Among the most desirable skills for a care worker in aged care there is one that stands out to me as a symbol of all that is most wrong with this industry.
Good time management.
What does this mean?
The average aged care workers shift is between four and eight hours long. You have an unpaid break of ten minutes in the morning, and thirty minutes for lunch on a typical eight hour shift. If you have a four hour shift, you get ten minutes.
You will usually work in pairs, and have up to thirty residents between you.
Your role encompasses taking care of their “Activities of Daily Living” or ADL’s for short.
Personal care – showering, elimination, skin, hair and oral care, dressing.
The things they need to maintain a normal, healthy life – eating, drinking, socialising, moving safely around their environment, exercise, participating in things that they enjoy.
Keeping their personal space in order – tidying their room, making their bed, keeping their clothes clean.
What this means in simple terms is that first thing in the morning, at 7am, you need to get as many of those 30 people up and ready for the day as you can. Breakfast is at 8am, so you need to prioritise. There is usually a roster for showers, being that residents who need help with showering may only shower on those days. They get a wash on alternate days.
You might have a few residents who are capable of getting up and dressing themselves, perhaps you might need to set them up but they can manage pretty well on days when they aren’t having a shower. So you’d go to them first and get them started. If you have good colleagues, they’ll have set out the person’s things the night before when they go to bed.
You need to launch straight into your showers. People get up whether they’re really ready to or not, undress, shower, clean the bathroom, dress, brush hair/dentures, make their bed and tidy up. You have about 15 minutes including getting that person to the breakfast table. Repeat this 3-4 times if you are having a good morning. Walk or push the rest of your residents to breakfast. I saved time with tricks like pushing one resident in a wheelchair and another walking beside holding onto my arm. No one likes to be late to breakfast!
Serve breakfast. Deliver trays to rooms. Feed people. Clean up. Return people to their rooms if they haven’t had their shower/wash yet, and take others to the common rooms.
It’s about 9 am. More showers/washes until about 10, moving people to where they need to be for the day, tidying rooms and changing linen in the rooms that really need it (wet beds) or those whose rostered day it is for clean sheets – everyone gets that once a week unless needed earlier.
By 10 you better have everyone up or nursing staff will be looking for you to find out why not. The only people who might still not be ready are those that need both carers to help transfer them. We do those next, but in between that there is morning tea to serve and feed to people, then clean up after. Plus there’s toileting of people who might not remember to go otherwise.
All beds better be made by this point, yep all 30. All rooms tidy. All soiled pads, towels and linen disposed of. Paperwork to start if you’re really having a great shift – unusual.
Now it’s lunch time, take everyone back to the dining room. Serve, make up and deliver trays, feed people. Clean up. Second carer usually leaves at this point.
Move people back to where they need to be. Toilet people. Change pads on those who need it, usually your bed or chair bound residents, which means take them back to their room and use a lifter to put them on the bed, change pad, put them back in the chair and take them back to the common room. You pair with someone from another section for these “doubles”.
Tidy up, toilet, paperwork, damn paperwork. Don’t forget in this time there are bells to answer for non-scheduled tasks, like “I wet my pants”, I can’t find the remote, where’s my newspaper etc. There’s also conversations with your residents. There’s visitors who want to know how Mum or Dad is doing. There’s nursing staff who need your help to turn a resident so they can dress a wound. There’s pressure area care for anyone bed or chair bound. There’s physio to squeeze in somewhere for some residents – usually done while they play bingo or watch Gone with the Wind, and you just lift their legs up and down for them.
There might be a resident who has had a fall and needs to be assessed by the nurse then helped up using a lifter. There might be someone needing pain relief so you’ve got to find the nurse. There’s wandering residents going in and out of other people’s rooms you need to redirect. There’s urinals and commodes to empty and steralise. Towels to restock. There’s sensor mats to pack away. There’s menus to complete for tomorrow. There’s management requesting your attention for some extra task, like water all the plants or clean out all the food in the shared fridge, or there’s a staff meeting, or mandatory training, or there’s your break, or going to the bathroom (or not).
And paperwork. Checklists of where a wandering patient is each and every half an hour. Mark off who has used their bowels today. Mark off what time you toileted someone on a regimen. Sign to say you cleaned Mrs. X’s dentures. Sign to say you changed the linen in 32 because it was soiled. Some places like you to write a short progress note for each person too – all 30 please and remember it’s just you now till 3pm – which was probably about half an hour ago. Handover to the afternoon staff. Return your pager.
Time management is a great skill when you’re in an office environment, where every day you have a to-do list and you mark it off as you go. Working with people – good time management is tough, because no day is ever the same. Mrs. P might be too tired to get up. Mr R might really want to wear his red shirt today, and you need to find it before he’ll do anything else. Ms. M might be having a really bad day, and just wants to walk around yelling. You might be working with a temporary staff member who has never been to your workplace before, and you need to help them with everything. You might have a student to supervise.
Time management in aged care often means cutting corners to get things done. It means paperwork is fudged. It means the fastest wash you’ve ever seen. It means shaving people while they sit on the toilet to save time, it means feeding two people at the same time. It means “sorry, I know you really want to talk but I am too busy.”
Some people are incredible at time management AND getting their work done. They are so task oriented. They work so fast, it’s like they’re everywhere at once. They are valuable. But only a very rare few can be good at time management AND really knowing and caring about their residents. For the rest of us, we work well past our paid time. We get our performance reviews marked with “poor time management skills”.
For me, I struggled with this. I don’t like to fail. I don’t like reasoning in my head that that conversation I had about someone’s dead husband is more important than whether I got all the tables wiped clean. I don’t like going home, and waking up in the middle of the night thinking “Oh my god, I forgot to take out those dentures!” This has happened to me more times than I can recall.
We need to allow for more staff, so that working with people becomes about meeting their needs in a timely but flexible manner, and not task-oriented, rigid schedules that force everyone to bend to their will.