Letter from an Australian nursing home worker

regina1934 at hotmail.com regina1934 at hotmail.com
Tue Apr 4 06:51:15 EST 2000


Taken from the World Socialist Web Site of the International Committee
of the Fourth International at:  http://www.wsws.org

http://www.wsws.org/articles/2000/apr2000/corr-a04.shtml

Letter from an Australian nursing home worker

4 April 2000

Below is a letter sent to the WSWS from a nursing home worker in
New South Wales, Australia on the recent article, "Kerosene baths
reveal systemic aged care crisis in Australia."

Dear WSWS,

I read the recent article on Australian nursing homes and would like to
offer some comments drawn from my experience in the industry. Firstly
I'd like to congratulate the authors for their honest assessment of the
industry. It was cut-throat and penny pinching before the change from
Residential Classification Index (RCI) to Residential Classification
Scale
(RCS). Minutes were counted; so long for a shower, so long for a meal,
so long on the toilet, and so on. Grams of food, mls of water, every
sliver
of soap, was accounted for. Even the amount of breathable air, per
room, was calculated. Since the RCS, conditions for both residents and
workers have dropped sharply.

Your article addressed the conditions of the elderly. I would like to
talk
about some of the problems of workers in the industry. Most of the staff
in nursing homes are either Assistants in Nursing (AIN's) or Residential
Care workers (RCW's). They are drawn from widely different sources.
Some are with qualifications unrecognised by Australians laws, some are
students, some farm girls, some refugees. Most are married and have a
family, even sometimes a sick parent at home. Some have another two
jobs.

The training they receive is always inadequate-maybe a week, more
often less. Their hours are long and dislocated with poor conditions.
Added to this is the frustration of working with people in need and
being
unable to help, assist or comfort them. If you work in a factory or an
office you don't have to talk or empathise with the product of your
labours. Computers don't cry or call out in pain when you turn them
over,
tools and dies don't grab at your sleeve and think you are their long
lost
grandchild. No one likes to see distress in others and the constant
clutching at the heart can, and does, wear out all.

In nursing homes the relationship between the needs of capital and the
needs of humanity are graphically revealed. The elderly are a commodity,
exploited and utilised to reach the rate of profit as efficiently as in
any
other enterprise. They resemble "battery hen" complexes more than
anything else. (The final aim in both is death.) Room after room,
crammed with elderly workers whose only "crime" has been to grow old
in a period of savage societal relations. (It is noteworthy the per year
funding of the elderly is about a quarter of a maximum security
prisoner.)

>From the front, nursing homes usually look nice and homey; flowers
along the path, kept lawns and cheerful residents. Inside, near the
front
door there's two comfy chairs. There's a chandelier (usually plastic) on
the ceiling, bright happy paintings and flowers. Proprietors like to
have a
good entrance; it creates a favourable impression on new relatives. It's
when you get out the back and upstairs you see the true picture.

As most of the nursing homes have two storeys, all the residents who can
walk and smile are put downstairs and nearer the front. The "problem
children"; who can't walk, have "behavioural" problems or are too poor
to have clean clothes go upstairs and towards the back. Without physio
and exercise they get sicker quicker and need to go to hospital more.

As a lot of the buildings are old and without lifts to get the resident
down
is a problem. The ambulance drivers used to carry them but had so many
work related injuries they banned the practise. So the nurses have to
carry the resident down and back up on return from hospital. When two
or three small woman are expected to carry a 110 kg. man up 20-30
steps, it is obvious injuries will occur and they will be severe.

In one nursing home, each of us had to lift eight residents onto chairs,
shower chairs and trolleys before breakfast every day. With all the
manoeuvring it came to 5.2 tonnes per head. It was the tip of the
iceberg.
We'd make 20-30 beds, push trolleys, stack linen and position the
patients in bed every two hours. All these actions are "ergonomically
wrong" for the spine. The tiny spinae erecta muscles at the bottom of
the
back aren't built for it. The big muscles that should be doing the work
are
the quadriceps in the thighs, but the rooms are so small, with too much
furniture jammed in, the nurses end up having to use their back muscles.

It's no surprise then that AINs lead the Workcover statistics in back
and
back related injuries. They share the same percentile of damage as
coal mining does for men. As a lot of them-over 45 percent-can't
speak English, most do not receive compensation or even treatment.
They are thrown out the door and told to come back when well. Even if
nurses do know their rights they still find themselves victimised
mercilessly on return to duties. A lot of women, working a second job
(even a third sometimes), do not let on if they are injured for fear of
losing their jobs. Permanent and severe damage results from any further
trauma.

Damage done psychologically can be no less crippling. Walking along
any corridor causes an instinctive feeling of sadness. The things people
like to do don't cease at the age of retirement. They still need to
talk,
chat, be cuddled, be cajoled, laugh, smile, show pictures of the grand
kids and all those social aspects. They reach out to try and keep as
much
of themselves-the pre-nursing home self-as alive as possible. But
there's never enough time. Workers feel this and feel guilty themselves,
often, adopting brusqueness as a cover.

Giving intimate care has problems also. Most people only wash
themselves, wipe their own bums, or one of their children's. Touching a
person whom you don't know is stressful. It takes time to learn how to
touch "neutrally". Doing so under speed-up is impossible. It becomes an
assembly line, a cattle crush. You focus on the leg or the arm, wash it
or
dress it then move on, usually feeling as if you haven't been able to do
the
job in the right way. The leg or wound has become a "thing in itself",
separate from the whole. It becomes "care" without "caring" and feels
hollow and false.

