Vale David Alberts
So much for sharing with you the joys, sorrows and frustrations one experiences working as an AIN in a nursing home. Instead, in my first four of five posts, I have railed against my employer, it’s managers and the aged care industry in general. If you interested in Aged Care and it’s careless business, I urge you to visit
http://www.agedcarecrisis.com/acc/
“an independent web site setup for the primary purpose of representing our elderly citizens with regards to aged care issues”.
In this post I will attempt and no doubt fail to stay on-topic, continuing on from where I left off in “We do Good”.
Dave Alberts lingered for a couple of weeks, dying a few days before Christmas. I remember coming on duty at 6:30 am, after my days off to find his bed empty, stripped of all its linen. In the handover report, we were told Dave died sometime between four and five. We must have only just missed saying goodbye to Dave’s mortal remains, because before the undertakers will come to collect a body, a Doctor has to be called in to cursorily view the body and sign the death certificate (failure of the heart muscle), and one can wait hours for a Doctor from an after-hours service to arrive to render this duty.
So if Dave died between 4:00 and 5:00 am, he died alone. Alone because Cathy and Ingrid, the two nurses on night duty would have been occupied with their third and final full nursing round of the shift, going from one resident to the next, checking their pads (disposable continence aide – like a jumbo babies nappy) to see if its soaked with enough urine to mandate changing, and if so washing the resident’s front and bottom; Turning those residents who are unable to reposition themselves in bed, from one side to the other, to avoid the formation of pressure sores. Changing any soiled bedclothes or soaked draw sheets, and even showering a resident if they are too faecally incontinent or worse if a colostomy bag has exploded. Woe the stench.
Dodgy Brothers caring management deem an adequate staffing level for the night duty shift, which is from 10:30 pm to 6:30 am to be one AIN and one EEN (Endorsed Enrolled Nurse) for 40 residents on C-wing, with one Registered Nurse (RN) to oversee the care of a hundred residents in the three wings of the facility. For C-wing, two nurses to do three ‘care’ rounds, and in between rounds to do the required documentation and the day and evening shift’s accumulated filing, answer resident’s buzzers and cries for attention, fulfilling their wants: a sip of water, cup of tea, a banana, sandwiches, ice-cream, biscuits, another box of tissues, bed pan or be gotten out of bed and taken to the toilet, heat pack, Panadol, sleeping pills, another blanket, turn the air conditioners up or down, take Rosie out of their room. Finally there is the walk round the wing every fifteen minutes to check residents are asleep, that none are trying to climb over the bed rails or worse fallen out of bed.
Normally on night duty, two nurses are barely adequate. Not however when a resident is dying. With three full care rounds and a hundred and one fiddly little time-consuming tasks, there is little ‘unproductive’ time to sit with a dying resident. There is also little incentive, and some nurses are emotionally unable, or too drained to cope. But Cathy and Ingrid who are without doubt night duty’s A-team could and would have tried. They’d skimped on duties, and skipped their breaks so that one of them could sit with Dave.
Like many residents, Dave appeared to be scared of dying, and having a nurse sit with him, hold his hand and tell him it was “Ok”, seemed to comfort him. Julia and I took turns sitting with Dave during the slack time on evening shift, which is towards the end of the shift, after most of our duties were done and most residents sleeping. I held his bony hand in mine, stroking his rough, dry paper-like skin with my fingers. Dave dozed on and off, opening his eyes to stare at me. I’d smile at him, tell him how good his life had been and how beautiful his wife Bessie still was. There was a photo on his bed-side table of Bessie taken soon after the war. She was a good looking woman who had aged gracefully unlike Dave.
Truth is I didn’t know if Dave’s life had been good. Born in Barcaldine, Dave enlisted in the army in 1941, aged 20, serving with the 2/9th Battalion. Dave fought at Milne bay, where for the first time the allies resisted and finally repelled the Japanese army until then all-conquering. Dave married Bessie soon after the war, they bought a house at Coopers Plains and had two daughters. Dave represented Queensland in rugby, and worked for the railways.
