Placing mum in Residential Aged Care – thoughts of a nurse/daughter

Of course, my personal lived experience is also inextricably intertwined with me being a nurse of 44 years.

As much as I try, these two “personas” cannot be separated, and both are apparent every time I visit mum.

Mum lived with me for 23 years, in a separate space, but in the latter years required ongoing and continuous daily care. However, during a period of insistent and heavy rain her space got flooded and my space was not designed for her. She went into respite care.

The first residential facility was 90 minutes from me – I could not get anything closer no matter how hard I tried. Potential permanent local providers could not talk about her because she was in a facility “out of area”, and the providers of the facility she was in, could not help as her home address was “out of their area”. Bureaucratic boundary madness.

The first facility was very old, I do wonder how it got through accreditation based on the physical environment. Mum’s tiny room could only fit one chair, a single bed and a tiny one-door wardrobe. Long, noisy and cold lino covered corridors with only two shared bathrooms, a single lift to the dining room (that was continuously broken), most staff changed regularly – apparently agency.

The food was really good (cooked on site by a European cook), most staff were really pleasant. No activities per se – most involved turning on the very large TV in the dining and sitting area.

Then a miracle happened – yes that’s how it felt. A local provider had a bed, we transferred mum to be near us, and care was now permanent. Nine months had passed.

Mum felt she had moved into what she said was a “5 star hotel”. She has a large private room, WITH carpet, WITH an ensuite, WITH a kitchenette (she now had a fridge), WITH a double wardrobe, WITH a wall mounted remote controlled TV, WITH storage space. There was also enough room for us to get her an electronic rising chair, buy her a bookcase and a display cabinet for her photos. She was SO happy and we were and still are – SO grateful.

Fast forward 12 months. Mum has declined physically and cognitively although still very much able to have a conversation and would pass a mental status exam (MSE). The staff work very hard and provide the best care they can. Many are nursing students and people brought in from overseas to look after our older family members.

Weekends are a challenge for the organisation, much of the staff are agency which fills the roster but of course this poses challenges as to not knowing the residents or their routines. Mum likes things done a certain way – and expects the staff to know what that is. It can be frustrating for her and the staff member.

Daily care needs are met but just as important is the many activities that mum gets involved in. Activities are often held in the lounge room and done as a large group and include name that tune, country etc. crosswords, exercise groups, singing, and craft.

The facility goes out of its way to have a roster of volunteers who take those residents who want to go out in the bus, pull weeds from the lovely garden area, and bring in dogs to pat.

There is always a choice of food on the menu, tea/coffee/hot chocolate/milkshakes are on offer regularly, usually accompanied by a scone with jam or cream or a Tim Tam. A wee dram of Port at night is not uncommon and helps mum relax into her comfortable bed.

As a daughter I am grateful and pleased with her care. She is safe, clean, well fed and entertained. As a nurse I am also grateful and pleased with her care, but I do notice ‘other’ things. The shortage of staff, many of whom come from an agency. Untrained nurses distributing medication – yes from a Webster pack – but are they aware they are administering? I get phone calls ALL the time about everything. Your mum has stubbed her toe, your mum said no to washing her hair today, your mum has a spot on her leg. Not major things and I appreciate being told but the extent of ‘reporting’ must be onerous for the staff.

The nurse in me notices a ‘crinkle’ on a sheet that could result in a pressure area, or the call buzzer just out of reach, the lemonade bottle that remains full as it’s too hard to open and mum doesn’t want to disturb the busy staff, or the flat tyres on the wheelchairs (who has time to pump these up). The nurse in me also notices all the ‘doing’ – the tasks that are done quickly, efficiently and effectively. Mum though, wants someone to sit with her, talk to her, look through her photo albums.

Staff just do not have time for that kind of interaction, and it’s that level of engagement that is desired. I walk right past the nurse’s station, in fact mum’s room is right opposite. The nurse in me notices that it is empty, the staff are always on the floor and when they are in the nurse’s station, they are writing up notes. They don’t congregate there to chat – and nor should they.

Ultimately, my mum is happy – she says so. We often chat about how aged care is portrayed on TV and all the terrible media that surrounds a complex, difficult job. Mum and I are not at all saying that bad things haven’t and don’t happen – but what we do know though, is that many people get great care from dedicated people who are often not acknowledged as much as they should be. Mum talks about being totally looked after and having her needs met.

Staff in residential aged care do work that many people just do not want to do, providing person-centred care to people in their own home (the facility), their pay rate in not at the top of the pile, they have challenging residents who have challenging families.

As a registered nurse and daughter – thank you to each and every person who works in residential aged care – I think you are all heroes.

Professor Lorna Moxham, RN, MHN, PhD(CQU), MEd(UNSW), BHSc(UWS), DASc(MIHE), Cert OH&S(CQU), Cert Qual Mngmt(CQU), Cert IV Training & Assessment(CQIT), FACMHN, FACN, MAICD, Professor of Mental Health Nursing / Credentialed Mental Health Nurse (ACMHN), University of Wollongong NSW Australia

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