Aged care workers cite abuse and neglect of nursing home patients
Lateline By Margot O'Neill
13 August, 2013
Aged care workers say their industry is facing a staffing crisis, with claims of abuse and neglect as patients struggle to get even basic care.
In phone calls and emails with scores of carers, nurses, facility managers and even former health bureaucrats, ABC's Lateline program has uncovered a pattern of failure in many facilities.
Staff say they often do not get time to properly feed, hydrate or toilet residents, that broken bones and infections can go undiagnosed and that there are frequent medication mistakes, at least 10 a month.
Lynette Dickens, a specialist palliative care nurse with more than 20 years' experience working in aged care, told Lateline of an instance in which an elderly man buzzed for help to go to the toilet but was left waiting for 30 minutes or more.
"According to him she said 'you've just had a pee, you don't need to go again' and he said 'I do!' and she abused him and walked outside," Ms Dickens said.
"He kept ringing the buzzer and he said 'I'm going to wet myself, please help me', and she grabbed the buzzer and threw it to the end of the bed and said 'I've got better things to do.'
"I put in an incident report. Nothing was done."
She says staff in many facilities often struggle to complete basic tasks, such as regular toileting.
"They feel very disillusioned and demoralised and feel they know they want to do a good job but that it's not possible," Ms Dickens said.
Elderly patients suffer as basic tasks ignored
With no mandatory minimum staff-to-patient ratio, Lateline has been told of shifts with one carer for 20 or 30 high-care patients.
It means residents can be left for hours in incontinence pads, risking dangerous skin and urinary tract infections.
Elderly patients sometimes have to plead for more because pads are locked up.
"In my experience, incontinence pads are rationed, generally three a day, and the rest are stored and locked away in a cupboard and only one person has the key," Ms Dickens said.
"So anybody wanting extras has to get permission."
Ms Dickens says three pads per day is not enough.
"Many residents were saturated from ankle to head, or in bed absolutely drenched in stale brown urine," she said.
Many staff also complain that doctors can be hard to find, with Ms Dickens remembering how one woman was left to die convulsing and asphyxiating on her own vomit for hours.
"It's quite traumatic, somebody choking on their own vomit, unable to take a breath," Ms Dickens said.
Ms Dickens intervened, trying to contact the woman's doctor, who did not respond. She tried the locum, who refused to come, and later the hospital, which refused admittance.
She finally called an ambulance, which meant the dying woman received some oxygen, which the nursing home had run out of.
"A carer stayed back after duty," Ms Dickens said.
"This lady had no family, no one else was there, it was only us."
Patient numbers rise as staff shrinks
There are now more chronically ill, dependent and demented elderly patients needing more complex medical care in nursing homes than ever before.
At the same time, there are less medically-qualified staff than ever before.
Seventy per cent of nursing home staff are now low-paid, low-skilled carers.
Many complete thorough training courses, but many do quick online course and some have a poor grasp of English.
Once on the job, they can be pressured to perform tasks beyond their limited training, such as attending complex wounds or dealing with catheters.
Sophie Cutriss, a registered nurse and aged care teacher who has worked in more than 10 aged care facilities over a 20-year career, says carers are supervised by a dwindling number of registered nurses who can be responsible for more than 100 patients.
Their jobs are made more difficult by the mountainous paperwork they are required to fill out each shift so management can access government subsidies.
Mrs Cutriss says staff are sometimes forced to cut corners.
"It's easier to pull the elderly person off their bed, shove them on a toilet chair and take them straight to the bathroom with very little privacy, and quicker to have them defecate and urinate in the shower, than take them to the toilet," she said.
"Elderly people are being dragged out of bed early in the morning to help staff try to get through all their work.
"And I must say that they are mostly caring, compassionate, empathic people who are trying to do their best."
A Victorian carer says he breaks the criminal code every night when he locks dementia patients in their rooms because he does not have enough staff to ensure their safety.
"Management has ignored my requests for extra staff," the carer said.
Some staff crack under the pressure or are the wrong kind of person to be working with the frail elderly.
"I saw an elderly lady smacked and pushed back in her chair," Ms Dickens said.
Mrs Cutriss said: "I've heard them told 'you smell like you've got a dead rat up your arse', or being yelled at, 'stop that' or 'get out you dirty old man', words like that."
Picking up on subtle changes in health is key: GP
Alzheimer's Australia chief executive Glenn Rees says in recent weeks the organisation has received a lot of correspondence detailing "disturbing" treatment of elderly people in care.
He said the time has come of the industry, community and government to overhaul the system.
"In some cases there is very, very poor care being delivered which is quite unacceptable and as an organisation we believe there should be zero tolerance of that," he said.
"We don't run away from the fact that poor quality of care has to be tackled and we think there are a number of ways in which the federal government and service providers and consumers can do that together."
Mr Rees said spot checks and the accreditation of service providers is designed to ensure a high standard of care "and clearly that hasn't happened".
"The preferable approach is to have some transparency in what the care outcomes are being achieved and that isn't in place - there aren't any quality indicators," he said.
"Much of the monitoring that goes on addresses the systems and compliance."
Dr Joachim Sturmberg, a health care academic and GP who treats patients in nursing homes, agrees and says the system is more about box ticking than looking after people.
"Frailty is not well understood - it means the physiological ability to respond to change is very limited and it is the stage before you pass on," he said.
He says good medical care of the elderly requires vigilance.
"[A patient's health] can be changed by small things, like urinary tract infection which, if not picked up, turns into delirium and can tip over into death," he said.
"Which is why it is important that staff are able to pick up subtle changes in the patient."
Many facilities still provide good care because of dedicated staff, but even the industry acknowledges it is a stressed system.
Families and staff say it means patients often needlessly suffer pain and indignity and sometimes die because of substandard clinical care.
Staff failed to notice patient had turned purple
John Walker, who works as an aged care nurse outside New South Wales, thought he could trust the staff looking after his mother, Thelma Walker, in a fully accredited New South Wales nursing home.
But as her health dangerously declined, no one even checked her temperature.
"If the nursing home had responded to my initial concerns and done assessments, the numbers would have told them things weren't right and they would have intervened," he said.
"She might still be alive."
Abridged
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