Most Canadians are familiar with nursing homes or long-term care facilities that provide 24-hour care to seniors who are no longer able to care for themselves independently – but we don’t spend a lot of time thinking about them. Given our rapidly aging population, and the likelihood that someone we love, or maybe even ourselves, will be living there one day, maybe we should.
What might surprise many is that 80 percent of residents in Canadian nursing homes are now living with some level of cognitive impairment. This number is expected to rise. By 2037, there will be an estimated 920,000 Canadians living with dementia.
What does this mean for our nursing homes?
Care needs are increasingly complex and demanding – and nursing homes are already struggling to provide the level of care required for even basic needs. The future looks bleak, unless we change our approach.
We recently published a study documenting the frequency with which care aides in Canada, the unregulated staff that provides upwards of 90 per cent of direct resident care in nursing home settings, skipped or rushed essential care tasks on their last shift because they had insufficient time. Essential care tasks include things like taking residents for a walk, talking with residents, performing mouth care, toileting, bathing, feeding, dressing and preparing residents for sleep.
Using Translating Research in Elder Care (TREC) survey data, we asked more than 4000 care aides across 93 urban nursing homes in Western Canada (Manitoba, Alberta, BC) about their care practices. Our study discovered that more than 65 percent of care aides reported rushing at least one essential care task and over 57 percent of care aides reported missing at least one essential care task altogether on their last shift.
The most frequently missed task was taking residents for a walk (37.2 percent) and the most frequently rushed task was talking with residents (49.2 percent). Mouth care was missed by 14.1 percent and rushed by 39.3 percent. Other critical care tasks, such as toileting, bathing, feeding, dressing and preparing residents for sleep were missed by less than 10 percent but rushed by more than 30 percent.
Although these figures are alarming and have significant negative repercussions for both the staff and the residents, solutions are available.
Our study found rates of missed care were higher in nursing homes with less favorable work environments, with factors such as poor social capital among staff (active connections through information sharing) and little organizational slack in staff and time – the cushion of resources that allows an organization to adapt successfully to pressures for adjustments or changes. Rushed care was associated with care aides’ perceptions that they had limited organizational slack in the area of adequate staff.
In other words, care aides working in a more favorable organizational context were less likely to miss or rush care tasks. This is good news, because we can modify organizational context through leadership and team communication, among other factors, and directly impact the quality of care a nursing home resident receives.
Care aides are dedicated and hard-working staff members who get significant meaning from their work, but they are at high risk for burnout and exhaustion. Addressing front line staff burnout, engagement and empowerment offers one important path to enabling care aides to work differently.
Jurisdictions should periodically measure missed and rushed care in nursing homes. And everything that can be done, should be done to ensure adequate staffing and resources. One important activity is to have sufficient pools of frontline staff to enable filling sick and other leaves.
There are potential harms for residents when staff have insufficient time and are forced to rush care tasks. Studies show in acute settings, missed care is associated with increased occurrence of falls, infections, pressure ulcers, medication errors and overall patient safety and mortality.
When caring for older adults who live with dementia, one of the most important things is to not rush the individual through their care. People with dementia need time — some places describe a need for “slow care.” Reorganizing care is another pathway to reducing rushed care.
Our seniors deserve better. It’s time we all paid more attention.
Carole A. Estabrooks is a professor, faculty of nursing, University of Alberta and Scientific Director of the Knowledge Utilization Studies Program (KUSP) and the pan-Canadian Translating Research in Elder Care (TREC) research program, Alberta, Canada. Yuting Song is a postdoctoral fellow.
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