Clue…it’s not lack of motivation or knowledge. A new paper, led by Sue Foster – social worker turned (fantastic) researcher – from Michal Boyd’s ELDER study pointed instead to structural factors. The HCAs she interviewed (along with Deborah Balmer) were highly knowledgeable about person-centred care and demonstrated a real commitment to putting the needs of residents.
It’s a very challenging job, but I love [the residents] just like my own. I love to see them happy, that’s the main thing. When they’re happy I’m happy, when they’re unhappy then I am unhappy too. I want them to feel at home you know, just like their own home. [HCA] at the centre of their practice, they experienced many constraints.
However, the environment and culture of the facilities often constrained HCAs from being able to provide the person-centred care they wanted to. Time was a factor:
Sometimes in this industry, I think people are so pushed for time, with their caring, there’s no time to just allocate someone to sit with that person, where maybe all they want is someone to sit and hold their hand, and give them the time. I feel that’s always a bit of a concern to me.
Other HCAs also commented on the hierarchical nature of Aged Care facilities, a finding in line with Susan Fryer’s work which identified the professional hierarchy as limiting HCAs role in end of life care. This is worrying given that it is often HCAs who are most aware of resident wellbeing.
I’d said to the RN a few times, you know, I’m really worried that he is going down, that he’s not wanting [sic] to be here. It’s hard sometimes. We don’t always get listened to. And it’s probably quite common because we do get attached to them. [HCA]
Sue also identified education and training gaps. Ultimately there appears to be a cognitive dissonance for HCAs when the focus of their training and development is on task‐based care, and yet they are also asked to embrace the philosophy of person‐centred care. She argues that organisations can respond to this by acknowledging the tensions this creates for HCAs and providing appropriate support and training has to be tailored to this direction. New ways need to be developed that allow HCAs to be full participants in the care team—people who have real and important knowledge about residents and their care needs.
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