Aged Care - 'Time is gold here'

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

[1] https://www.gen-agedcaredata.gov.au/

[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.

Exploding Information Processing Demands at Work

Data, Data, and More Data: Exploding Information Processing Demands at Work

By MK Ward

Tech means big opportunity and money rewarded to some who work in the industry. From the outside, these resources are extremely attractive, but there is a balance and high resources can also mean high demands. We see this in some of the roles at one of Australia’s major telecommunications company.

MC is a customer technology strategist. He starts with the problem and then matches the problem to current technologies to build a system that will create a “full solution” for customers.  The pace of development means MC needs to spend time reading online, in webinars, conferences or other means to stay up to date: “I keep up on things like augmented reality, AI, automation, internet of things, and more” he notes. 

MC‘s job requires a huge amount of information processing. Fortunately MC has high motivation to learn, which means he enjoys the cognitive demands in his job. Beyond passively processing information, a high level of vigilance is required and some degree of proactivity in searching for the new.

“Data explosions in all of these developments also means data security is increasingly important. False positives are an issue, because there’s a dozen threats a minute but then there may be a more malicious and credible threat. Those must be noticed and responded to appropriately.”

Another example comes from M, an account manager in the same company. M manages the accounts for education clients such as universities and the Department of Education. M’s typical day begins with calls at 7am. He works with lots of people on the east coast of Australia, which is two to three hours ahead of time. M tries not to take any meetings before 6:30am. But the emails don’t go away:

 “I’ll typically answer emails for an hour or two and then I’m in or out of meetings or on phone calls all day. I spend 75% of the time on the phone and the rest of the time in meetings or on my way to meetings. I get 300 emails a day.”

D, a Service Delivery Manager in the same company, ensures that technology solutions get delivered to clients. D gets a couple hundred emails a day on average.

In all of these jobs, technology has meant more information to process rather than less, suggesting modern technologies do not always “remove” work as is typically assumed. An example is the large amount of information that is now generated automatically, but still needs to be dealt with:

 “In our world, we have a lot of automation. We have an automated workflow for internal processes, so a fair bit of our emails are automated alerts from the system sharing information about statuses of projects or information about other things that are happening, rather than from another co-worker or other human.”

In the context of all of these information processing demands, it is important to ensure that other demands in work are minimized. This seems not always to be the case. D observes the effect of poor processes on her work load:

 “We’re not doing the job we’re meant to do because we’re putting out fires a lot…We have to spend sometimes 5 hours dealing with the complexities in our own organisation, and taking on tasks that should be done by other internal teams as a result. Sometimes we need to do other teams jobs in order to minimize turnaround time for the customer. It would be fine if we just needed to do what our job says we are meant to do.”

Some demand comes from role conflict, or having conflicting expectations from different people.  Mike observes: “right now my job is split between pre-sales design and post-sales support, but I’m evaluated solely on pre-sales KPIs….I do spend a bit too much time on support and troubleshooting”.

If the amount of data in the world is doubling every two years, as some commentators have argued, information processing demands will become higher than ever in many jobs. Similarly, it will be more important than ever to ensure good processes and clear, compatible work roles.

Beth - The Stereotyped Childcare Educator

So much more than changing nappies

Beth scored her job as 7/10 (with ten being the most fantastic job imaginable).

Beth works in the toddler room of a childcare centre in Perth. We find her in a sandbox made out of an old boat, with three toddlers playing at her feet. Some sand is being tipped over heads (with much amusement to the little ones), but the issue is resolved lovingly and swiftly. Beth deals with the 'sand-on-heads' incident and continues the conversation exactly where she had left it - making it clear to us how much of her job involves multi-tasking. We are impressed.

Beth loves her job and would not change it for any other job in the world. Her fascination and passion in seeing toddlers grow, and developing their skills, is evident from the loving way she describes her role. "It is about seeing all the changes that happen and the development and knowing that you have helped the (kids) to learn these new things.”

Beth recognises her work as "work" and is clear about the physical and psychological exertion it requires. “It is physically and emotionally exhausting. We are all human too and you have your trials and tribulations in your home life, but your problems stay at the door.”  

She explains that the work they do is only possible with a supportive team, one with team members that complement each other. To her, the key is to have a team with colleagues that are open,  communicate well, and helpful. The work can become overwhelming at times and that the best support is a colleague who looks at you and recognises that it is getting too much for you in this moment, makes you aware of it, and helps you find a way out of it. Humour helps a lot as well.

Beth also thinks that the surroundings and the centre in itself (which is physically very beautiful), and the positive way in which the centre is managed, makes her job one of the best she can think of.

But Beth experiences a lack of recognition from others for her job. She reflects about the ways in which some others see her work – "it is not all bouncing babies up and down.. it is a lot more". She describes the conversations she often has with men in particular, and even other people who work in the education sector, who are convinced that she and her colleagues "just change nappies".

Beth says: “A lot of what we do is so much more. It is about child development, psychology, a lot of reporting... And of course, we change nappies, because that is what children at that age need. But there is so much more to what we do. But our work has that stigma of babysitting.”

When we ask Beth what the one thing is that she would like to change about her job, she has to think a little bit but then comes straight out to say:“Oh, I know one thing I would like to change! If the pay was better, this job would be a ten out of ten. I am not a money-driven person, but when you look at the responsibilities that we have on a day-to-day basis – I sometimes scare myself, thinking about what it means to look after someone else’s children.... We are given this wonderful responsibility and we love it.... but we are not paid much.”

We agree with Beth: this job is such an important one, it should be more highly rewarded than it is.