Standard 7 supports all of the other Aged Care Quality Standards and it’s one of the most important parts of providing quality care. It is obvious that one of the most important parts of providing quality aged care support is having the right people and the capacity to do so.
Staffing is one of the key issues that has been raised again and again in the Aged Care Royal Commission.
The quality of your service depends heavily on the quality of your staff.
‘I get quality care and services when I need them from people who are knowledgeable, capable and caring.'
Lean on me
When you’re not strong,
I’ll help you carry on
Just like the words of the song Lean On Me, we need a workforce that can provide the care and support that people need, but able to provide this in a way that doesn’t take away a person’s independence.
Leaning implies that the person needs support when, how and where it is needed. It does not mean that staff do things that the person, or their carer, can still do. It is really important to get the balance right. As ‘support workers’ we should never take over – even where it is the faster option.
For it won't be long
‘Til I'm gonna need
Somebody to lean on
It’s a fact that we are all getting older and at some (future) point there will likely come a time when we also need care and support. It’s helpful for your workforce (and that includes management) to think about how they would want to be ‘cared’ for, or if that’s too far out, how they want their parent or grandparent to be cared for.
While we want staff to be effective and efficient in their work, we need to recognise that we are working with people, people who have feelings and emotions. Being efficient is something that management like to see. Being effective is more reflective on the client; are we meeting their needs in their preferred way?
‘The organisation has a workforce that is sufficient and is skilled and qualified to provide safe, respectful and quality care and services.'
Managing Staffing Levels Effectively
The new Standard requires organisations to have systems in place to manage staff numbers and ensure that they have staff with the right skill sets on duty. This, of course, is very relevant in a residential setting, but also applies in home care too. After all, if staff don’t turn up, or there aren't enough of them, or the skill mix isn't there, then this limits things like:
- being able to offer activities;
- providing social support that's needed; or
- completing key services in a timely manner like domestic assistance.
We need to ensure that we are allocating sufficient time for staff to complete tasks. We want to minimise falls, skin tears and harm to clients. To do this, we need to roster sufficient staff on to support clients in a timely manner that ensures key needs are met, like ‘getting to the toilet in time’. We need to ensure that staff are allocated sufficient time to assist clients in an unhurried manner.
To achieve this, we need to ensure our rostering systems are effective, as are our supervision and staff job allocation processes.
So, rostering sufficient numbers of staff on at peak periods, as well as having staff with the right skills and qualifications, is key in both residential and home care settings.
Now an effective rostering system is not necessarily one that micromanages time down to the last second. We live in a world where we need to be flexible. Sometimes, the best option for an effective roster system is to build in contingency.
This is, after all, what happens when you call your telecommunications business or a plumber. Rather than giving you a set time, which for a variety of reasons they may not be able to meet, they provide a timeframe. This could mean choosing a time between certain hours or perhaps it’s as simple as a morning or afternoon appointment.
Some aged care services, particularly those operating in rural areas where staff have to travel some distance between clients, need this type of flexible arrangement. While it might not be as convenient, it can be effective, ensuring that the job does get done.
Providing Continuity of Care
One thing I learnt from my time managing a large regional aged care service was that clients hated change – a change of staff, that is.
The service had a policy at the time of rotating staff around every six months. Not only was this a logistical nightmare having to rework the roster, we also had to alert clients of the change and manage the complaints that arose.
While the intent was to ensure that clients didn’t become too reliant on one person and minimise ‘scope creep’ (where staff began to do more and more for the client outside their care plan), it didn’t make clients or support workers happy. We only did this once during my time there, as I learnt that it was better to provide closer professional supervision and maintain an open dialogue with staff about client needs or requests.
I also discovered that it was more effective to discuss anticipated staff absences with clients beforehand and work out how they wanted to manage this. Some people would choose to suspend a service for the period, for example, house cleaning, rather than have a new person come into their home.
Where suspending a service was not desirable, we implemented a buddy system. This allowed us to provide continuity of care to a client and involved a second staff member working alongside the current staff member for a few weeks before the planned leave. The staff member would learn how the client liked things done and clients became comfortable with the idea of a new person in their space.
This is also effective when planning an expansion of services to a client and allowed us to manage emergency situations where the staff member was unable to attend work due to sickness and/or family situations.
In many current service contexts, staff turnover can be quite high and it’s just not possible to assign the same staff member, so it may be that your service has a ‘pool’ of staff that are used to support clients, especially in relation to personal care and social support.
It’s also important to ensure clients with special needs, like dementia are supported by staff with the right skill sets and experience. Your service should aim to minimise change of staff and prioritise services based on need – for example, personal care before domestic assistance.
Matching Staff and Clients
Matching clients and staff is also something I’ve learned over the years. Some clients prefer a chatty, upbeat person to provide their support, while others prefer someone with a calm demeanour who gets in and gets the job done. As a manager, a number of complaints arose more from a mismatch of the staff member to the client, rather than the staff member not being able to do the task.
Of course, there are always limitations in what we, as service providers, can do. Sometimes we will struggle to meet the individual’s requests. This might be because we are meeting other requirements such as ensuring our staff have required breaks, that their mental health and wellbeing is being supported and of course ensuring that if they are ill, giving them time off so they don’t pass on illnesses to clients.
