Health – HDC: Failures in care for elderly rest home residents

Deputy Health and Disability Commissioner Rose Wall today released two reports which found Radius Residential Care Limited in breach of the Code of Health and Disability Services Consumers’ Rights (the Code) for failures relating to the care provided to two elderly people at separate rest homes.

Ms Wall said both cases highlighted the importance of having robust protocols in place to monitor what is happening to an elderly person in a rest home from one day to the next and plan their care accordingly.

“It is critical if someone’s condition is deteriorating that this is picked up early and all staff involved in their care are consistently managing the symptoms in the most appropriate manner. This includes seeking specialist expertise when it is warranted,” Ms Wall said.

“Supporting elderly people at the end stages of their lives has its unique set of challenges. It can be extremely distressing for their families and those who care for them to witness their demise. Communication is so valuable both in terms of how information is conveyed and when.”

The first report concerns the failures by the rest home to provide appropriate care and services to an elderly man.

The man, who had dementia and prostate cancer, was admitted to the rest home in 2017. He was prescribed bowel medications by the public hospital, but the use of these was not noted in his care plan. Over the course of 7 days, he did not have any bowel movement, and at a subsequent hospital appointment, was found to have impacted faeces. He was then transferred back to the rest home, and experienced an unwitnessed fall. His family was not notified until the following day.

Ms Wall said the man “suffered unnecessary and avoidable pain, distress, and indignity in his final weeks” and commented on how upsetting it must have been for his family to see him in such circumstances.

“Basic components of his care were deficient. Clearly, he required comprehensive and considerable support, given his age and prostate cancer, dementia, and progressive decline in general function,” Ms Wall said.

Ms Wall considered that care and services in relation to the man’s bowel management and preparation of a care plan were not appropriate. In particular, the care plan did not refer to the man’s bowel medications, these were not administered as required, and no short-term care plan was prepared, or a care plan updated, following his re-admission to the rest home. Ms Wall considered that these were systemic issues.

Ms Wall recommended that the rest home apologise to the man’s wife. She also recommended that it conduct an audit on its patient admission care plans and provide a written update on the steps taken to address an issue identified in its most recent HealthCERT audit.

As a result of the incident, the rest home has advised that it has held various training and education sessions, and has improved its electronic reminder system, to remind staff of pending appointments.

The full report for case 17HDC01178 is available on the HDC website.

The second report is about the failure by a rest home to seek specialist input sooner in its care of an elderly woman.

The woman had advanced dementia and restricted mobility. She developed a pressure injury on her left heel and another pressure injury on her right heel three months later. Neither injury fully healed. She was reviewed by a wounds nurse specialist. Sadly, shortly after the specialist review, the woman deteriorated and died.

Ms Wall found there had been a number of failings by staff which demonstrated a pattern of poor care and poor compliance with policy, for which Radius was ultimately responsible.

“As this Office has stated previously, inaction and failure by multiple staff to adhere to policies and procedures points towards an environment that does not support and assist staff sufficiently to do what is required of them and ensure that its residents consistently receive optimal support,” Ms Wall said.

Ms Wall also noted the importance of recognising the grief and emotions that a family may experience at the end of a loved one’s life, and of ensuring that communications in that context are considered appropriately.

Ms Wall recommended that Radius apologise to the woman’s family, which it has done. She made a number of other recommendations including that Radius conduct a random audit of wound documentation, arrange wound care training for its rest home staff, and consider changes to its communication policies around the importance of communication with family and pressure injuries.

The full report for case 18HDC01053 is available on the HDC website.