Dave was admitted to the nursing home about three years ago, with Parkinson’s disease, dementia and difficulties with swallowing. When he was admitted he could walk short distances with the aide of a rollator and a couple of nurses to steady him, but soon lost the ability to even stand, partly because there were not enough nursing and physiotherapy hours to persist with this activity. Dave deteriorated rapidly, acquiring contractures in the legs. To prevent these worsening, Dave spent several uncomfortable hours each day in a fall-out chair, with his knees able to bend only slightly. As comfortable as these chairs are, Dave always looked uncomfortable in them. He rarely spoke but stared at you accusingly, especially when you tried to feed him his unpresentable, unpalatable “texture modified” meal. Think of the worst baby’s food you have ever seen, then have it regurgitated , and you may begin to appreciate how unappetising these “soft” meals look. If you are what you eat, then no wonder every resident at Dodgy Brothers Care looks elderly and frail and sick.
Dave was a difficult and time consuming feed, one some nurses tried to avoid getting stuck with. He would often cough when he a mouth full of food, and several times I ended up wearing half his meal on my uniform. If he wasn’t ready for another mouthful, he’d shake his head, and often a nurse would take this as a signal that Dave did not want more of his meal, even when he had only consumed a few spoonfuls.
To force feed a resident who does not want to eat may be construed as assault and Dodgy Brother’s bulging policy and procedure’s manual is most definite on client assault: Instant Dismissal. No ifs. No buts. Dodgy Brother’s is very big on protecting it’s clients. However I have often seen residents with bruised lips, perhaps caused by a spoon being forced past clenched lips. I admit I have even done it myself. I wish Dodgy Brother’s forest destroying document was as big on defining adequate staffing levels. For if it were, perhaps we would have enough nurses and nursing hours to spend the time necessary to make sure a resident eats as much of their meal in as leisurely a fashion as they want or were used to before age and infirmity incarcerated them in a nursing home.
Instead meal times are rushed affairs, with nurses trying to hurry feeding a resident so that all residents can be fed in the time allowed. All Dodgy Brother’s Care facilities in South East Queensland have the resident’s meals prepared at a secured central catering facility, which for some reason nurses refer to as “Soylent green”. Meals are cooked and stored using the ‘cook-chill’ method, which involves rapidly freezing huge catering trays containing the meal. A refrigerated truck visits once a week, usually late at night, when residents are all asleep to offload several trolleys stacked high with these trays, which are then rolled into the freezers.
If it’s the second Monday on the Winter menu, for dinner the catering trays containing Soylent Green’s attempt at Mongolian Lamb, both normal and “texture-modified” are taken out of the freezer, and placed in the regenerator to be heated and then served to the residents. The only difference between a normal meal and a ‘texture-modified’ meals is that the later tray is put though an industrial blender first coming out as is soft sludgy muck. Presentation. Presentation. Presentation. Not.
The cook-chill system of regenerating and serving meals is now the standard in Aged Care facilities. Owners and Managers of nursing homes love it because it is such a money saver. You do not have to hire cooks and you can slash your kitchen staff and hence employee payroll expenses. For management there is one slight drawback with the system: Meals must be consumed within ninety minutes of regeneration because of the slight possibility of bacterial contamination leading to food poisoning. For residents there is one major drawback: no freshly prepared on the premises home cooked meals.
By the time the catering trays of Normal and Texture-Modified Mongolian Lamb are placed in C-wings dented Bain Marie, ready for plating to residents, up to forty five minutes may have passed since the trays left the regenerators. That leaves less than an hour to fed the residents.
Currently six of C-wing’s residents require no assistance or supervision with their meals. Nine require supervision and or partial assistance to eat their meals – so that Mary does not pour her cup of milky tea onto her plate of Mongolian lamb, or so that Rosie the ‘hobbit’ does not succeed installing Mary’s and Eugenia’s sweats, or Jack again leaving his dentures in the powdered scrambled egg, or to stop Vincent from choking once more from trying to ram his whole meal down his throat in one go.
