clinical focus
When care goes missing
Staffing issues and the increasingly complex needs of residents are leading to some tasks going undone.
Julie Henderson interviewed by Dallas Bastian
Toileting, answering bells and rehabilitative care are areas in which residential aged-care workers say they miss duties across their shifts, new research has found.
Dr Julie Henderson from Flinders University is a member of the team behind the research, which set out to explore the frequency and causes of missed care duties in residential aged care in New South Wales, Victoria and South Australia.
Henderson says studies into missed care have been conducted in acute-care settings and demonstrate the impact that a lack of human and other resources has upon decisions to omit care; however, she added that less is known about missed care in residential facilities.
Through data collected from surveys with just under 1000 registered nurses, enrolled nurses and personal care assistants, the team found that missed duties occurred on all shifts and that all tasks are missed at least part of the time.
The primary reasons for missed duties are staffing shortages and difficulties in meeting the complex needs that arise from increased resident acuity.
“ The management of residents with multiple co-morbidities and behavioural issues was seen as creating a need for RNs which was not always met,” the study reads.
A respondent from NSW said:“ To simply say aged care is another home for the residents and therefore they do not need clinical care is not the case. RNs reduce the need to send residents to acute-care hospitals by managing them in the home. This could be achieved better with more RNs per resident.”
Aged Care Insite sat down with Henderson to discuss factors affecting missed duties and what stakeholders should take away from the study’ s findings.
ACI: You surveyed people working in residential aged care in New South Wales, Victoria and South Australia, and respondents identified missed care across all shifts. What were some of the key areas workers identified? JH: This is part of a larger study that a team at Flinders has been doing around missed care, which is care nurses aren’ t able to complete. We’ ve surveyed more than 7000 nurses in New South Wales, Victoria, Tasmania, and South Australia, and from that sample I’ ve drawn the aged-care nurses – we’ ve got 922 of those. The activities they were missing most were part of unplanned care, meaning things that aren’ t scheduled, like toileting residents within five minutes of them asking and answering call bells. They were also often missing rehabilitative care, meaning they weren’ t finding time to walk with residents and maintain residents’ function.
The study also explored the reasons care was missed, and identified staffing shortages and increased demands related to resident acuity as key causes. What was revealed through the open questions about the impact these issues are having on missed care? There were probably two issues that came through the open questions. One of those was skill mix and the lack of RNs on site. This was becoming an issue because the residents had greater clinical needs. Part of that was because hospitals were pushing people out into residential aged care earlier or [ keeping ] people in residential aged care, rather than sending them to hospital. But also, aged-care staff are increasingly providing end-of-life care for residents.
What aspects of the current state of the aged-care sector may be contributing to or aggravating these issues? There has been a shift toward user-pays models, and also there have been moves, particularly in New South Wales, towards not requiring an RN on site in aged care. This has made a difference in what aged care can offer. There also are changes in the [ Aged Care Funding Instrument ] that are going to mean less funding for complex healthcare, at a time when those needs are becoming more acute.
24 agedcareinsite. com. au