By Dr Maggie Haertsch (PhD)
For those leaders familiar with the Australian Business Excellence Framework, understanding the customer journey and the customer experience is central to the development of a high performing organisation. There are a number of research studies that help us understand that when we align the person’s experience of health care, and in this case residential aged care, then the overall efficiency and effectiveness of the service improves. There are many aged care leaders who eat with residents and stay overnight, so this is something not so unusual. Taking this moment to put down my thoughts and share my experience more widely seemed opportune.
I arrived around 9pm after a long day working in the home as a newly appointed executive. I had arranged to stay overnight with the Clinical Care Manager and everyone working that shift was expecting me. The care team found the spare bed and we all wheeled it into the space where the fourth bed used to be. The day before, my neighbours in the other two beds has said it was ok if I joined them. I’m not sure they remembered I was coming but they were already well and truly asleep. I only hoped that my arrival didn’t disturb them. One very kind Assistant In Nursing folded the two bath towels into neat square bundles and placed them carefully on the bottom corner of my bed. She then placed a small well-worn blue and white striped washer in the middle of the towels welcoming me and wishing me a good sleep. She rummaged in her pocket and with a big smile pulled out a lolly in a single wrap packet saying she wished she could give me a chocolate and placed it on the middle of the washer. Such a small touch spoke volumes to me, the kindness, the thoughtfulness and importantly the recognition of an event that perhaps no other senior team member before during her many years of service, had actually spent the night. There were plenty of giggles as they directed me to the bathrooms, a choice of big and small white shower rooms with grey lino floors housing a toilet, shower and hand basin, as well as an array of all sorts of equipment such as raised toilet seats and shower chairs. The door didn’t lock so I was quick with my shower. It was a relief to wash off the day and enter this new experience. I didn’t wear a nighty but a comfortable dress and leggings so that I appeared to be dressed should I need to walk around, save any embarrassment for the team.
Lately, I have been wondering why a sleepover like this takes people by surprise. I wanted it to be low key. I slipped in not to make any fuss. I am not a resident, I don’t have their care needs, I have the independence and capacity to do what I will. This is the stark opposite to most residents living in the home. This is why I try to step into their world.
Clean and refreshed I stood at the door of this expansive bedroom. I could see the two women in beds near the window with curtains drawn highlighting their segmented spaces. I admired the single bed with white crisp sheets waiting for me. I saw I had a buzzer and was tempted to ring it and test the response. I turned on my fluorescent light over my bed head to read for a little while though it was a big stretch to reach it (not so user friendly). I plugged in my phone to charge. A short text to my friend who instructed me to not get used to this, it’s before my time.
I climbed into the very high narrow bed and curled up as the curtains around me were closed. I wondered how many people had died in this bed. I scanned my view noting the large round white clock with black numbers. It was the right time. The length of the curtains would show the shins and feet of anyone walking by. I took in the room’s air, no smells or unpleasant odours, and I watched the ceiling fan do its job.
I dropped my book into my basket. In no time I was asleep.
I woke with whispering voices talking very gently to the woman in the bed diagonally. The clock was at 2am. Then the clock was at 4am and then again at 6am, time for me to rise. I showered and dressed for work, my office just down the hill. I thanked my roommates, the care team, stripped my bed, placed the linen into the linen bags and left quietly.
I tried to imagine the life of my neighbour. I heard her throughout the night periodically being turned, changed and comforted. The starkness of the lino gave a clinical harsh feeling to the room but within it was a warmth, an indescribable feeling of a life force that is slow, calm and gentle. A life force on the precipice of death.
Yes, I was woken by sounds and the infamous buzzers. I know the care team were probably on extra alert to not disturb me, and yes I discovered maintenance that needed doing. But what this experience gave me was time to discover and reflect on what it can be really like living in the home and what we as a service must do, to make it one of the best moments of that person’s life before they die. A dignified, intimate and unpretentious sharing of life between the resident and carers.
As I collected my bag my neighbour was being lifted from her bed with the help of three of the care team. Their words were reassuring, explaining as they went. She is a quiet shy person and I thought to myself just how challenging this routine could be.
Imagine a wrong move, an inappropriate word or being rushed and indignantly pushing the resident to get the task done. Imagine having her thin skin tear and the pain it brings; imagine the pain of a bruise so easily made when care isn’t as it should be. These are marks, physical evidence, that tell us something isn’t right.
As I woke throughout the night I am sure that many of the residents do something similar letting their minds wander, traversing their lives. I know of older people retracing the scenes of their life as a movie in their minds. Perhaps it is a way of resolving the unresolved or being comforted by those that are no longer present.
The words and thoughts shared by the care team to a resident can reaffirm a sense of belonging and love but sadly can also be a cause for fear and feelings of powerlessness. I wonder if they like being called “darling”, not being given a choice with what to wear, showered with water that is almost cold, or being left to wait at the table for 30 minutes after dinner before being moved. I wonder how many residents feel part of a community, feel valued and understood? Most of all I wonder how they are left to ruminate with thoughts triggered by our words. “I told you I was busy”, “you just have to wait”, “we are so short-staffed I would like to help you but I can’t just now”, “stop pressing your buzzer I will come back when I am ready”… it happens and worse. The tone and loudness of the voice, the impersonal ‘get the task done’ approach is demeaning.
We don’t pay enough attention to the emotional intelligence needed and the true meaning of being a partner in care. It’s that ability to ‘read a room’ and tune into the needs and situation of a person without forthrightly pressing your own point. It’s the ability to be on a journey together and not one that sees the provider and resident in opposition.
If all the people working in residential aged care services truly understood an older person’s everyday real experience then there would be no room for anything other than enabling them to have each day as meaningful as it can be. The role of the aged care team is to enable and support not “do things to them”.
The sleepover is only one way of learning. Shining a brilliant light on great support, sensitive communication and a heartfelt connection, as older people live out their final days, it is the legacy we need to keep replicating. If we can do anything to better understand the resident’s experience, we should embrace it.
I look forward to a time when an employee sleeping at an aged care home doesn’t come as a surprise, it’s an expectation.
SAI Global, Australian Business Excellence Framework. https://www.saiglobal.com/improve/excellencemodels/businessexcellenceframework/
Doyle C, Lennox L, Bell D. A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open 2013;3:e001570. doi:10.1136/bmjopen-2012- 001570