Tribune News Service
Chandigarh, June 2Untimely and tragic deaths of Swaran Singh from Bharpurgarh village in Amloh, Punjab, and Shanti Devi from Solan, Himachal Pradesh, are extremely difficult to reconcile with for their families. Amid their immense grief, both families find some consolation in knowing that the death of their dear ones gave precious gift of life to some. The decision impacted eight lives with donation of liver, kidneys and corneas at the PGI. It was the fateful day of May 29 when Swaran Singh, 42, got critically injured after falling from a motorcycle. He sustained serious head injuries and fell unconscious. Initially, he was admitted to the Civil Hospital, Khanna. The family rushed him to the PGI on May 30. Swaran could not be revived and declared brain dead on the night of May 31. When it became clear that Swaran would not survive his head injuries, Navdeep Bansal, transplant coordinator at the PGI, approached Daljit Kaur, wife of deceased Swaran Singh, to request if she could consider organ donation. Daljit, along with her son Harman Singh, showcased immense grit and consented for organ donation. “There are no words to describe someone being in our position. I was thinking if we could save someone else from going through this, then let’s do it. At least, some other family will be saved from the trauma that we are facing today,” said Daljit. Following the family’s consent, transplant surgeons retrieved liver, kidneys and corneas from the donor, Swaran Singh, which on transplantation gave new lease of life to three terminally ill patients battling for life and gave the gift of sight to two others, thereby, helping five lives in all. The PGI witnessed equally magnanimous gesture from the family of Shanti Devi, 63, from Solan, Himachal Pradesh, when they consented for organ donation which resulted in saving the life of one patient suffering from end-stage renal failure. The corneas of the deceased will be used for another two patients at the PGI, thereby giving them sight and impacting their lives. The day of May 31 started as usual for Shanti Devi, but it ended with a tragedy. Shanti Devi, who was riding pillion on a scooter with her son Sunil, suddenly fell from the vehicle and received fatal head injuries. Seeing no improvement at the local hospital where Shanti Devi was admitted initially, the family immediately brought her to the PGI on that day itself without losing any time. However, the destiny had some other plan as Shanti finally succumbed to her injuries on June 1. The mishaps
Yet this "blunt instrument" delivers results in hospitals where patients have "ever-changing needs".
To date, protests and petitions to boost staffing ratios have failed. Mandated nurse-to-resident ratios are opposed by Ken Wyatt, Minister for Aged Care, and the peak bodies representing for-profit and non-for profit aged care homes. They argue mandated ratios would increase costs and limit flexibility.
But the current "flexible staffing" approach leaves the decision whether to have a registered nurse on duty at the discretion of the provider/manager. Evidence suggests some managers do not employ additional staff when care needs increase.
The following example illustrates why staffing levels should not be decided entirely by managers.
I witnessed an elderly woman die in excruciating pain because no-one on the night shift was qualified to administer the prescribed morphine.
My friend was so traumatised by the situation, she could not remain at her mother's bedside to hold her hand.
Although the needs of older people in aged care homes are variable, over 80 per cent of residents have high care needs. The staffing profile of aged care homes today does not reflect the resident profile. If it did, we would have seen a large increase in the number of registered nurses.
Instead, the number of registered nurses has decreased while the number of less-skilled personal care attendants has risen substantially. Registered nurses now account for less than 15 per cent of the workforce, while personal care attendants make up 72 per cent.
Overseas studies show the ratio of registered nurses-to-residents has a positive impact on the standards of care in an aged care home. This research demonstrates that staffing levels and skills are the most critical determinants of care in an aged care home.
Whether residents' care needs are due to cognitive decline, incontinence or chronic pain, residents invariably benefit from having registered nurses on duty.
Although aged care homes are not funded to provide hospital-level care, the government subsidy of around 0 a day for each resident should be tied to direct care for residents, not profits for providers. However, StewartBrown's Aged Care Performance Survey indicates the top 25 per cent of aged care homes made a profit of ,285 per resident per year.
Although additional staff will increase operating costs, it is alarmist to state that some aged care homes, particularly those in rural and remote areas, will be forced to close. The worst-case scenario is that governments may need to assist some aged care homes to remain viable.
In Victoria, many rural aged care homes are owned by the government. In 2016, the Safe Patient Care Act was introduced, This Act prescribes ratios of registered nurses for the 181 publicly-owned aged care homes.
Cate Carnell pointed out on ABC's The Drum that the abuse at Oakden Older Persons Mental Health Service occurred despite a high ratio of registered nurses. However, the Independent Commissioner Against Corruption's investigation into Oakden described poor systems, unacceptable work practices and poor workplace culture. The Commissioner found relatives' concerns fell on deaf ears..