The remaining 25 residents of C-wing require total assistance with their meals: they have to be fed every mouthful of their meal and given every sip of their drink.
Dear reader (if any) please feel free to do the mathematics: For breakfast and lunch, five AINs and two RNs to assist 25 fully and 9 partially dependent residents with their meals in less than forty five minutes. For the evening meal the figures are even worse: four AIN and one RN. A nurse has at most ten minutes to feed a resident their meal!!! No wonder the weight fell off Dave.
Well once again I have slipped off topic. I wanted to focus on Dave’s death, and I have drifted into describing how a nursing home works. I’m going to stop now and try again later. Since I began writing this post almost two weeks ago, two residents of C-wing have died. I’m heading home to see my mother for a week. It would be Dad’s 81st birthday next Sunday, so I want to be home with Mum. Before Dad died I made him a promise – I promised to look after Mum and I am not living up to this promise.
So until I return Good bye.
http://www.agedcarecrisis.com/acc/
“an independent web site setup for the primary purpose of representing our elderly citizens with regards to aged care issues”.
In this post I will attempt and no doubt fail to stay on-topic, continuing on from where I left off in “We do Good”.
Dave Alberts lingered for a couple of weeks, dying a few days before Christmas. I remember coming on duty at 6:30 am, after my days off to find his bed empty, stripped of all its linen. In the handover report, we were told Dave died sometime between four and five. We must have only just missed saying goodbye to Dave’s mortal remains, because before the undertakers will come to collect a body, a Doctor has to be called in to cursorily view the body and sign the death certificate (failure of the heart muscle), and one can wait hours for a Doctor from an after-hours service to arrive to render this duty.
So if Dave died between 4:00 and 5:00 am, he died alone. Alone because Cathy and Ingrid, the two nurses on night duty would have been occupied with their third and final full nursing round of the shift, going from one resident to the next, checking their pads (disposable continence aide – like a jumbo babies nappy) to see if its soaked with enough urine to mandate changing, and if so washing the resident’s front and bottom; Turning those residents who are unable to reposition themselves in bed, from one side to the other, to avoid the formation of pressure sores. Changing any soiled bedclothes or soaked draw sheets, and even showering a resident if they are too faecally incontinent or worse if a colostomy bag has exploded. Woe the stench.
Dodgy Brothers caring management deem an adequate staffing level for the night duty shift, which is from 10:30 pm to 6:30 am to be one AIN and one EEN (Endorsed Enrolled Nurse) for 40 residents on C-wing, with one Registered Nurse (RN) to oversee the care of a hundred residents in the three wings of the facility. For C-wing, two nurses to do three ‘care’ rounds, and in between rounds to do the required documentation and the day and evening shift’s accumulated filing, answer resident’s buzzers and cries for attention, fulfilling their wants: a sip of water, cup of tea, a banana, sandwiches, ice-cream, biscuits, another box of tissues, bed pan or be gotten out of bed and taken to the toilet, heat pack, Panadol, sleeping pills, another blanket, turn the air conditioners up or down, take Rosie out of their room. Finally there is the walk round the wing every fifteen minutes to check residents are asleep, that none are trying to climb over the bed rails or worse fallen out of bed.
Normally on night duty, two nurses are barely adequate. Not however when a resident is dying. With three full care rounds and a hundred and one fiddly little time-consuming tasks, there is little ‘unproductive’ time to sit with a dying resident. There is also little incentive, and some nurses are emotionally unable, or too drained to cope. But Cathy and Ingrid who are without doubt night duty’s A-team could and would have tried. They’d skimped on duties, and skipped their breaks so that one of them could sit with Dave.
