El reto del valor añadido en Guatemala

Formal staff roles in the CHs were not always strictly adhered to. Frequently, staff shortages required staff to cover a different role to their own. For example, it was not

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uncommon, especially in Bullace View or Gage Hill (the two homes not providing nursing care), for the manager, assistant manager or a senior carer to cover absence by kitchen staff and to prepare the meals for the day as the main cook. In each of the four case study homes the manager or assistant manager covered at least one night shift during the six weeks I was at the home. At Mirabelle Way the manager covered three night shifts consecutively. Often staff redistribution would be at the expense of the care team. For example, if staff members were utilised in the kitchen they were no longer available to the floor or if they were covering a night shift their day shift may not be covered. If care staff were swapped they were usually no longer available to help on their regular shift (for instance, they may do a night shift instead of an evening shift) and shifts ran one staff member short. This could result in a frantic shift for the remaining carers, adding to stress and pressure, and ultimately affecting the residents and the care they received. Kitchen duties and night shifts appeared to be prioritised over day care shifts, where it was perceived that staff could manage with one less staff member.

Activity staff were often redeployed in times of staff shortages. For example, at Gage Hill, Holly, an activity coordinator was also hired as a laundry worker. When another laundry worker was off sick she was asked to cover the laundry rather than continue with her previously arranged shift in the activity coordinator role. This also occurred at Bullace View where, Karen, the activity coordinator also worked as a carer and was at one point required to show a prospective resident around the home instead of continue with her activity duties. Karen was also required to cover care or kitchen shifts if the home was short staffed instead of providing the activities arranged. This reflects the status of activity work at the homes: viewed as an extra, but not essential. If an activity coordinator was off sick their shift was not covered, although, on one occasion, Bullace View did have a volunteer who worked on a day that the activity coordinator was away at a training event. The secondary position of activity staff, and the limited hours they worked, makes utilising them to target NPIs at BPSD a poor option. Instead care staff, viewed as essential and on duty 24 hours a day, would be better placed in the current system to deliver these interventions.

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At Mirabelle Way the whole staff team managed behaviours. Laundry workers, domestic staff, administration staff and gardeners all fostered relationships with residents at the home. The contact between these staff members and the residents was encouraged and as such, at times, they were in positions where they managed behaviours too. The administration staff were often accompanied by residents in the office even though some things would regularly go missing. Sometimes a resident would be aggressive or shouting; at other times they could be sorting through the office folders and paperwork or just sitting quietly. One day Lucy an administration worker had to go around the corner to make a telephone call in another room as a resident was shouting so much. I made notes of an informal chat I had with her later that day:

Lucy (office worker) said they were supposed to write incident sheets, but that there was no time as she had had (resident name) in the office a lot of the morning so had not got much work done and was now behind with things ... she cannot possibly fill out all the incident forms she would need as the

behaviour was pretty constant. Lucy said it was difficult. When she took the job she thought she would be in an office working, she didn’t realise that residents would be in and out all the time. She said she wouldn’t change it, but that it was hard to cope with the behaviour sometimes. (16th July 2012, Observation notes; Mirabelle Way)

This open access policy meant that residents’ behaviours could make non-care staff’s working lives more difficult, yet the residents, and often the non-care staff, gained a lot from it. The close relationships between all staff members and residents came across as a positive aspect of the home. It was not uncommon to find a resident helping the domestic staff or for the laundry staff to be affectionate with residents. This open set up presented Mirabelle Way as prioritising the home as belonging to the residents, not the staff team. This was not found in the other case studies to the same extent.

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