Living in a world of numbers
We live in a world of numbers.
When we are young, one of the first numbers we are taught is our age. We will proudly say we are three and a half, or nearly four. When we get close to drinking or driving age we count the number of days left to go to “adulthood”. We have PINS, bank account numbers, number plates, the list is endless. When we are older, we may even lie about our age (not my wife, though - she really is 29 every year). At university as students we learn in anatomy there are 206 bones in the human body, what a healthy BMI and blood pressure number is, pathology level ranges that are normal and what is abnormal - a seemingly endless list as well.
When you work in aged care, one of the first things you learn is how much everything is about numbers as well.
Nursing homes need to live and breathe numbers, especially the financial numbers. The residents and the staff who look after the residents are the lifeblood, but the financial numbers are what determines how and where this lifeblood circulates.
Seventy per cent.
This number is how much of a nursing home’s income comes from ACFI.
As clinicians working and reporting to nursing home management, it's suddenly essential to become familiar with a dizzying new range of numbers that has a language of its own. We need to see Mrs X, under a 4A, checking she’s had a 12.3, for 20 minutes while assessing her pain on a scale from 0-10. To find a resident, we can’t even find them if we don’t know their room number!
Amongst all these numbers it can be easy to lose sight of why we do what we do.
None of us started out working in aged care, or as clinicians, because we were most concerned with (financial) numbers.
But we can’t hide from the numbers either. They determine what management is able to provide the residents we look after, whether we can get that new set of parallel bars, or that fancy new piece of gym equipment (and they even pay our wages).
The numbers don’t have to be in opposition to us.
I see a lot of good clinicians, who rail against the “money driven” aspect of aged care even as they accept their wages and equipment that are funded through these vital numbers.
When we have changes in budget numbers, such as recently occurred, we suddenly all realise how vital these numbers are. Cuts to complex care funding and budgets of up to 10% mean nursing homes are having to get by with less.
So we can’t avoid numbers. We can only do our best as ethical clinicians to work within the numbers we have, to do the best we can for the organisations and the residents and staff we work with the numbers we are given, and do what we can to help these numbers.
Numbers, for me, are just a tool. Not good or bad on their own, but what you do with this tool can be. We can decide to interpret these numbers negatively or positively. A hammer can be used to break or it can build. I need to know the number on my ultrasound machine to make sure it gives the effect I’m after, but I’m the one controlling where it goes and for how long. Too short and it's ineffective, too long and it can be harmful.
An ACFI number, although important, doesn’t determine exactly what I do in a treatment. Sure, I need to be aware of what that number (say a 4B) means I am required to do. But once I’ve met my requirement, I'm left with an awesome freedom in the therapeutic space we’ve created to interact further with my resident. I am blessed to be able to form a personal connection, just me and my client. I always aim to do my very best in the number of minutes I’ve been given to make a difference in their lives. I can measure the movement they have before and after my treatment. The difference between 0 and 10 degrees of dorsiflexion in an ankle can make a BIG difference whether someone trips on a carpet and falls.
The difference between a lonely resident feeling no-one cares about them, or that one one person does, is huge. The difference between one breath and none is very, very important.
So next time you’re feeling overwhelmed by this world of numbers that we're all born into, remember this.
The only number that really matters is this.
Your resident and you.
1 + 1 = ...
Well, you and your resident determine the answer to that. How you interpret and use that number is up to you.