Interview with the Care Services Manager

Note: Interviewer is referred to as JW (author of this thesis) Interviewee is referred to as CSM (Home Manager)

JW: I introduced a small group of seven or less people to creative poetry and prose sessions last year. You only arrived at the end of my sixteen months of sessions but you were supportive of what I was doing and I thought residents’ responses were encouraging.

CSM: The problem we have is that aged care homes must meet residential aged

care accreditation standards, which are rigorous in their examination of the range of activities offered in RACFs. We provide a broad choice of activities throughout the week. Each RACF must validate its expenditure but the Federal Government does not give subsidies or provide financial assistance for these

activities. A high ratio of staff to residents is necessary for leisure activities and it is not economically sound for us to engage one member of staff for small groups of residents. We provide a broad choice of activities throughout the week. A musical group usually comes once a week playing familiar songs. The diversional therapists introduce a variety of activities such as singing and drama, cookery classes and mystery bus tours. There is a craft room so that artwork can take place. We now have a special garden for residents who choose to work there, and a vegie garden We are also now keeping chickens. We plan to introduce dance in the near future.

JW: You have made so many changes in the year since I left. This is such an exciting time for the Home.

CSM: We are fortunate in having a remarkable resource in our volunteers, many of

whom dedicate many hours a week; some volunteers work here full time and we would be unable to offer the present range of activities without their assistance.

JW: I was reading the Australian Medical Association Report to the Government

2010, which spoke of the shortage of doctors nationally, who were prepared to work in RACFs.

CSM: We are lucky here in having a good, reliable service for our residents and clear paths of assistance for reportable ranges of medical needs. We are able to get professional advice directly by email, fax or phone. Out of hours we can always contact a doctor through GPAssist. Tasmania has a system of care, which is not available in all mainland states. The procedures and order of procedures are stated by Medicare Local, who lay out emergency decision guidelines.

JW: There has been publicity about the high rate of psychotropic drugs used in

dementia patients and almost half the residents in aged care homes in Australia receive psychotropic drugs. Sink and others claim this medication only benefits one in five patients and can cause harm or even death to others (Sink et. al., 2005).

CSM: We are a restraint-free Home and these drugs are not used here. However

they are used widely throughout Australia. They are still used at the local hospital and in some RACFs in Tasmania. The reason these drugs are used is as a restraint; physical restraints are also used in some establishments. An

explanation for the high usage of psychotropic drugs can be that although doctors have to prescribe the medication, they may do so if the nurse on duty contacts them stating that the patient is uncontrollable. These medications are only used in the most severe cases of violence with dementia patients and the same applies to physical restraints. Every resident goes through a

pharmacy review. There are trials which take them off drugs and which test the drugs that best meet their needs.

JW: I read that nurses working in aged care are paid less than other nurses. Do you find it difficult to engage enough suitably trained and well qualified nurses?

CSM: Yes. There has been for some years a widespread view, particularly among

young trainees, that aged care is a less attractive choice for a nursing career. Our vacancies are often filled by older women who are attracted by the more permanent structure in aged care. These nurses are usually good at forming relationships with residents, their families and friends. This is more important to them than monetary rewards. But fewer younger people are interested in working in RACFs as they do not see such a clear promotional ladder as might occur in a hospital for example. It is also true that nurses working in aged care Homes are paid less than elsewhere, but when employed in not-for-profit Homes, they receive a salary package with $16,000 a year tax exemption,

compared to $9,000 tax exemption for nurses working in hospitals, which probably puts them on an equal footing financially. But we are fortunate in having full time volunteer staff who are priceless.

JW: I see that you offer palliative care here.

CSM: The population today is ageing, and our intake is much older now than it was

in the past. I foresee nursing homes becoming hospices in the future. We are well equipped here to provide palliative care services and have all the

necessary supplies, furnishings, and suitably trained staff. We receive Government funding to do this.

JW: The government has recently introduced two levels of service for residents in

RACFs, so that for additional payments residents can buy a varied menu and a choice of leisure activities. What is your opinion of this new system?

CSM: The newer part of this facility has been approved by the Government as

suitable for offering the additional for-payment services. However, we do not use this service. Everyone who comes here is treated individually and equally. I cannot imagine a situation where a resident might say “I would like to have a similar meal to the lady in the next room”, and I would have to refuse her unless she paid an additional fee.

JW: I am so glad to hear you say that. I was concerned that residents might be

refused access to creative writing unless they paid extra to attend classes. Thank you for giving me so much of your time. I wish you every success in the future.