Louise scores her job 8/10 (ten being the most enjoyable job you can imagine).
by Caroline Knight
By 2061, the Australian Bureau of Statistics projects that 22% of the population will be 65 years of age or older, with 5% being 85 years or older. That is almost double the numbers in those age categories today.
The ageing population presents a challenge for providing care. It is not just the numbers of people; it's also the complexity of the care. For example, about half of people living in aged care residential units have depression, dementia, or another mental health condition[2]. This complexity puts a strain on current care resources, with too few trained nurses available to help maintain individuals’ comfort, dignity and mobility. Indeed, a nursing workforce shortfall of 123,000 is projected by 2030[3].
We took a step inside one residential care unit for older people in Perth, Australia, to find out how aged care workers cope with some of the challenges of this type of work.
Louise[4] is very enthusiastic about her job, rating it ‘8 or 9 out of ten’. She tells us:
‘I do love caring for people, especially those in need... I have compassion to share.’. ‘If you don’t care, it’s not good. In this job, you need to care. You need to look after the residents [in the way that] I want for me when I grow old’.
The significance of Louise’s job is very important to her. She recounts how the residents she looks after ‘forget’ they are in pain when people are taking notice of them. If she is away, they say to her “oh I missed you, where have you been, are you sick?”. This dynamic interaction with the residents is what makes Louise value her job so much. She loves to make a difference to peoples’ lives, no matter how small.
Good quality academic research suggests that task significance is an important aspect of work that has many positive consequences[5]. In essence, high task significance means you believe your work benefits other people and is valued by them. Care workers who experience task significance are likely to feel more satisfied in their jobs, purposeful, and rewarded for their efforts. The motivational effects drive better performance. Other beneficial effects include decreased turnover, which Louise tells us is true of the particular unit she works in.
This positive aspect of a care job, however, can sometimes be eroded by high job demands and poor working conditions, and lead to burnout, sickness absence and turnover[6]. One report suggests that 32% of nurses and midwives are considering leaving the profession, with 71% reporting more work than they can do well due to insufficient staffing, too much administration, and an inappropriate skill mix. The stresses and strains of the job can impact quality of care and dissuade people entering the profession.
Louise uses creative strategies to develop and maintain rapport with the residents whilst efficiently managing her workload. She makes a point of talking as she works, finding out about those she cares for while she’s washing and dressing them. She laughs and jokes with the residents, providing some much needed cheer and respite from the daily routine.
Yet the emotional and physical effort Louise puts in does take its toll. She reports how she often returns home ‘exhausted’ and recovers by having a nap. She notes how her exhaustion can affect her family as it can leave her with little patience and resources, telling us:
‘Sometimes if you’re tired you’ll be angry, angry to your kids and I don’t want that result. The children are affected also when you go home because you’re very tired’.
Louise tells us how she’s lucky to have a supportive husband, which means she is better able to recover from the work demands before returning back the next day.
But how do carers cope if they don’t have such support at home? Or if their proactive strategies to recover sufficiently before the next shift do not succeed, or wear thin over time? These are important questions in such a critical profession that is so important to our society.
For Louise, the work load challenges will not be solved by having robots as carers (see below), but rather require more funding. Louise told us how she goes to church to pray that the government will ‘give the funding back’, becoming teary eyed at the crisis she sees looming.
We hope that Australia will not go the same way as some residential units in the UK (see “A little more”) and will ensure there are enough carers in each facility to provide care that supports human dignity.
A little more..
A crisis in care?
Without proper resources and planning, Australia could be heading for a crisis in care to rival the infamous 2013 Mid-Staffordshire NHS Foundation Trust Public Inquiry in the UK[1]. This inquiry highlighted how older people suffered a lack of basic care, compassion, and dignity, being left unwashed, unfed and dehydrated. At the same time, carers of older people reported their jobs to be lacking significance, reward, and purpose due to the tendency towards long-term progressive deterioration of older peoples’ illnesses[2]. A similar situation may well evolve in Australia if the funding is not sufficient and the experiences of other countries are ignored.
[1] Francis, R. (February, 2013). Report of the mid Staffordshire NHS Foundation Trust. Public Inquiry chaired by Francis QC, London: The Stationery Office.
[2] Patterson, M., Nolan, M., Rick, J., Brown, J., Adams, R., & Musson, G. (2011). From metrics to meaning: Culture change and quality of acute hospital care for older people. National Institute for Health Research Service Delivery and Organisation Programme. London, UK: HMSO.
Techonology advances
We asked Louise whether she’d noticed the rise of technology in the workplace. She told us that i-pads now exist to record medication given to residents, where before pen-and-paper was used. Indeed, documentation is increasingly computerised, with time allocated for it each shift. The prospect of robots taking over the job fills her with sadness: ‘How can you say your feelings with a robot? How can it feel your feelings? Hopefully it won’t happen’. For some purposes, and in some contexts, however, robots may be useful. Japan is trialling robots for people living with dementia, for safety and therapeutic reasons as well as to decrease social isolation and loneliness[1]. Robots can help transfer people from beds to chairs, assist them with personal hygiene, remind them about medication and mealtimes, and engage them in games and exercise. If used appropriately, robots might help people retain independence and live at home longer.
[1] Ries, N, & Sulgihara, T. (2017, February 1). Robot revolution: why technology for older people must be designed with care and respect. The Conversation. Retrieved from: https://theconversation.com/robot-revolution-why-technology-for-older-people-must-be-designed-with-care-and-respect-71082
Refences
[2] Philips, J., Currow, D., Parker, D., & Ries, N. (2017, December 20). Australia’s aged care residents are very sick, yet the government doesn’t prioritise medical care. The Conversation. Retrieved from: https://theconversation.com/australias-aged-care-residents-are-very-sick-yet-the-government-doesnt-prioritise-medical-care-88690
[3] Holland, P., & Tham, T. L. (2016, September 28). Burnt-out and overworked, Australia’s nurses and midwives consider leaving profession. The Conversation. Retrieved from: https://theconversation.com/burnt-out-and-overworked-australias-nurses-and-midwives-consider-leaving-profession-66141
[4] The name has been changed to protect the identity of the Aged Care Worker.
[5] Grant, A. (2008). The significance of task significance: Job performance effects, relational mechanisms, and boundary conditions. Journal of Applied Psychology, 93(1), 108-124.
[6] Humphrey, S., E., Nahrgang, J. D., & Morgeson, F. P. (2007). Integrating motivational, social and contextual work design features: A meta-analytic summary and theoretical extension of the work design literature. Journal of Applied Psychology, 92(5), 1332-1356.
Behind the scenes
by Caroline Knight
The residential unit we visited for older people was located in a pleasant, quiet suburb. Constructed on one floor, it was designed carefully with mobility issues in mind. A large, canteen style dining hall forms the ‘centre’ of the unit with residents’ rooms and other purpose built rooms and facilities encircling it (e.g. a hairdressing room, chapel, offices). A leafy outdoor courtyard with a shaded table and chairs offers some outdoor relief for residents whilst maintaining privacy from neighbouring residential units.
Lynne, the sketcher and myself met Louise outside her regular hours, allowing her plenty of time to talk to us, which we were grateful for. Louise greeted us enthusiastically and was very helpful, showing us around and answering all our questions. The sense of teamwork and camaraderie was also apparent by our friendly encounters with other staff members who were intrigued by what we were doing and Lynne’s sketches.
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