Waking, showering and dressing aged care residents at 6am

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The following question was asked in Ask Judith in the LAMP. Nurses are being told to have residents showered and drressed at 6am, but many of the residents prefer not to get up this early. Have you had a similar predicament in your workplace?

Update February 2016: Read our latest blog post on this issue.

Question: Surely aged care residents have rights? I am an RN in a nursing home where we have two starting times for day shift: 6am and 7am. The DoN has told me I am to direct employees who start at 6am to get residents out of bed, showered and in chairs.  While there are a couple of residents who like to get up early, the majority are not happy to be woken and showered at this time, and the nursing staff feel terrible doing this. Should this be happening? I thought the residents had rights.

Answer: Yes, you are correct. The residents do have rights. Under the Charter of Residents Rights and Responsibilities, each resident of a residential care service (which includes an aged care home) has the right to be treated and accepted as an individual and to have his or her individual preferences taken into account and treated with respect.

Do you work in aged care? What would you do if your manager told you to get the residents up and ready before they wanted to?

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30 COMMENTS

  1. I think this is a common problem in aged care. It is ironic that the Residents’ Charter of Rights stresses that people in aged care should have their preferences catered for as much as feasible, yet in reality this doesn’t happen. Residents are expected, or feel that they should, fit into expectations. They may see how stretched staff are to provide services, so they try to fit in regardless of their personal preferences. Partly the reason for this is that staffing is often inadequate, in numbers and/or skill mix, so the little personal touches that should mean so much get lost in the rush to get the work done.

  2. Simply stated i work so i get up at 5.30am and shower, if i work an afternoon i shower lunchtime, if i work nights i shower 7.30pm. However when its my day off i shower approx 830am, on holidays i shower when ever (but dly). Now why do we get retired ppl up at 6 – 8am unless they want to or have to get to an early appt. You can shower ppl in the evening or afternoon too. So ethically and legally ‘Residents Charter of Rights’ provide plenty of rationale as why to not shower at 6 – 7am, also OH&S (yes look it up) legally states staff cannot be expected to perform this type of work at the end of a 8/10/12 hr night shift as they bodies are tired, out of sarcadium rhythm and that is how injuries could occur. Good luck. Management stop trying to fit 10hrs work on Night and Morning shift – give showers to Afternoon staff and solve this issue.

  3. Isn’t there a DOHA regulation that states residents can’t be gotten up any earlier than one hour prior to breakfast? Earlier only if that is their choice.

  4. I think we all are to be blame and guilty of waking resident up at 6am and getting them dress. It all started from the top (management) to the bottom (carer). The management will try to get the maximum resident dress so that they will not have to put enough heads to cover the early shift. The morning staff will moan to that night staff haven’t dress X NUMBER of resident. The night Staff will dress X amount resident to avoid and stop the early staff complain or management pull them in the office. When you share your opinion you become trouble maker.
    When having inspection the inspector will just go through the paper work if the paper work in order means everything in order.
    Personally we are the one to be blame for bad practice but we are also helpless. (Don’t mention whistleblower, CQC )
    The care provider will provide training but are we practicing them … are we allowed to practice what we trained? Does the care provider is following all basic the guideline? ….ask yourself…
    Nurses to me are the most offenders being the most educated and know what the right thing to do is. They will never challenge management decision when it comes to provide care…?
    Everyone has forgotten the resident is more important at the end of the day. We there to look after the resident but instead the resident have become just a number … A number for the day staff “How many has been dressed up”. A number for night staff “How many we have to dress”. A number for management how much we will get financially.
    6am is not the ideal time to wake people up and get them up regardless if they went to bed early (this is excuses). If someone is awake and want to get up its okay or wonder.
    The ideal time is about 7am.
    Ask yourself or imagine someone come to you at 6am and started washing you and dressing you up. That is not acceptable especially for old people.
    My opinion management should do more to support early staff with more heads to overcome this issue. Night staff should not get resident who are asleep at 6am. (I know very often management of senior staff mention that was the resident choice… Is it true? Ask yourself
    This debate will never end until some act on it…

    • It is now 2017 and the problem is still unresolved… I work nights and I will always wait for residents to wake up themselves, then and only then will I assist them to get up for the day if that is what they wish. I stopped worrying about morning shift yelling at me or questioning me why… sometimes I just have way too many residents all wanting the toilet at the same time. There is only 1 carer for 30 residents and if I am in showering a resident and my pager is going off there is nothing I can do. I do stress as some residents are high falls risks, not fair on the residents to be forced to wait!

  5. Where I work, I do nightshift, 5 days a week, 9 hr shifts. Management, who have their rules, nominate the same resident for the morning 6.30 shower, this poor lady hates it, every morning saying she doesn’t want to get in the trolley bath, but we cannot do anything because management says we must shower 2 residents every morning. The lady gets quite upset every morning, it makes me sick, but if we say anything we get abused by management. I would also like to make a point that when the accreditors come in the home knows and puts extra staff on and all we are the best then as soon as they leave hey presto, guess what, back to normal. I think all the visits should be unannounced. They can’t even read the paperwork properly, I called them in when the staff were not toileting as they should and they had to fix it and as soon as they go it’s back to normal, they need real people who know what’s going on to learn these accrediting jobs. Rant over.

