Academic journal article Australian Health Review

Time Spent on Daytime Direct Care Activities by Personal Carers in Two Australian Residential Aged Care Facilities: A Time-Motion Study

Academic journal article Australian Health Review

Time Spent on Daytime Direct Care Activities by Personal Carers in Two Australian Residential Aged Care Facilities: A Time-Motion Study

Article excerpt


With a rapidly aging population, the number of older people needing residentialaged care in Australia is expected toincrease.1 However, the direct care workforce has a chronic shortage of trained staff.2 This represents a big challenge for residential aged care facilities (RACFs) to provide quality, safe, efficient and appropriate delivery of care.

Personal carers (PCs) provide personal care to meet aged care residents' daily needs (e.g. personal hygiene). Richardson and Martin, in 'The Care of Older Australians: A Picture of The Residential Aged Care Workforce', reported that more than 66% of PCs felt that they did not have enough time to spend with each resident.3 This leads to a question about how PCs spent their time with residents.

Knowledge about how PCs spent their time can improve nursing managers' understanding about the time required to directly meet residents' care needs, thus estimating staff work- load. This can inform evidence-based decisions on whether task re-allocation is needed4 in order to maintain quality of care and improve work efficiency.5

In addition, this knowledge will set the baseline for examining the impact of any implemented change,4 such as introductionofanelectronic informationsystem.6-8Furthermore, such details are important in informing public policy or mana- gerial decision on staffing levels,9 either for newly built aged care facilities or existing facilities in which resident case mix has changed.

In lean management, time is also an important measure.10 Lean management aims to use less to do more.11 By making the performance visible, reducing the number of non-value-adding activities, eliminating waste and standardising the work, lean management has the potential to optimise care processes.10-12 The first step to lean management is making the care process visible, and time is a key measure of the process.12

Direct care activities are those directly involved with residents.13-15 Previous studies have focused on the time spent on caring for dementia residents.16,17 Several studies provided broad understanding of how PCs spend their time. They reported that 30%-45% of a PC's time was spent on direct care in RACFs.6,15,18 However, none of these studies reported how much time was allocated to each direct care activity in high-care RACFs. This limits the understanding about the time needed for meeting different care needs.

To fill this gap, the aim of the present study was to examine how much time is spent on each direct care activity, and the frequency and duration of conducting these activities.


A time - motion observational study was conducted in 2010. An observer shadowed a participant and recorded this person's activities sequentially for a period of time using a predefined classification system of activities.19

Classification of activities

The classification system was developed over the course of three focus group discussions. Each focus group contained three researchers and three registered nurses (RNs) with extensive work experience in aged care. A previously validated classifica- tion system14 was given to the focus group as an initial version. During the three discussions, this system was tuned to make it more appropriate for a time-motion study. The final version contained 58 activities that were grouped into direct care, indirect care, infection control, oral communication, documentation, transit, staff break and other activities not included in the previous categories.15

Only direct care activities are presented in this paper. These were further classified into eight subcategories, which were intended to provide adequate granularity, yet remaining abstract enough for conceptualisation and presentation (see Table 1). To name each category, the wording from the aged care funding instrument was used.


Two RACFs were recruited. The first, operated by a non-profit organisation, was located in Sydney and had 155 beds. …

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