Like many residents, Dave appeared to be scared of dying, and having a nurse sit with him, hold his hand and tell him it was “Ok”, seemed to comfort him. Julia and I took turns sitting with Dave during the slack time on evening shift, which is towards the end of the shift, after most of our duties were done and most residents sleeping. I held his bony hand in mine, stroking his rough, dry paper-like skin with my fingers. Dave dozed on and off, opening his eyes to stare at me. I’d smile at him, tell him how good his life had been and how beautiful his wife Bessie still was. There was a photo on his bed-side table of Bessie taken soon after the war. She was a good looking woman who had aged gracefully unlike Dave.
Truth is I didn’t know if Dave’s life had been good. Born in Barcaldine, Dave enlisted in the army in 1941, aged 20, serving with the 2/9th Battalion. Dave fought at Milne bay, where for the first time the allies resisted and finally repelled the Japanese army until then all-conquering. Dave married Bessie soon after the war, they bought a house at Coopers Plains and had two daughters. Dave represented Queensland in rugby, and worked for the railways.
Dave was admitted to the nursing home about three years ago, with Parkinson’s disease, dementia and difficulties with swallowing. When he was admitted he could walk short distances with the aide of a rollator and a couple of nurses to steady him, but soon lost the ability to even stand, partly because there were not enough nursing and physiotherapy hours to persist with this activity. Dave deteriorated rapidly, acquiring contractures in the legs. To prevent these worsening, Dave spent several uncomfortable hours each day in a fall-out chair, with his knees able to bend only slightly. As comfortable as these chairs are, Dave always looked uncomfortable in them. He rarely spoke but stared at you accusingly, especially when you tried to feed him his unpresentable, unpalatable “texture modified” meal. Think of the worst baby’s food you have ever seen, then have it regurgitated , and you may begin to appreciate how unappetising these “soft” meals look. If you are what you eat, then no wonder every resident at Dodgy Brothers Care looks elderly and frail and sick.
Dave was a difficult and time consuming feed, one some nurses tried to avoid getting stuck with. He would often cough when he a mouth full of food, and several times I ended up wearing half his meal on my uniform. If he wasn’t ready for another mouthful, he’d shake his head, and often a nurse would take this as a signal that Dave did not want more of his meal, even when he had only consumed a few spoonfuls.
To force feed a resident who does not want to eat may be construed as assault and Dodgy Brother’s bulging policy and procedure’s manual is most definite on client assault: Instant Dismissal. No ifs. No buts. Dodgy Brother’s is very big on protecting it’s clients. However I have often seen residents with bruised lips, perhaps caused by a spoon being forced past clenched lips. I admit I have even done it myself. I wish Dodgy Brother’s forest destroying document was as big on defining adequate staffing levels. For if it were, perhaps we would have enough nurses and nursing hours to spend the time necessary to make sure a resident eats as much of their meal in as leisurely a fashion as they want or were used to before age and infirmity incarcerated them in a nursing home.
Instead meal times are rushed affairs, with nurses trying to hurry feeding a resident so that all residents can be fed in the time allowed. All Dodgy Brother’s Care facilities in South East Queensland have the resident’s meals prepared at a secured central catering facility, which for some reason nurses refer to as “Soylent green”. Meals are cooked and stored using the ‘cook-chill’ method, which involves rapidly freezing huge catering trays containing the meal. A refrigerated truck visits once a week, usually late at night, when residents are all asleep to offload several trolleys stacked high with these trays, which are then rolled into the freezers.
If it’s the second Monday on the Winter menu, for dinner the catering trays containing Soylent Green’s attempt at Mongolian Lamb, both normal and “texture-modified” are taken out of the freezer, and placed in the regenerator to be heated and then served to the residents. The only difference between a normal meal and a ‘texture-modified’ meals is that the later tray is put though an industrial blender first coming out as is soft sludgy muck. Presentation. Presentation. Presentation. Not.
The cook-chill system of regenerating and serving meals is now the standard in Aged Care facilities. Owners and Managers of nursing homes love it because it is such a money saver. You do not have to hire cooks and you can slash your kitchen staff and hence employee payroll expenses. For management there is one slight drawback with the system: Meals must be consumed within ninety minutes of regeneration because of the slight possibility of bacterial contamination leading to food poisoning. For residents there is one major drawback: no freshly prepared on the premises home cooked meals.
