Aged care and untrained staff


Dr Jean Booth


The aged today are largely cared for by untrained staff, with supervision from a Registered or Enrolled nurse. The role of the Registered Nurse is onerous where they could be responsible for up to and more than 60 residents in a shift.

Despite regulation and inspections by the Department of Health and Ageing, we are continuing to hear of mistreatment of the aged in Residential Aged care Facilities, which shows that not much has changed in the history of the sector.

In early colonial days, aged care was delivered by convict women who were sent to work in the asylums as a punishment. Some likened these women to prostitutes in that they were the only women who would work for the wage that was offered.

General hospitals were using the asylums to ease pressure on hospitals by transferring chronically ill patients to these asylums.

Public outrage at the treatment of older people escalated until an inquiry in 1877 recommended that Nightingale trained nurses should care for the aged in these facilities.  It was then that legislation recognised the needs of the elderly and that this care could best be provided by Nightingale trained nurses.

Unfortunately in these early days of our colony there were those in the community who believed that untrained staff were sufficient to care for the elderly.

Is it any different today? Despite the move to Nightingale trained nurses, since 1997, government policies have largely been responsible for the reduction in the number of Registered Nurses caring for the aged. The belief continues that middle aged women with “tender loving care” are all that is necessary to deliver this care.

Registered nurses working in aged care are paid less than their counterparts in the acute sector; they carry a much heavier workload, supervise untrained/minimally trained staff, and continue to deal with families, make critical clinical decisions about their residents and also attempt to provide the best possible care to their residents.

Is it any wonder we cannot attract registered nurses to the aged care sector?

The needs of the elderly in our facilities are becoming more and more complex. Even this is not enough for Governments to identify the need for more Registered Nurses in Aged Care.

Successive inquiries into aged care have been very costly, but largely ignored by Governments. On launching the Productivity Commission Inquiry Report ‘Caring for Older Australians’ the Prime Minister has announced a review to be conducted before the Government responds to the recommendations of this Inquiry.

Once again, money has been spent on yet another inquiry. This inquiry will, I am sure, be placed alongside the plethora of inquiries already conducted by previous governments that are gathering dust in some government storeroom.

We don’t need another review to see that it is becoming increasingly impossible for registered nurses to work in aged care, and that this is compromising the care of residents.

Recently an elderly resident was left strapped to a toilet and died.  Was it because of staff neglect, or is the government to blame? Almost certainly a person lost their job over this. But would it have occurred if more trained staff were employed? Is this situation a result of staff neglect, or the result of a system which drains as much as it can from staff that have no more to give?

Since the early colonial days, in a nutshell, not much has changed. It is no longer a requirement to have registered nurses employed in aged care but care of the aged is going backwards.

Untrained staff are now the major carers of our aged and wages remain low—prostitutes are much better paid. Because of these conditions registered nurses, the ones who can deliver the best care to our aged are increasingly becoming a scarce commodity in the aged care industry.

Dr Jean Booth is a Lecturer in Nursing at the La Trobe Rural Health School, La Trobe University.