;
    ANMF Federal Secretary Lee Thomas said the project was undertaken by the ANMF in conjunction with the ANMF’s South Australian Branch, the Flinders University Research Team and the University of South Australia, as a result of the “monumental failure” of governments to establish evidence based staffing levels and skills mix in the aged care sector.

    “The report’s findings reflect feedback from ANMF members working on the ground in aged care and is consistent with the stories from members about the increasing difficulty they experience in providing decent care to residents, many with dementia and other high-complex needs,” Ms Thomas said today.

    “Whilst the number of people in residential aged care has nearly doubled from 134,810 in 1995 to 263,788 in 2014, consecutive governments have failed to legislate the minimum number of staff with necessary skills. As the report shows, missed care is a regular occurrence in residential aged care.”

    The ANMF provided the report to the Chair of the Senate Enquiry into the aged care workforce with the hope the Committee will use the evidence and outcomes and make significant recommendations to legislate minimum staffing levels and skills mix in residential care.

    Recommendations from the Committee are due in April 2017.

  11. Belinda,
    I hear you. My 81 year old mother has been in high care since June when she fell and broke her ankle in 3 places and has never recovered fully. She has been in and out of depression since being a resident of high care due to the appalling food served (3 nuggets and a blob of potato, or a party pie, sausage roll and bowl of soup, two pieces of fruit a week, for a couple of examples). She has all her wits about her but she cannot get mobile at all without the assistance of two staff members. She has waited for up to 1.5 hours to go to the bathroom, by which time she was in tears. She presses her buzzer but no one comes for at least 1/2 hr in most cases as they don’t have enough staff to adequately care for all the patients. The staff do their best.

    Yesterday my mother had a TIA (mini stroke), an ambulance wasn’t called for 4 hours! It was only that there was a volunteer in her room at the time and heard her make a funny sound and saw she was in trouble and called for immediate help that she was seen to fairly soon. But the nursing home still did not call an ambulance until the family rang her GP and he phoned and asked for her to be taken to hospital. This is not good enough. I feel for the staff who are under so much pressure to look after so many patients and there just aren’t enough of them to be effective.

    • Hi Janene, I hear what you are saying, I am a registered nurse and have been working in aged care for nearly 30 years. If aged care was adequately staff with RNs and EENs there should be no need for a resident to be sent to hospital for having a TIA. Staff should be able to observe the residents clinical signs. Most people who suffer TIAs recover fairly quickly and without adverse effects. There should be qualified staff around the clock, staff who are able to assess clinically, contact doctors when necessary, give medications appropriately, attend wound care, review care needs and adjust care plans, educate care staff…….the list goes on and on! I do believe there are times residents need to be transferred to hospital for assessment and treatment, but I also see the times when a resident has been sent unnecessarily to sit in the ED with even less care because so many others need treatment more urgently. A nursing home will never be an acute care hospital, but staffing must be adequate to provide the care, the safety and the peace of mind for our elderly residents.

  12. I work in Aged Care on the PM shift (1500 – 2300). We have a total of 10 AIN to 128 resident’s. We constantly struggle as we have more behaviors to care for due to “sun dowing” with our Dementia residents. We also have Palliative Care Resident’s and also many resident’s who require x2 AIN with all ADL’s. We would love to spend more 1 on 1 time woth our residents. But we have to prioritise and understand who needs are more “urgent “. We do try our very best to care for our residents. We try to knock on every door and ask if our residents need help. Then we have our documentation to do. If we do not do our paperwork we get in trouble from Management. We are just not being heard when we say we need more staff. I have so much empathy and respect for my Residents. I go home absolutely exhausted. I go home thinking I have not done enough . Nurse ratios need to happen now in Aged Care.

  13. The problem is with the big companies that buy nursing homes and make money and don’t deliver on the care that the elderly need ! The big companies need to be told that there is a ratio and guess what u have to pay for it !

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