In these cases, we may need to substitute the client’s preferred support worker for another with whom the client does not have an established relationship. In this instance, making the time to discuss the required change with the client can ease this situation (and reduce the incidence of complaints), along with educating the staff member on client preferences and requirements.
Providing Relevant Client Information
One of my bug-bears is when staff are sent out to support a client but are not provided with sufficient, relevant information about the person. I’ve had staff reiterate this frustration to me.
‘I felt stupid because I didn’t realise the person was in a same-sex relationship.'
‘I didn’t realise that the client needed to have their medications before we got them into the shower.'
‘I wish I had been told that they like things done a certain way, it would have saved all of us a lot of time.'
Providing key information to your staff about the client, their important relationships, their relevant health issues, aids and equipment used, or their stated preferences, is an important part of preparing a staff member to provide a quality service.
Employing the right staff
I guess that brings us to the staff member themselves. Are you employing the right people?
These are the people that your clients are ‘leaning on’. They need to understand the problems and issues that your clients may be facing.
Employing the wrong person can be worse than employing no one.
When you start the recruitment process, are you checking your position descriptions first? In these days of being adaptable and meeting individual client needs, do your position descriptions adequately describe the role you are expecting staff to perform?
Many times when I’ve reviewed position descriptions for organisations, they do not accurately reflect the role and scope of the expected position. The position description should also reflect any required qualifications for the role, along with any desirable ones.
Having KPIs / performance expectations clearly written and included are also helpful.
Of course, you need to ensure the staff you employ are suitable in other ways. The requirement to meet a current Criminal History Check should be in all position descriptions for any staff member who is likely to be in contact with clients. They should be obtained and reviewed prior to a person commencing, and don’t forget that they need to be re-checked at least every three years.
What about your reference checks? Please follow up on these, do not rely solely on the response to the selection criteria (it may not have been written by the person) or their own words at an interview. In these days of staff shortages, some organisations may be tempted to accept and employ a staff member before they get ‘snapped up’ by another. Don’t overlook this essential step, and if you discover the referee is someone’s brother or cousin, perhaps you might want to reconsider appointing them.
Are your staff culturally competent?
Yes, this might mean the person has relevant language skills to communicate effectively with a client, but it also includes understanding the historical background of the client and the experiences that have shaped them.
Someone recently told me of an older traditional Aboriginal man’s description of cultural competency as ‘I don’t need you to learn everything about my culture, and I don’t need to learn everything about your culture. We just have to understand and accept the differences and walk together, side by side.’
Providing an Effective Induction and Orientation
When you commence a new staff member are you providing an appropriate induction? You know the old saying ‘a penny in time saves nine’? Well, time and money spent on providing a good solid induction for a new staff member can really pay for itself.
You are less likely to experience complaints from the client or their family when your staff know the expectations of the client they are supporting. You'll also have a happier, more confident staff member if they know their boundaries and understand how to complete your internal processes.
Training and understanding policies, procedures and industry standards
Staff training is a critical part of ensuring your workforce have the right skill sets and competency. They also need to know what the organisation policies and procedures are – for example, what to do in an emergency situation like finding a client who has had a fall.
Does your Staff Handbook clearly reference organisation policy and procedures and cover issues like privacy and confidentiality, client safety and missing clients? Is there clear information about personal and work standards, workplace health and safety, managing risk, etc; and are these topics regularly reinforced in staff meetings or toolbox talks?
Staff also need to know about industry expectations – like the new Aged Care Standards. Understanding fundamental changes like the consumer outcome focus, and what the requirements and expectations are is critical to being able to meet the level of care and services the community expect and be compliant.
Pruning where necessary
Probation Periods – sometimes people look really good on paper, they present well at an interview, but once they are in place… well, let’s just say things fall apart.
Probation periods are an opportunity for you to evaluate how well the person ‘fits’ your organisation. You need to be monitoring performance and providing feedback in a timely manner to all new staff, as well as to staff who are promoted or moved to a new role. If you have any concerns, address these early on. Sometimes people have misinterpreted an instruction or missed a step along the way; early intervention helps align the new employee to your organisation’s processes.
If they can’t or won’t follow organisational procedure and appropriate instruction though, they may need to be moved on. This is what probation periods are all about, after all.
Providing supervision and ongoing professional development
We want the correct medications to be dispensed, we want clients to receive personal care that supports the person’s dignity, and we want them to have access to tasty and nutritious meals that cater to their health needs. To do this, we need to ensure we have qualified and competent staff who are able to carry out this task.
Once we employ the right people:
- do we encourage them to keep training and maintaining skills?
- do we establish what behaviours and standards are expected when supporting clients?
- do we support regular staff appraisals and provide timely feedback?
- do we provide staff with a support network and resources to encourage quality outcomes?
- do we assist our staff to understand the health conditions and issues that the people they care for may be experiencing?
- do we provide staff with opportunities to be a part of problem solving processes rather than simply passive recipients of solutions?
Get your Human Resources right and you’ll have a solid base that you and your clients can ‘lean on’.
We hope you enjoyed this article on the seventh Standard. This blog post is part of a series on the New Aged Care Standards, where we investigate how and why they were developed and take an in depth look at each of the Standards to give you ideas for implementing these effectively within your organisation. If this is of relevance to you and you’re not signed up for our short email alerts, fill in the quick form at the right of the page and we will let you know when the next post is released. We also send a monthly round up of blog posts and videos.
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