Nurses impress at royal commission   

Evidence from nurses was well received at the inquiry into Australia’s aged care system.

A Royal Commissioner has praised three NSWNMA members for their “very constructive” suggestions on how to improve aged care.

Commissioner Richard Tracey spoke at a hearing of the Royal Commission into Aged Care Quality and Safety in Sydney in May.

His remarks followed evidence from a panel of aged care workers made up of two assistants in 
nursing, Susan and Sue; a registered nurse referred to only as
Elizabeth; and retired diversional therapist Maggie.

Commissioner Tracey said: “We’ve really heard the voice from the coalface this morning – what it’s really like in institutions that care for our elderly and we thank you for that, and for your very constructive suggestions about how aged care in this country can be improved, both as to quality and to safety. We’re very grateful. Thank you for coming.”

Understaffing of nursing homes was a major theme of the panel’s evidence.

Witnesses said understaffing meant there was not enough time to provide care and led to episodes of missed care.

Workers could not provide individual care and were forced to work unpaid overtime in order to complete their tasks.


Commissioner Tracey is one of two commissioners running the inquiry into Australia’s aged care system.

His fellow commissioner, Lynelle Briggs, said the inquiry had heard arguments from the industry that it was “virtually impossible” to specify staffing levels and staffing ratios.

Commissioner Briggs asked: “Do you see a way or a means to increase or think about how staffing levels might be increased in a way that 
a government or a provider can 
relate to?”

Elizabeth said the nurses’ union had done a lot of research into aged care ratios and recommended a staff mix of 30 per cent RNs, 20 per cent ENs and 50 per cent AiNs, which would provide “reasonable care”.

She said that with current staffing levels, “all you’re basically doing at the moment is warehousing people.”

Accountants did not understand the consequences of insufficient staffing and there was a gap between “people trying to manage the money and the people trying to deliver 
the care”.


Counsel assisting the com-mission, Paul Bolster, asked if one RN and two AiNs was sufficient to adequately care for 60 residents – half with dementia – on a night shift.

Elizabeth said that was insufficient to take care of bedridden residents who needed to be turned every two hours to avoid bed sores as well as deal with medical problems affecting people with dementia.

“You’re then having to deal with the difficult behaviours that they can sometimes experience such as becoming agitated overnight, wandering, and if somebody falls, you’ve got to be able to assess 
them for a fractured neck or femur,” she said.

Mr Bolster asked the AiNs if they had enough time to “do all the things that you need to do in your ordinary shift at work? Does it happen often?”

Sue said she had to stay back most nights in order to finish caring for residents while Susan said she was never able to finish her shifts on time.

“If I’m on a floor with 40 people I don’t have a cleaner, a laundry person, a kitchen staff. I have to do all that, plus answer call buzzers, attend to people that are on the floor, in pain … you can never get it done,” Susan said.

Both AiNs said they were given no extra staffing to deal with residents’ palliative care needs.

Susan said staff needed more training on how to deal with palliative care and current training was “just not good enough.”


The commission heard that residents with dementia often became more confused, restless or insecure late in the afternoon 
or early evening – a process known as “sundowning”.

Maggie said diversional therapists were most needed between 4.30pm and 7.30pm to help residents who experience sundowning.

She was asked how managements reacted when she sought to change hours to meet the needs of the people with dementia.

She replied: “To be perfectly honest, management don’t want to know about it. They don’t seem to understand the need for people with dementia requiring the space to walk, yes, just to be themselves, really.”

Sue said her workplace had had a successful trial of afternoon activity officers “but that just faded out and went back to normal 8.30am to 4pm.”

She agreed that this was “a fault in the system”.

Susan said: “We don’t get any help at all, usually, on night shift with problem behaviours.

“Sundowners can happen, as they said, any time but mostly from about 4 o’clock because they’re frightened, they want to look for their family, nothing looks the same, they’re not feeling the same.

“They’re not eating the same, nothing is familiar.”

Asked about chemical restraint, panel members said it should not be acceptable and was used because too few staff were employed.

Elizabeth said instead of employing “specials” to provide one-to-one care, nursing homes resorted to chemical restraint, “because … everyone looks fine, everyone looks, you know, they’re all clean and tidy and they’re not crying out. But they’re not actually getting the care they need and being treated like a person with needs.”

She said: “I can’t think of a time where it (chemical restraint) actually should be happening at all. So then rather than give proper care, you just sedate people so then they’re not annoying you. And it’s just not acceptable.”

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