This post may be one of my more challenging ones but I believe this is a conversation that needs to be had…..Do we really know what care our loved ones are receiving? I visit the aged care facility every day pretty much (and we are in one of the best) and am fairly intuitive when it comes to people, but sometimes I question what can happen to a person with dementia when we are not there?
I am concerned about night time shifts when care staff are stretched and often filled by agency carers or staff not known to the person with dementia. This is the ‘key ingredient’ for trouble to occur. If I put myself in the person with dementia’s shoes , I wake up unsettled at night and set off the motion detector in my room, as I walk around lost. A carer comes in to investigate and they tell me to “get back into bed” . I am shocked as the tall figure in the shadows barks the order (with no-one else to be accountable to), the carer is a complete stranger treating me like a child and they don’t even know me or may not want to know me. They may talk down to me sternly to evoke a quick response to avoid waking other residents. The carer may be no-nonsense, they may be empathic, they may be from a different culture, they may be understanding. Whoever that single carer is, and what they know and what they stand for, will potentially determine my future.
Even though we protect our loved one across most of the day, you can never protect them 24/7 and we are subject to the ‘system’. If the care staff deem the person with dementia difficult or is seen to display ‘difficult or aggressive behaviours’ an ambulance or police could be called at their discretion. Everyone has a different tolerance and we all have different ‘tipping points’. The result is potentially a life changing scenario that can rip families apart and send the person with dementia deep into the mental health system, which could be avoided with more intensive staff training and strategic rostering. The costs blow out everywhere as the work is loaded onto emergency services, security staff, extra nurses, doctors and carers who are all required to deal with the aftermath.
My point is this – aged care facilities need to invest deeper into their dementia training and focus on the key elements such as ‘tone of voice’ , the ‘power of touch & body language’ and diversionary tactics. When words are no longer effective and the person with dementia simply does not understand anymore, you are simply wasting your breath…..Perhaps roster key staff on at night with advanced dementia training so that good decisions can be made and create an accountability that keeps everyone safe and sound. It may take the courage to actually add a person to a shift in the short term or invest some more training dollars, but the long term cost savings and resident safety and happiness is paramount. The families will be happier and the pressure valve released off a system that could potentially blow.
PS – The role of the agency carer or nurse is often not understood or valued by people, and can sometimes be given the ‘cold shoulder’ by regular staff who may treat them as the ‘enemy’. I actually believe agency carers and nurses are vital and courageous ,and under the most pressure, as they continually walk into potentially dangerous situations with very little resident knowledge or background (let alone facility procedures). Perhaps developing a team of agency based ‘dementia champions’ is the way to go? …Is this possible?