  6. I work nightshift with one other staff member. We are allocated 12 showers between us. Half of these residents are very high care which takes more time. We are waking residents at 4.30 am to shower them so we can finish our shift on time. We have had this problem for a long time. We have approached management and RNs with our concerns. All they say to us is (they the residents) don’t know what’s happening or what time it is so don’t worry about it. They tell us that if we keep complaining they will get someone else to do the job. All it is is a business to them – make money, turn an eye to what is really going on. How can we fix this problem?

    • Same here. We have to have everybody ready by breakfast, so we start showering at 4:30 am, then leave the poor souls sitting in a chair for up to the next two and a half hours in the dark waiting for breakfast.The DON doesn’t care and says if we don’t want to do it, we are welcome to go. It’s the same in my other job. I work on an ICU two days a week as well. Despite the fact they have the same staffing round the clock, all the patients (awake, asleep, intubated, non-intubated, it doesn’t matter) get washed between 2am and 4am. Prior to that, I worked on a private CCU in Hobart where the patients all got washed between 3 and 7am and again at 8pm.

      • It is illegal to shower residents before 6am according to the federal Aged Care Act and associated Principles – unless a resident expressly requests a shower before 6am. It’s not appropriate to do these daily living activities at unsociable hours just to suit the facility – it must be ‘client centred’, which this is not – the facility will need to find another way to staff properly to meet clients’ needs, rather than impose this unreasonable routine on older people. The NSWNMA has assisted aged care branches to deal with this as a workloads issue and to negotiate a different way with management, from a client-centred approach. (The Aged Care Rights Centre (TARS) has assisted advocates on this as well.) Please contact your nurses’ union to discuss what can be done to change this practice.

        • Hey, where can I get a printout of this information? Or even just a website with this listed? We’re having major issues with this at our facility. Would love to have some rock solid proof that myself and other night staff are correct. None of our residents want to be up so early. It breaks our hearts 🙁 We often get in trouble for simply changing their continence aid and leaving them.

          • The website has it and the facility must display it, by law. You legally can not wake anyone before 6am in an aged care facility. You are able to provide comfort showers through the night. These are showers to help residents settle if residents are hot or can’t sleep or are incontinent.

  7. I have one resident at my workplace who gets up early to have a shower at 5am prior to the medication round at 6am but it is her choice. I do not enjoy waking up residents just to shower them prior to morning staff coming on shift, but morning staff complain of the workload. I also look after dementia residents. I ask them if they are awake if they would like to get ready for the day and if they want a shower then I help them and if not I assist them with a wash.

  8. I do the night shift and must do 3 allocated showers before 6am. Sometimes these 3 refuse to have a shower. I am then forced to wake up 3 others to show I showered 3 residents. Also, if I don’t shower 3 I am pulled up by the morning shift and management.

  9. Such an internationally common issue affected by power-seeking staff, attitudes, work ethic, short staffing. Some do challenge it. Opposing residents choice/wants (rights if you like) is a form of abuse.

  10. RNs & HCAs are openly admitting abuse of elderly people.
    At my last job we had advanced dementia residents who got up when they wanted to. They rose from 3am to a day in bed. Breakfast was at 9am and those not up had a tray taken to their rooms, same with lunch & tea. They were all usually up for supper trolley
    Showers were never offered as many people with dementia are afraid of showers.
    This approach to residents is the only thing I agreed with with Care UK. However on the residential units residents were woken up, washed & dressed.

  11. It is abuse to get residents up at before 6am, can’t believe this is still being done. Staff need to join the union so then hopefully if they do speak up they won’t be bullied by management. And to request that night shift shower residents at the end of their shift is unreasonable. We do have nurses who are task orientated and have to start showers before breakfast. I think morning shift should start at 7am, this could help to slow up things before breakfast.

  12. I work in a small facility where we are expected to shower at the end of night shift some high care residents who are awake and unsettled, using lifters. Some residents that require a bed sponge and left in bed who are not awake and this can happen well before 6am. This is because day shift in a certain wing has too many heavy residents compared to the other wings.

  13. At the facility I work, we’re told by management to have 5 showers done by 6am in the dementia wing and 6 showers by 6am in the low/high care section. If we don’t we get hauled up to the office with a please explain or be fired meeting. We purposely wake residents up anywhere from 2am to get the showers done, our falls have greatly increased and if we speak about it we’re told to say nothing. I’ve looked up the act, resident charter of rights etc as mentioned above and found nothing. Can you provide hard evidence about showering before 6am or did you just want to sound important as none that asked got a reply. Sorry if I seem bitchy, I’m over forcing people into a shower against their wishes.

  14. Hi John

    We don’t even do this to animals, let alone humans. Come on, how would you like to be woken at 2am for a shower. I am not a legal expert, but I am humane and this would surely breach the Human Rights Act. If the families of these residents knew this was going on, I am sure they could make a complaint to Department of Health, in your State and to Local Federal Minister of Health. This is against a persons, patients rights and this is instituted into every health system in the western world.

