It's hard to break down and paint this picture of systemic neglect because of the constant exposure to it. I'll start by saying that I believe when most workers start out, they have the best of intentions. You see their optimism, their hesitation and anxiety when initially getting used to how best to help the residents. They have the most energy and enthusiasm having not yet become accustomed to the daily grind and brutal realities. That's when their standards slide. They're surrounded by people that have given up on giving it their best because they don't have the time to do so. When forced to make compromises on the standard of care they wish to provide, they slowly lose faith in their profession.
Workload
The section I work in the most is High Care. We have 20-22 residents. Of those, approximately 12-14 are two-assist (require two people to assist safely and usually a lifting machine). 1 might be palliative, another few might be violent. 8 to 10 might be High Falls Risks which require (at minimum) half hourly checks and basically constant supervision, because many have dementia and might not, for example, remember whether or not they can walk. We have a nurse floating around who is often in other sections, and three carers. After dinner it goes down to two carers for 1.5 hours due to staff breaks having to be covered. In that 90 minute period which is at a peak time (everyone wants to go to bed or to the toilet), those two carers are for the most part unable to supervise everyone because they're required to help the two-assist residents. What do you think the negligence is in this scenario?
Three carers actually might not sound so bad, but consider also the types of people that tend to end up in such jobs. Lots of migrant workers that don't have the best understanding of the English language and are there more because it's one of the easier jobs to get (they don't have the heart for the job). We also have a high staff turnover due to the conditions, so many of the workers are often new to the job or the facility and basically slow everything down. They don't know the routine and are spread out among the more experienced workers who simply don't have time to train and keep up with the workload. This means that most often you don't have a good, solid, efficient team.
Sanitary conditions
I work for one of the better workplaces apparently... a not for profit religious organisation. They pass accreditation with ease, but then they're given notice of inspections beforehand! They don't employ cleaners where I work, but rather ask that the kitchen staff do a few rooms each day. They're not professional cleaners and their training is worthless. This averages out to any 1 room being cleaned once every 20 days. What management don't like to really acknowledge or think about is how stretched for time each individual worker is. How many of those kitchen staff do a thorough job of cleaning given their time constraints? What's worse is that when you really start to think about it, the rooms aren't given a proper, professional clean after someone's death. Many of those that die have MRSA or other nasty, reasonably infectious conditions. It's often left up to me (my own initiative) to clean those vacant rooms when I can find the time, knowing it won't be cleaned properly otherwise.
The toilets, for example.. never scrubbed down. I will do this (if I still have any energy in the tank) late at night when the workload is reduced. The majority of carers will use those times to get onto their iPhone or watch TV.. and to be honest I can understand why. They need to sit down and rest!
Oral Hygiene
When I first started working in Aged Care I would wonder when the residents oral hygiene was attended to, as being on placement I never witnessed teeth being brushed? In time it occurred to me that residents teeth never/rarely get brushed. I recall asking one of my buddy shift partners "When do you brush the residents teeth?". The buddy responded "the afternoon shift does that". It turns out the afternoon shift doesn't clean teeth either. The residents lose any natural remaining teeth very rapidly as they're given cordial and orange/pineapple juice constantly and never get them brushed if they're unable to do so themselves. Most residents either have dementia or struggle/are unable to walk. The most the average carer will do for a resident is pull out their dentures and stick them in a denture cup (if the resident is lucky they might even get Steradent, but at my facility they're only provided once a week). If the resident happens to have partial dentures, the dentures will be cleaned and the natural teeth remain unbrushed.
This is where things get interesting for me when examining why the carers would be so careless. I don't actually blame them. Where once I would have, I now understand it's entirely the fault of management and to a larger extent, the government. We're for the most part forced to prioritize care needs due to a complete and utter lack of staff. It's a triage service, if you will, where you really have to consider whether to brush the residents teeth or attend to all the other residents that have more pressing needs. We barely have enough time to toilet the residents properly. I'm not using this as justification for myself, as I do my best to find the time however possible.. but for most workers I think that it's too much to expect. If you're having a bad run though where a higher number of residents have been incontinent, for example, you simply won't have the time to give 100% to everyone.
I've complained to management on multiple occasions about this issue. I've given examples of residents who still have their cognitive faculties mentioning how wonderful it is to finally have their teeth brushed. I'll have examples of the constantly hardened toothbrushes and the many toothpaste tubes which have crusted over. On the occasions where I've referred to residents, management informed me that those residents are inclined to make things up. When mentioning the physical evidence, they stated that it's up to me to lead by example and teach the others. Every 6 months or so a residents family will complain about the state of their loved ones teeth. We get an angry letter from the manager stating how the situation is "outrageous", and are instructed to sign off on that particular residents oral health.. but the rest of the residents and the greater problem is ignored. There'll be times where the residents don't have toothbrushes and there are none available in stock. I once waited a month before management acted on the issue.
Cost cutting measures
One of the big problems is getting access to continence pads. The nurses lock them up at the request of management. We have a set number of pads per resident regardless of how incontinent the person may be. A more experienced carer or nurse might say that more than X number of continence pads shouldn't be necessary if the the residents are toileted properly, but then they have to stop and think of time limitations imposed on the carers/residents... and usually by the afternoon the pad allotted for my shift will be missing. They also have to think about the fact that many of these residents have no idea what's going on, unable to distinguish when they're sitting on a toilet or a seat. They're also often given laxatives/suppositories. Due to this, I then have to go search for the nurse so that they can unlock access to continence pads. This can take some time. I then have to fill out a form explaining why I had to take the pad, for which resident etc.
Wet wipes... often necessary and certainly a preferred method of wiping off hardened feces in more sensitive places. A rarity. A good day is when you have been supplied with wet wipes. Carers try to hoard them and hide them so that the managers buy more, but we're often left short.
Biscuits are another issue.. yes, biscuits! Management don't trust the carers when it comes to food, and in particular the biscuits. They lock the biscuits up. This is frustrating because part of our job is to offer the residents supper, but all that the management make readily available are these sandwiches. The residents often don't want to eat an egg sandwich for supper and so refuse. This is a problem because they can be vulnerable to losing weight. When I want to give them biscuits, I have to find the nurse and get her to get the special keys which have to be unlocked from a cupboard in the office. Most carers don't have the time or will to bother going to such trouble.
Paperwork
One of the ways in which the facility generates money is through paperwork. We have to sign off for what we do to help the resident. For example, if a resident needs a cream applied we sign off that we've applied it. We're told off if we don't sign something, as that is a clear sign we're not doing our job. This is where it gets murky.. they add all these tasks which are frankly absolutely impossible to achieve in any one shift. For example, four minute massages of the resident that are required daily, heat packs (they're hard to find), sorbolene creams applied (often none available), hip protectors on/off (often unavailable/soiled). It can't all be done, but they expect us to sign it anyway. The ACFI manager goes through all the paperwork every so often and if we haven't completed such on a certain date, she'll call us into her office and make us sign it. I refuse. I'm one of the few people that simply won't sign it if I haven't been able to do it.
A clear example of this... incompetent system is when you see carers have signed off on activities for people that have died. This happens often enough. It's common with bowel charts for carers to enter into the computer system that a certain resident has used/not used their bowels when they've been dead for days. Another one is that they don't look at the date/month where they're signing. I've seen the month of May filled in entirely with signatures when it's April, for example. This makes it obvious that carers are simply signing without having actually looked at what they're signing for, and most of them will admit to this when not around the managers.
...to be continued! I'll next write about my confrontations with management and the ways in which they punish me indirectly.
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