It’s bedtime for the residents of the nursing home. Marita de Kleijne is putting a client to bed when she hears a commotion in the hallway. She immediately knows what time it is: that is the lady with dementia who feels lonely, then gets out of bed and looks for other residents. “Then suddenly she is at the bedside of someone else, who is already dozing off. Of course he is shocked.” But De Kleijne is alone in her hallway with eleven residents. What do you do then? Leave the person already in the hoist to calm the unrest, or finish what you were doing and possibly let the unrest get out of hand?
65-year-old De Kleijne has experienced these types of situations almost every day in recent years in her work as a nursing IG in the nursing home. She specializes in elderly people with psychological problems. She will soon say goodbye: she will take early retirement. “I won’t last until I’m 67. The staff shortage makes the workload too high and the work less fun.”
She’s not the only one who thinks so. This Thursday, the Center for Ethics and Health (CEG), in collaboration with the professional association for caregivers and nurses V&VN, will publish a report that outlines the dilemmas of care providers in elderly care and disability care in times of scarcity. They often have to choose who they will and will not help, the report shows, or they cannot devote enough time and attention to clients.
Putting out fires
I’ll be with you shortlyis the title of the report. De Kleijne: “How often we have to say that. Sometimes fifty times before we can actually come.” She also shouted it during the situation with the demented woman in the hallway. “I left the resident I was working with safely behind me – elevator down, bed at a safe height – and went out into the hallway, clearing the rubble that had arisen in a few seconds. I left the door ajar so that the other resident could hear me shout: ‘I’ll be right with you.’”
Going around the block, going shopping together, playing a game in the evening: it is no longer possible
38-year-old Marieke, who is a supervisor at a residential location for thirty people with intellectual disabilities, recognizes this. Because it concerns her employer, she does not want her surname in the newspaper. Her clients live in their own apartment, but the location has communal living rooms. Actually, they have to take care of the group with two caregivers during the day, but in practice she is on her own. “And alone I often cannot provide the residents with the care they need.”
She must limit herself to what is strictly necessary, she says. “That means keeping alive. Giving medicine and putting food on the table. But ensuring the quality of life, by going around the block, doing the shopping together, playing a game in the evening: it is no longer possible. Because you are constantly putting out fires.”
It creates distressing situations and unrest in the group, according to Marieke. ‘Contact moments’, where the care provider visits the client, are cancelled, clients are often helped by substitutes and when she is there, she is not always fully there. “The honest story is that I always keep one eye on the clock, because I know there is still so much to do.” Clients often do not know substitutes and find them a bit scary. “There are a lot of residents who now say: if it is a substitute, then preferably not. Also because they often simply do not have enough knowledge and experience of this type of care.”
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Daytime activities
Residents feel the unrest and “bring it into the group,” Marieke explains. “That means arguments between clients or between clients and substitutes. This is usually limited to verbal aggression, but occasionally items also break. You see that kind of escalation increasing as people receive less attention. And that means that we have our hands even fuller.” It is a very negative vicious circle, says Marieke. “That often makes me sad and sometimes cynical.”
She mentions a sixty-year-old client with a mild intellectual disability. “We have time to inject his insulin for him and prepare medicine and food. But when I get there, his house is a complete mess. That creates chaos in his head. He needs guidance in keeping his household in order, but I don’t have time for that. You notice that it makes him rebellious and depressed.”
Activities are seen as an extra, but they are not – how would you like a life without activities?
What doesn’t help, says Marieke, is that day care often does not take place, because there are shortages there too. Dave (41), who is an activity supervisor in disability care, also knows this and does not want her surname in the newspaper for the same reason as Marieke. Activities are often the first to be cut back, says Dave, because they are seen as an extra. “But it’s not – how would you like a life without activities?”
Dave regularly has to volunteer in his spare time because otherwise a group would be without activity. He works with people who function at the level of zero to two year olds. In the past – he has been doing this work for twenty years – there were three of them in such a group. But now he too is alone, in a group that should include about five people. That number of clients can rise to nine or ten, because some clients do not dare to join a substitute in the group and therefore join his group.
“I used to be able to divide the work between colleagues, so one person could do some laundry with someone, the other could go for a bike ride.” The fact that this is disappearing is reflected in the behavior of clients: they cry more often and throw things more. “Connecting is very important with this group, and that is no longer possible.”
Fear of contamination
All three healthcare providers say that the large number of substitutes has a negative impact on the well-being of clients. For example, because they do not have the right knowledge and experience and the permanent staff does not have the time to guide them. “At management level people sometimes think: aren’t there enough figures? But those are not the right figures,” says Marieke. “You have to see it as a kind of whispering game,” says Dave. “Substitutes do not know the clients, they have to read a personality from a piece of paper.”
For example, Marita de Kleijne’s client with dementia from the nursing home has a fear of contamination. That’s why she gets two slices of bread in a plastic bag on her plate for breakfast. “Simple, you would think. But not if you don’t know her and don’t have time to read the care plan. Then you take a sandwich out of the bag and take it to the lady. She reacts aggressively and the substitute care provider does not understand why. The resident sitting next to the lady also gets the full brunt.”
Over the past five or six years I have often thought: it couldn’t get any worse. And yet it kept getting worse
The scarcity started about ten years ago, says De Kleijne, and it got worse over time. “Over the past five or six years I have often thought: it couldn’t get any worse. And yet it kept getting worse.”
She has enjoyed her work for thirty years. “There is always disrespectful talk about washing buttocks in nursing care. That’s part of it: we all have buttocks, they all need to be washed. But this work is mainly about making contact. You have to know who someone is to know how to care for someone. But you need peace for that. That peace is no longer there.”
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