clinical focus
What tasks were more frequently completed across all
shifts? What did the results reveal about the ranking of tasks?
The tasks that were most commonly completed were the
complex care tasks. Having said that, there are not enough staff
to complete those tasks [and still fulfil other duties]. It was the
complex items that were directly related to resident care, such
as checking blood glucose levels and IV management or CVC
line management. These tasks were being done at the cost of
other tasks that RNs performed, such as documentation, so
while these tasks were being completed, other aspects of the
RN role weren’t being completed.
You said, given recent changes in regulation and funding
of aged care, missed care in residential aged care warrants
further exploration. What should stakeholders, including
policymakers, do with these sorts of findings, or what should
further research delve into?
This study broke down the findings by state. What differences
were found between the states and what issues were present
across all three geographical areas that were looked into?
Staffing and acuity issues were in all states. All states were also
reporting having residents with higher acuity and not having enough
staff to deliver care [for them], but there were differences. In South
Australia, one of the key issues was the lack of assistive staff; they just
didn’t have enough clerical staff, enough other staff. So RNs were
doing many administrative tasks that took them away from doing the
hands-on care. In New South Wales, they were reporting a lot more
churn of residents, but also reported that there were sudden changes
in resident acuity and the volume of residents.
The big issue is that the residents are having higher clinical
needs, but there are fewer RNs, proportionally. A key issue
is that there isn’t the skill base there to manage the level of
acuity that residents have. In terms of further research, we
need to look more at the increasing private ownership of
residential aged care, and see whether these user-pays models
are making a difference in terms of the quality of care. There
does seem to be some evidence that the actual hours of care
being offered by all staff is being reduced in residential aged
care. We need to look at the impact of that in terms of care
outcomes for residents.
If these issues aren’t addressed, what hope is there that
missed care will be minimised?
Staffing is fundamental. If you don’t have enough people on the
floor, and they’re spread so thin that they can’t do these extra
unplanned care tasks, I can’t see how the situation can improve.
With residents having less [time with staff], the quality of care is
likely to get worse, and they’re more likely to have care missed.
It’s more likely to lead to adverse outcomes. ■
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