The Practice of Assistants in Nursing: A study of resource distribution at the bedside in nursing homes

Abstract

The provision of residential care to elderly people in Australia has received much attention since the introduction of aged care reform in 1997. In Australia, as in most parts of the world, increasing numbers of people are likely to enter aged care because of the increasing percentage of populations approaching the age bracket of 65 years and over, particularly within the next 20 years. Focus on the quality and cost of provision of care, particularly in nursing homes, which until recent times has remained mostly invisible, is continually scrutinised and highlighted in the current public arena. Issues such as the standard of care, appropriateness of staffing levels and costs associated with the delivery of care have been reflected in policy development and the advent of aged care structural reform. As macro policy aims to balance the social issues of nursing home care equally against the cost of provision of such care, the 'trickle down effect' on the quality and type of care delivered to residents at the micro-level of the bedside has not been explored. This study is primarily concerned with the micro-level of care experienced at the bedside in Australian residential care and, as a consequence, it examines the practice of assistants in nursing (AINs) employed in Australian nursing homes. In particular, it identifies and examines AINs' notions of equality and, in turn, how these are influenced by contextual factors within the nursing home industry, in terms of their distribution of resources at the bedside. This issue is significant, given that the majority of employees in nursing homes who deliver bedside care are AINs. How they distribute resources impacts upon the type and quality of care that is delivered, and the quality of life that older persons experience in nursing homes on a day-to-day basis.