By the time the catering trays of Normal and Texture-Modified Mongolian Lamb are placed in C-wings dented Bain Marie, ready for plating to residents, up to forty five minutes may have passed since the trays left the regenerators. That leaves less than an hour to fed the residents.
Currently six of C-wing’s residents require no assistance or supervision with their meals. Nine require supervision and or partial assistance to eat their meals – so that Mary does not pour her cup of milky tea onto her plate of Mongolian lamb, or so that Rosie the ‘hobbit’ does not succeed installing Mary’s and Eugenia’s sweats, or Jack again leaving his dentures in the powdered scrambled egg, or to stop Vincent from choking once more from trying to ram his whole meal down his throat in one go.
The remaining 25 residents of C-wing require total assistance with their meals: they have to be fed every mouthful of their meal and given every sip of their drink.
Dear reader (if any) please feel free to do the mathematics: For breakfast and lunch, five AINs and two RNs to assist 25 fully and 9 partially dependent residents with their meals in less than forty five minutes. For the evening meal the figures are even worse: four AIN and one RN. A nurse has at most ten minutes to feed a resident their meal!!! No wonder the weight fell off Dave.
Well once again I have slipped off topic. I wanted to focus on Dave’s death, and I have drifted into describing how a nursing home works. I’m going to stop now and try again later. Since I began writing this post almost two weeks ago, two residents of C-wing have died. I’m heading home to see my mother for a week. It would be Dad’s 81st birthday next Sunday, so I want to be home with Mum. Before Dad died I made him a promise – I promised to look after Mum and I am not living up to this promise.
So until I return Good bye.
posted by rbeare at Wednesday, June 29, 2005
14 Comments:
Another interesting, if not particularly uplifting, entry.
;-)
It's terrible that you have to rush through things like that - those people deserve more. The stuff you were saying about Dave made me think a bit - just about all the things he had done, and how it all boiled down to him dying alone. It's shit, I wouldn't want to go like that. Plus it made me think about dying one day. As a 'ten foot tall and bulletproof' idiot, death doesn't even seem like a possibility to me, and I almost never consider it.
I wouldn't like having to deal with death as much as you do - it'd make me think far too much.
Robbie - brilliant blog. A well chronicled account of working in an Australian Accredited aged care facility.
Professor Tony Broe's scathing attack on SBS Insight (20 sep. 05) comments about accreditation:
"Accreditation in Australia of nursing homes is a joke... we do not have benchmarks that measure not these catastrophic things but simple things like people on too much medication for behavioural control. We don't have an outcome for it. What we have are process outcomes they're not really what happens to people. We do not have a system of benchmarks of care that we can actually measure nursing homes by for good outcomes, and I think if anything comes out of a group like this, the pressure must be there because I was told that the concept of benchmarks of care is dead in the water at the moment. How can that be?"
We, at agedcarecrisis.com, hope to explore benchmarks on quality of care with Professor Tony Broe - just one aspect that is in dire straights. Staffing issues are very high on our list too.
Thanks again, Lynda Saltarelli
Great read Robbie Bear!!
Robbie,
I don't know you but from reading this story it would appear you are a very caring and compassionate AIN.
I am sure that David Alberts would have appreciated the comfort that you gave him, just by sitting with him and holding his hand and gently talking with him during his last day and hours of life. I nearlly cried when I read this story, because as a nurse/carer myself I know what it is like to 'find the time' to sit and hold the dying persons' hand and give comfort. Many staff cannot do it because of the emotion...I look at it like 'would I like to die alone...no I wouldn't. So many residents DO die alone to which I think is very sad.
Good on you Robbie.
Judy
Thanks Robbie,
I have just found your website via agedcarecrisis.com Great read. We have a website at http://www.agedcareact.wordpress.com and have added your blog. Thanks.
Phil and Belinda Essam
not that much different fomr my own experience as a student....where is the accreditation team when these things are happening?
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