Crisis? What crisis?

Person Centred care are the new combination of weasel words bandied about by the industry this season. Brochures and internet promotions tell the would-be consumer about care designed around their specific needs. However it is not uncommon, in fact it is the norm, to find the simplest expression of human need, that of personal hygiene, governed not by personal preference or expressed wishes but by the available human resources on any given day.

Assistance with personal hygiene is a fundamental element of aged care. It provides nursing staff the opportunity to engage in social interaction with the resident in the most basic and intimate fashion getting know them and develop a greater understanding of their needs; it also allows an appropriately qualified nurse the opportunity to asses other aspects of a residents needs in terms of failing health, impaired skin integrity and changes in dependence levels. One might expect a flexible and varied set of arrangements to enable these assessments to be undertaken at the same time as meeting a basic human need reflecting the personal wishes of the consumer. What does exist in direct contrast to a flexible and person centred approach is a "shower list", where people are allocated showers on alternate days or less frequently split between evening and morning shifts where by the vast amount of personal care is undertaken by Personal Care Assistants in a militaristic and time pressured way.

Many aged care services had baths installed after the changes to building certification brought in the'90's. An inspection of facilities now will find that these bathrooms have either had the bath removed and or converted into a makeshift store room. Bathing a person takes time, time to fill the bath, time to bathe the individual and then emptying and cleaning the bath. Accordingly they are rarely if ever utilised. This may, on the surface, seem to be a trivial point but it does underline the impact reduced care hours has upon quality of care.

This meagre allocation of personnel in terms of numbers and skill mix has negative impacts in a variety of other areas – there are usually more residents who need assistance to eat ( regrettably referred to as "feeds") than there are staff to help them in a timely manner – cold meals is a common source of complaint in aged care. Similarly there is little time available for meaningful and non-pharmaceutical interventions to manage some behaviours of concern or simply to socialise with the family and residents to foster a well-developed caring relationship. It should come as no surprise that there remains an over dependence on the use of anti-psychotic medication and benzodiazepine derivatives to manage behaviours of concern exhibited by residents especially those suffering with dementia. Human resource and skill allocation limitation does not allow for simple effective nursing interventions to resolve or mitigate these problems.

The truth about aged care is that is becoming more complex over time. Residents are admitted to care with higher levels of acuity later in their lives and with multiple co-morbidities requiring more and better qualified staff. Yet the industry trend is heading in the other direction in terms of staffing numbers and mix at breakneck speed. It is only a matter of time before we see more headlines detailing more crises and, sadly, an inadequate and inappropriate response from both the industry and government.