    I cannot see why your facility would request night staff to do this, except if they are understaffed. If you belong to the Union collectively you can make a difference. Also, go to the media as a last resort, expose them for what they are. It may not be written into any document, stating what time some one can be showered, but tell that to a Judge and see what they say. Even hardened criminals doing life sentences for unmentionable crimes are not woken at 2am for a shower, so why is your Management exempt from this?

  15. Hi, I too work nightshift in a RACF, we were recently told that we were to have 4 residents up and showered by 7am or and I quote ‘would be answering questions as to why’…this has been an ongoing issue, night staff have up till now been refusing to drag people out of bed to shower them based on two reasons, 1. the residents have rights and 2. the staff are at higher risk of injury when showering at that time of the morning. I have been unable to locate any document that implicitly states that it is illegal to get residents up prior to 6am and I have had no luck locating any documents that state the increased risk of injury to workers (WHS) if they are forced to shower residents at this time. If anyone could direct me to a website or any other information that I can access to prove to management that in fact they are not only breaching the Aged Care Act but also the WHS laws then I would be eternally grateful. This antiquated system of dragging people out of bed against their wishes must be stopped, we are in the business of caring for people but yet management expect us to ‘herd’ them like cattle into the shower just to ‘get the job done’, its unethical and in my opinion abusive. Rant over, if anyone could help me locate the abovementioned documents/webpage I will get that bit closer to ending this practice at my workplace. Thanks.

  16. Same here, I work in Morning Shift at 6am they are force to get up, go to toilet then shower. Some of them telling me,” I am sick” or ” I feel bad today” reasons just to not take them in the shower room. While showering them, i feel pity on them because if you will put you self on the same situation you won’t be happy. Why they have to get up very early for a shower while after breakfast they will just seat on the lounge watching TV, and some sleep on their seat. They are like prison in a way, because they cant do freely what they want to do. They were old and their life is not long enough so they have to be happy and be treated well. But as staff, still have to follow the rules otherwise you will be in trouble by the management. I wish there will be a solution to this problem. And hope the Government will make a move for the good of elderly people in Age Care Facilities.

    • As an excuse, this is completely indefensible in court: you are regarded as entirely responsible for the choices you make, irrespective of what the management ‘rules’ are.

      I can guarantee that it’s not policy in your workplace (not anywhere, no matter what people say), but rather something the other nurses say, and even if it was written into the staff guidance documents, management would simply say that as a nurse and a professional, you have leeway to interpret their guidance.

      The absolute reality is that this stupid business of getting residents up at 5 or 6 am happens because the nurses either promote it, are too passive and gutless to change it or simply fail at all levels to advocate for their patients.

      I’ve seen nursing homes that tailor their care to patient needs and wants, not by the clock, and it makes no difference to workload, it just requires a degree of flexibility.

      And anywhere management has tried to change this practice and introduce client centred care, the biggest opponents have always been the nursing staff.

      Get real, if it’s happening at your workplace, it shouldn’t be.

  17. I work for a large care company. We as carers are being told by the home manager to get 6 baths done per day. The senior in charge is told to allocate the clients for baths and showers. All the staff feel pressured and feel like they are abusing the clients and overall not giving choice. My line manager is supportive and is telling staff if a refusal is verbalised to document it. I have overheard the manager telling senior staff they should be waking people for their morning medication so they are finished earlier. The senior staff have refused to do this as they fear for clients’ safety i.e choking, but the manager then said they won’t choke if they are taken from bed and placed in a chair… so basically clients are not being given choice of when THEY want to get up. Reporting these actions is getting us nowhere.

  18. I work 8pm untill 8am on a unit with 19 residents in a dementia home, 5 of which need two members of staff. We are told by management to start waking up residents at 5am, but a certain team leader wants them to start getting up at 4:30am. I am on my own with 19 residents until this point. We’re also expected to get as many residents up as possible before 7:30, which simply isn’t enough time to meet their indevidual needs. Please if anyone knows of any laws on waking up residants or on residant to staff ratios, please link here so I can stand up for their rights and the staff’s.

  19. I’m hearing you all. As an RN with over 35 years in the industry, I am still amazed that in RACF we still spruke “person-centred care” – crap! Management and the bean counters still expect that night staff – the bare minimum of staff – get these people out of bed at unruly hours for showers – for no other reason than to save a buck and make it easier for day shift. Night shift medication round is started way too early to try to fit everything in. Then there are notes and charts and assessments etc to be attended. Not to mention the safety of our staff – fatigue, increased risk of injury to staff and to the residents that we are caring for. Then of course there is the drive home. Put more staff on day shift! Why is there not legislation on this? Why is there not written anywhere guidelines around the whole night shift duties. And yes I have heard those in management too stating ‘if you don’t like it there is the door, night shift are lazy etc etc’. Night shift has its own dynamic as does day and afternoon. We do, but not as we say. It seems that every aged care facility is the same! If only the public really knew what goes on behind closed doors. Shame, Shane, shame. God I dread getting old.

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