Every residential house is staffed according to criteria such as the number of service users in the house, the number of days a week the house is open and the level of independence of the service-user residents. So, according to the needs of the residents, in some houses, staff members ‘monitor’ for a few hours each day or even less often; in some houses staff will be present with residents while they are in the house, from afternoon to the following morning; and in some houses staff members are present 24-hours a day, 365 days a year.
The residential house in which I work is one of the homes staffed on a 24-hour basis. Five service users are with us—two of them do not go home, the other three go home on a regular basis—one for two nights during the week and the other two for alternate weekends with their families. Each day one staff member starts the work-day in the afternoon, stays overnight and into the following morning, when another starts at 8.00am and finishes that evening at 8.00pm.
In the community house in which I work there are five persons with an intellectual disability—four ladies and one gentleman. All of them attend a day centre or workshop during the day. So, what do I do when they are away? To answer this question, I have taken one day of my 8-to-8 and recorded what was happening. Of course every day is slightly different—some days the phone rings every ten minutes; other days are quieter, but the day I have recorded is representative of what would happen on any given day in a community house similar to mine.
Today is Thursday. It is a few minutes to 8.00 and I have just arrived at work. My colleague who was on over night has started work at 7.30- So, when I get in, two ladies are already up and enjoying their breakast. We exchange morning greetings and I prepare a second bowl of cereal and coffee, as requested by ‘Jane’. I go upstairs to the staff room to put away my bag, and have a word with my colleague who tells me that there was nothing special to report overnight. I leave her to carry on giving out morning medications.
The third lady is ready for her bath. ‘Susan’ is bathed, dried and dressed and then assisted downstairs for her breakfast. ‘John’ is also bathed, shaved and dressed. By 8.45, while John has his breakfast, my colleague also sits in the kitchen, writing up her overnight report.
9.10 Everybody is downstairs, daypacks ready and checked. They all have a diary, clean clothes and lunch. We wait for the bus to take them to their day centres. The bus arrives at 9.25 and in ten minutes everyone is on the way. My colleague’s shift should finish at 9.30, but often the overnight staff stay on until about 10-00 so that we can discuss any issues from the previous day.
10-00 I am on my own now until 3.00pm. First, I make a phone call—it seems that most of the agencies we need to contact don’t answer calls in the afternoon! We order some special food from central pharmacy once a month—I’ve checked what we will need by the time it can be delivered next week.
Then I call our local doctor’s surgery to check on Jane’s urine sample which was left in eight days ago. Yes, the results are back, but unfortunately the sample was contaminated and we will have to take in another one.
I lodge both calls into the house diary so that my colleague will know what was ordered and the information from the surgery. I also put the details about the urine sample onto a form in Jane’s personal file.
10-30 Cleaning time. Every day the day-shift staff goes through the same routine. The kitchen is tidied, dishes and worktops cleaned and the floor washed. Both bathrooms need to be cleaned too, the sitting room tidied and surfaces polished. Then there’s the hovering, bed making etc. The washer and dryer are in action too—it’s nice to get all the clothes, bedclothes and towels dry and put away before 2.30-
11.45 Cleaning is nearly finished. The phone rings. One of the day centres tells me that they have to cancel the meeting scheduled with them next Tuesday. Would we please phone them at the end of next week to arrange another appointment? They apologise—one of their staff members is out sick and they are too short-handed to fit in the meeting. More information to be entered in our diary.
12.25 Time for coffee. As I wait for the kettle to boil. I have a look in the fridge to be sure there’s enough food for the evening meal and breakfast. Milk is delivered, but we shop for the rest—not always easy because we have no shops nearby, and no transport. Luckily that’s not a problem today—we already have enough food in.
13.00 After coffee and fruit, time to do the ‘medication stock control’—the specific task to be completed on each Thursday. I count all the medications on the premises and record numbers on the appropriate record sheet. I check that everything tallies with last week’s record and that the correct medications have been given and recorded in the interim. No problem—everything is in order.
13.40 I want to get in touch with my supervisor to see if I can have the overnight off in four weeks’ time, as I’ve requested.
13.45 I make a start on the ironing.
14.15 I go out to call to the surgery for a sterile container. Then by bus to the day centre, to act as a bus escort. I need to meet the driver there at 15.00- I’ll also collect our post and petty cash allowance there.
15.10 We leave the day centre in the bus and pick up additional passengers at two other workshops.
15.45 We’re back at our community house. The overnight staff arrived at 15.00 and she has had time to read the house diary. We all have tea and fruit and talk about the day. We talk about the clients’ day and read their diary entries. Until dinnertime, we have activities together. Today is a nice afternoon, so we go for a walk, four of us and then three on a second stroll—some of the women like to come both times. Then we ‘play the piano’ (if you can really call it that). And we do some exercises.
17.00 I start making the meal, with the help of one of the clients and under the watchful eye of another one.
18.00 Mealtime together. With seven of us around the table, we have quite a bit of cleaning-up to do afterwards.
19.00 Time for bath for one of the women. It takes several minutes to persuade her upstairs, but then she unwinds amid the bubble bath and gets ready for the night. At 19.40 she is in her bedroom. One of the other clients has also gone to her room. I sit on her bed and we chat and choose her clothes for the following day.
19.55 My colleague prepares to dispense medications. I make my farewells to everyone.
20-02 Out the door—my twelve-hour shift is over-
This was a good day—a day when everything went according to plan. Sometimes work time is wasted trying to contact someone you need to talk to, or the day could be put into disarray because you have to go to cover for an emergency in another house, or to a meeting. Then you’d spend the rest of the day trying to catch up on the hours you missed in your own house, usually with uncompleted tasks overspilling to the following day.
There are, of course, some days when you have time to spare! Such an extra hour is always welcome as it can provide a chance to tackle paperwork, tidying up files, cooking ahead—it’s especially useful to freeze meals ahead in our house, because two of our service users are on special diets and their favourites, prepared in advance, are very welcome in coming days.
One of the best advantages of having staff on 12-hour shifts is that if one of our service users shows any sign of impending illness, even a cold, we can easily take the decision to keep him/her at home for the day. If we had no midday staff on duty, we would have to find other staff to cover for those hours, which can be very difficult. We prefer not to ask service users to spend the day at a different house—when you’re feeling a bit under the weather, you want your own familiar space or bed. With our ageing population of residents, daytime staff cover becomes even more important—our service users can more easily avail of a ‘rest day’, as they wish.
The eight-to-eight shifts are not only for the difficult days, they also facilitate making better use of free time. We can plan a relatively quiet shopping trip for one service user (not on a hectically-crowded Saturday), and we can really ‘make a day of it’, with lunch out and the chance to chat. Such opportunities for one-to-one time are appreciated both by service users and staff.