Changing the Attitude of Caregivers is Essential to Improve Care in Residential Facilities

For many years now I have promoted that a residential facility is the resident's home.  It is not the home of the people who own it, nor is it the home of the caregivers, managers or Registered Nurses.  Unless everyone working in the home and the family and friends that visit a facility understand this concept, the person in care will continue to be disempowered and devalued as a person.

As a trainer, I take every opportunity to get this concept across.  I do not care if the facility belongs to a large corporate entity or an individual, this concept is paramount to the resident being empowered as a person.

From my perspective and what I have witnessed over many years working in aged and disability care, it seems to be that when a person works in a facility, they then have to make all the decisions for the person in care.  No matter how much a manager or owner tells them to get a person to choose their own clothes, or time of shower, unless the concept that the facility is the residents home is emphasised, encouraged and promoted, these very basic rights of any person will continue to be violated.

A caregiver, and that includes Registered Nurses  Enrolled Nurses, Managers and Owners, in fact anyone who delivers care, has to understand, the only difference between a residents own home and a residential facility, is the size of the building. 

Every person in their home, has their own personal space.  It may be a space shared with a partner, but it is designated their own space.  This is their sanctuary. A place where they keep their precious belongings, the things they don’t want to share with anyone else.  The rest of the house is shared by anyone that comes into the house.  The kitchen, living room, bathroom, toilet or any other room is common ground. 

The same is for a residential facility.   A resident’s bedroom is their sanctuary.  A place where they go to rest, relax, keep their treasures, invite people in to talk to and so forth.  The rest of the facility is common area where people mix and mingle, where they share common interests.  They share the dining room, the lounges, the bathrooms and toilets.  It is communal area,

When a caregiver, and that is anyone who gives care, clearly understands this concepts, they will be more respectful of the residents personal space, and the person they are giving care to.

They care has to be delivers to a person as if that person is in their own home.  As if the facility is the house outside the gate of the facility.  Where they would give the person the same respect and choices.  They knock on the door, they allow them to choose their own clothes, use their own toiletries and so forth.

For a resident to have to fit into the caregiver’s daily schedule rather than the other way round, is disrespectful.  When there is a clash of time for shower or any other care, the caregiver needs to negotiate a time that is agreeable to both and if they don’t know how to negotiate or what negotiation means, they are taught. 

Caregivers have to think of their work not as a job that has to be done in a time frame, where everyone fits into their schedule

depending on how they plan their day, but rather, how they can plan their day around the resident.  There is always enough time to get everything done.

Caregivers will find most of the so called “challenging behaviours” will disappear when they work with the person rather than disempowering them to fit into their schedule.  It is a shift away from task orientation to person centred care.  While this is, in many cases encouraged, unless the caregiver actually knows what person centred care is, they will continue to deliver care to their own schedule.

It is up to Registered Nurses and Managers to promote this type of care.  We can’t blame the caregivers.  We need to teach and coach them into changing the way they think.

I believe that, almost without a exception, all cases of unsatisfactory care, abuse or neglect is purely down to a lack of understanding.  When I promote this way of thinking while I am training, the caregivers eyes light up.  They have never thought about this way of giving care.  This is why I promote this in every training session.

If the caregivers don’t get this concept, residents in care will continue to be under valued and disempowered but it needs to be promoted more widely.

I am in a very privileged position where I have the ability to influence large numbers of people through my training and writing.  The book, “The Art of Caregiving” is a way for a caregiver’s to understand the differences in each person, including themselves.  Thinking of the residential facility as a residents home where they live 24 hours a day, 7 days a week, is

an extension of this philosophy.  The caregiver goes home to their own home everyday they finish work while the resident stays in the facility. 

If we want to change the way care is delivered everyone who is involved in a persons care, has to understand this concept.  After all, one day, it could be you receiving care.  Do you want to be disempowered and devalued as a person because you are no longer able to take care of yourself? 

Leigh Kelly RN ADN
Managing Director
Clinical Update (NZ) Ltd

Leigh has been working in aged and disability care sector since 1974.  She is the author of “Life’s and Illusion” and “The Art of Caregiving”, two book on care delivery.  She now works as a full time trainer providing Clinical Updates for Registered Nurses and Caregiver training Updates.  Her company, Clinical Update (NZ) Ltd, provides inhouse training updates for all required topics under District Health Board Contracts and Health & Disability Safety Standards.  She is available to speak at conferences and inhouse training.  For a full list of topics and upcoming workshops or for more information contact Leigh at


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