Philosophy of Care Essential to Good Residential Care

While the facts are that many of the larger Rest Homes and Continuing Care facilities are owned by overseas interests this should not influence the care which is the over all aim of residential care.

Yes the workforce is poorly paid for the work they do and deserve a higher wages but paying more money to the caregivers is not necessarily going to get better caregivers.  In some cases you will only get better paid poor caregivers.  Paying higher wages must be linked to training.  There has to be an incentive and a return on the investment outlaid. 

However let us not forget that many caregivers are dedicated people who see their work as a vocation.  Training is the icing on the cake, the insurance policy in you like that takes a caregiver from average to exceptional.

Whether good care is given or not doesn’t come from the board room.  It comes from the direction of the Managers and Registered Nurses on the floor.  Giving good care comes from a philosophy of those who are at helm of the facility.  While a Board may develop a philosophy of care, if they have never worked in a facility to see how the philosophy is applied it is just glossy paper for the promotional material. 

So where do the problems arise?   They are in many areas.

The auditing system is a paper based system and outcomes based.  However this is a far better system than what was in prior to the introduction of Health and Disability Safety Standards in 2000.  The previous regulated system did not turn up any more information than the current system however now it is easier to track what is happening in a facility. 

Another problem is some auditors have a background that is far removed from residential care.  Residential care has a culture of its own.  For instance it is vastly different to a public hospital. Yet this is the background of some of the auditors.   Their mind set that is based on acute/ chronic nursing not residential care.  People in residential care have a totally different profile and needs. 

Completing a subjective audit is not possible.  There are too many variables that would come out of it.  The only way an audit can be performed is through the systems and processes which can highlight concerns.  However these concerns do not necessarily indicate poor care, rather people who have poor processes.

Training is the only way to improve care.  While all facilities are required to have a training plan that covers many topics often the training budget is so meager Managers are restricted in what they can afford to purchase. 

The Registered Nurse or Manager (and sometimes the same person has both roles) is suppose to fit training into their already busy schedule as well as ensure audits are completed, adequate supplies available, human resource management, marketing and interviewing of prospective residents and so on.  To add training and development of staff is a huge ask.  It is just not humanely possible for a person to do all the work that is required of them.  The ultimate result is burn out often resulting in the person leaving the profession usually for good.  What a loss.

Unfortunately some profit driven facilities appear to see training as a cost, not an investment. 

So while people will continue to complain about care that is given or lack of it as the case may be, it will only be addressed through caregivers receiving the appropriate training from skilled and qualified people.  I have yet to meet a Manager who can be good at all the roles they are suppose to play.  

There are a variety of training packages available for Rest Homes and Continuing Care facilities that are done in house.  However many of these are self-directed learning packages.  For the student to get the maximum out of the learning it is essential that they have 1:1 or group sessions with a qualified person who can guide them through the process and answer their questions or ask them questions to ensure they understand what they have learned/written.   Self directed learning is more difficult for people with ESOL.  While they are keen to learn the fact is that many of the words written they do not understand.  We are doing them a huge disservice if we do not undertake to spend more time helping them understand what they are learning.   

Ultimately the delivery of care and philosophy falls on the shoulders of the person heading the facility.  If they run a people centred facility, it will be evident.  Caregivers also need to understand residential care facilities are the residents home – irrespective to the number of beds.  The mindset has to shift from doing a job to one of assisting a person to live their life as if they were living in their own home. We have to stop medicalising these facilities.

This can be done. 

When the mind set shifts from doing a job to walking into a person’s home everyday they come to work, delivery of care will change.  The building may be owned by a company or person but it is not their home.  It is the resident’s home.  The staff, owners and Managers all have their homes to go to but the residents live in the building 24/7.  Each resident has their own personal space albeit one room, as you do. The rest of the facility is communal.  Like your home.  The only difference between residential care and your home is the size.

When this philosophy is fully grasped and understood only then will care be given to the level we all expect to receive.  It is after all the residents that pay the wages of everyone who works there.  The business entity is only the filter.  Let’s not forget this.


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