21 Oct 2019

Commissioner finds rest home at fault in care of elderly woman

2:51 pm on 21 October 2019

The deputy Health and Disability Commissioner has found several failures in the care of an elderly woman at a Cambridge rest home, but her son says the report is a whitewash.

Elderly woman's hands, care for the elderly concept

Photo: 123rf.com

Ninety-one-year-old Freda Love was a hospital-level resident at the Bupa Care Services St Kilda rest home for six months beginning in August 2016.

Her son, Robert Love, had previously complained to the rest home and the Waikato DHB about her treatment, however, no action was taken.

He had also complained to the Disputes Tribunal which found there had been a systemic failure to provide a reasonable level of care.

Deputy Commissioner Rose Wall said Bupa had the ultimate responsibility to ensure Mrs Love received an appropriate level of care, however, this standard was not met, and it had breached the Code of Health and Disability Services Consumers' Rights.

There were multiple times where Mrs Love's catheter had leaked, saturating her bedding in urine or was not positioned correctly causing her pain and distress.

"Multiple individual incidents occurred that showed a lack of knowledge and skill regarding IDC [catheter] cares by its staff, including poor placement of the catheter bag, poor placement of the catheter tubing, incorrect positioning of the IDC tubing while in the hoist, and the catheter not being secured, resulting in it becoming dislodged.," Ms Wall said.

"Bupa St Kilda staff should have been guided by the policy and care plan summary to provide IDC cares, and I am critical that at times staff did not adhere to the care plan and policy."

Ms Wall said Bupa did not act quickly enough in getting its staff trained in catheter management and in hoist and transfer training.

Omissions in medical notes outlined

An independent nurse who assisted with the investigation also made the comment there were omissions in some of Mrs Love's medical notes.

"The progress notes are generally well documented by care staff and registered nursing staff. Most of the entries by the care staff are very thorough. However, there are omissions in relation to specific events, e.g. how the catheter became dislodged soon after admission."

Other issues were also noted, including inadequate wound treatment by putting a dressing on broken skin and not referring to a wound specialist sooner and uncomfortably hot temperatures in Mrs Love's room.

"It was recorded that the corridors at Bupa St Kilda were between 27 and 35.5 degrees Celsius and the rooms were between 26.5 and 34.1 degrees Celsius," the report said.

"In my view, the high temperatures recorded were concerning for the health and well-being of [Mrs Love] and other Bupa St Kilda residents," Ms Wall said.

Independent adviser Jan Grant also noted Bupa should have done more when the relationship between staff and Mrs Love's family began to break down.

"In my opinion, it would have been helpful to have requested the input of a geriatrician, a wound care nurse specialist and a catheter care nurse specialist much earlier. This may well have guided the St Kilda team in their care planning and delivery, and helped allay the concerns that [Robert Love] was experiencing."

Ms Wall said Bupa had breached Right 4(1) of the Code, which states: every consumer has the right to have services provided with reasonable care and skill.

She recommended Bupa provide a written apology to Mr Love, provide evidence that all registered nurses and caregivers at the rest home be trained in IDC cares and management, audit its compliance with its policy regarding temperature monitoring, consider whether staff training on effective communication with family members is required and disseminate the report among all the care homes owned and operated by Bupa New Zealand.

Bupa New Zealand chief operating officer Maggie Owens said it would accept the recommendations.

"We regret the distress experienced by Mrs Love and we unreservedly apologise to her son, Mr Love. We have made a number of improvements at our St Kilda care home since 2016, including further clinical education and additional training. The care and wellbeing of our residents is our highest priority and we recognise and accept the recommendations from the Health and Disability Commissioner's final report."

Apology brings little comfort to woman's son

However, Mr Love said he did not need another apology and doubted the report would lead to any change.

"Ms Wall does not appreciate that I have had all the apologies I will ever require from this company."

He said it was astonishing Bupa was only found to have breached Right 4(1) of the Code.

"My mother's right to effective communication and her right to be fully informed (Rights 5 and 6) were not provided, as Bupa frequently ignored my written complaints and lied when they did respond. Further, she was never told that staff were untrained and inexperienced. Her right to make an informed choice and give informed consent (Right 7) was clearly denied on multiple occasions due to this reason, as were her rights regarding teaching, if indeed any teaching was actually undertaken (Right 9).

"Bupa's delivery of service and care was such that it is impossible to find a right, as defined in the HDC code, that was not breached and on multiple occasions."

He said the HDC process had been biased and corrupt - favouring the provider over the consumer.

"Communication from HDC has been marked with errors, demonstrably false statements, undeniable conflicts of interest, long periods of unexplained silence, refusal to discuss complaints and issues, changes of staff, an unwillingness to provide or share information, incorrect interpretations of the Official Information Act and a cold absence of support.

"Tomorrow, will anyone in a Bupa care facility within New Zealand be at less risk as a result of this report? I do not think so. This is because the real lessons that will be taken from this report, at least at a corporate level, is that you can still game the system - it already works for them. If you can delay criticism for a few years the consequences, in every sense, will be financially insignificant.

"From my perspective, as the aggrieved consumer seeking the championship they offer, it has been an unexpectedly dissatisfying experience," Mr Love said.

Commissioner Anthony Hill said he was confident the process had been fair.

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