Then there are the residents with "difficult behaviours", i.e., a
euphemism
to cover everything from schizophrenia, brain damage, dementia,
personality disorders, etc. Many spend their day in a chemical fog;
alive
without living. Likewise emotional reactions, are often interpreted as
mental illness. The resident who shows sadness by crying is diagnosed
with depression and given anti-depressants. One who angers at being
hurried and responds with aggression is given tranquillisers. One
wanting
to go home is a wanderer and will probably be tied to a chair and get
drugs as well. The solution is always to drug the residents down to the
level of their surrounds.

Yet it is well known that most of the behaviours which relate to
sedation
orders are easier and more humanly managed with environmental
measures. One example is the dementia patients, many of whom prefer
circular paths. They experience less frustration with a circle and do
not
get as irritable. If they walk all day in a hallway, only to meet wall
at
either end they become confused and frustrated at not being able to
proceed. Sooner or later they will lash out and have sedation ordered.
This only increases the chance of falling, thus a fractured hip, then so
on
and on.

Sometimes if they're feeling useless, old or rejected by family or
staff, or
so they don't have to face the daily pain, residents will stay sedated
all
day. I have heard old ladies ask, almost in tears, for sleeping pills at
5
p.m. This puts the nurse between the needs of the market and the needs
of humanity. What do you do? The pills will last 4-5 hours, take them
now and the resident might wake in the night. The skeleton crew on
nights won't be happy. But here's someone old enough to be your
grandmother, in real extremis, sick to death of the whole "slow dying"
business, asking for help. What do you do? Either way you lose; you
either gripe with your colleagues or the resident.

It becomes clear at times like this, there is no answer and no way to
solve the problem on the job. But where do you go to get something
done about it? Well, not last year's Annual Conference of the New South
Wales Nurses Association (NSWNA), where the dominant feeling was,
yep, sure, there were a few "issues and concerns", but nothing worth
cancelling the ball for.

A feature was the unusually large turnover of delegates-131 out of 400.
What this represented was hard to establish. There was the annual
blooding of apprentice bureaucrats and the usual number of "tourists"
down for the free trip, etc. Among the others were some who were
curious and some who came to see if anything could be done. For many
it was their first time so close to the union bureaucracy and so by the
end
of the conference-no matter how wide-eyed at the beginning-most
were outraged. They had expected a certain amount of cynicism and
horse-trading. But never the sheer indifference and remoteness of the
top
table to staffing, conditions and cutbacks-the everyday working life of
the membership.

That their number was a concern to the leadership was seen by the
special "Branch Official Training" courses that ran leading up to the
conference. The aim being to prevent any unseemly displays of
independence or democracy. At the conference they were put in their
place, by being referred to as "virgins". A type of initiation or
"bastardisation" into the hurly burly of unionism. If one put forward a
resolution or spoke, the delegate or someone else, would say:
"I'm/here's
a virgin delegate ... " Self-conscious and mocking laughter would
follow.

The last day was the "Professional" day, the conference theme had been
"Psychedelia". Purple and orange lights flashed and turned and streamers
and balloons flopped in the air conditioning, while we listened to the
spokesmen for Aged Care. He was thorough and scrupulous. His
presentation listed each and every Government cut made to staff, food,
medicines and diversional activities. He compared it to the OECD
countries and to the USA. Everywhere, he said, had problems. At the
end he went through what was the motor cause of it all. It wasn't the
economy or the attitudes of society, none of that sort of thing. It was
the
discourse, he said. If only they had of called them Nursing Care
Facilities
the funding wouldn't have been withdrawn. The fact they were called
Aged Care Facilities had doomed them.

Gerald Durrell had a story concerning the toilet habits of a breed of
rat.
In the wild it buried its faeces under trees. In captivity it would
defecate
in a corner of its cage and start burying motions. When it finished
scrabbling, the rat would believe the faeces to be buried. The rat could
still see them and smell them. On occasions-its cage being too
small-unavoidably stumble over them. Even then, with faeces matted
and dripping from its paws and whiskers, there was still part of the
rat's
brain insisting, its faeces lay buried.

It seemed the same at the Conference. Here's the health system-a
shambles-waiting lists, infection rates, nursing home scandals, hospital
deaths, etc. Add in massive anger and discontent among both health
workers and patients-and you have abundant evidence, right under
your nose-of "something rotten in the state" of New South Wales. But
at the NSWNA Conference, to the top table at least-it was all dug and
buried. We were to ignore the evidence of our senses and reduce
ourselves to the perspective of a soiled rat.

By this time, it was clear that the problems of nurses, the elderly and
the
health system were not going to be solved here. For some of the
delegates-maybe even most-this might have meant nothing. But there
were others for whom it was a revelation, and they were going to start
to
do some thinking on the way home.

Regards,

A health worker
Auburn, Australia

See Also:
Kerosene baths reveal systemic aged care crisis in Australia
[10 March 2000] http://www.wsws.org/articles/2000/mar2000/aged-m10.shtml

Readers: The WSWS invites your comments. Please send e-mail :
editor at wsws.org




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