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ROYAL COMMISSION: “Inadequate care” and mismanagement of palliative care

The second week of the third series of the Royal Commission into Aged Care hearings in Sydney started today, with a case study from a Bupa Aged Care facility in Sydney focussing on one resident's quality, safety and care, as well as frustrations from counsel assisting over an indirect witness statement.

Maureen Berry, Executive Clinical Advisor at Bupa Aged Care, gave a statement on behalf of Bupa even though she didn't have direct involvement in the case. [Source: Aged Care Royal Commission ]
Maureen Berry, Executive Clinical Advisor at Bupa Aged Care, gave a statement on behalf of Bupa even though she didn't have direct involvement in the case. [Source: Aged Care Royal Commission ]

The fourth case study investigated 70 year old Mrs DE who died after four weeks at Bupa Aged Care Willoughby nursing home.

Her daughters, Ms DI and Ms DJ, both gave evidence to the commission with firm beliefs that the aged care facility was not feeding their mother or adequately caring for her, and did not give them appropriate communication around their mother’s palliative care in 2017.

Counsel Assisting Ms Brooke Hutchins says in her opening statement to the commission that Mrs DE relied on Bupa to provide care suited to Mrs DE’s needs, however, “The level of care provided by Bupa to Mrs DE fell way below her daughter's expectations.”

Mrs DE was placed into the Bupa Willoughby site originally on a respite basis in July 2017, but after a hospital visit that saw her physical and cognitive condition decline, the daughters decided to place their mother into the facility permanently, needing full-time care.

When explaining to her mother the need to put her into long-term care, Ms DI says, “We couldn’t have been sure there was comprehension of what we were saying. It was indicative of the state she was in… We were confident [Bupa] had everything we needed”.

Mrs DE was bed-bound and needed to be fed by staff, something outlined when she was put into the nursing home permanently, but both daughters believed they were the only ones taking the time to feed her.

At times, there were trays sitting next to her bed, untouched. When asking nurses if they had fed her, they would put a spoon near her mouth to show Mrs DE wouldn’t willingly eat, and put the rest of the meal into the bin.

“Every time we went, her face was more sunken. We had family members visiting from interstate. They also observed she was really declining and was not eating or drinking much. She looked really unwell,” says Ms DI.

In one case, their mother’s speech pathologist showed the daughters a video how to properly feed their mother due to her increasing dysphasia, a deficiency in speech or comprehension.

Ms DI questioned why she was being shown the video, with the speech pathologist saying there was no point showing the nurses because family members seem to do a lot of the feeding of their loved ones in the facility.

“She had more faith in me feeding my mother, me with a newborn child, rather than the nurses here,” says Ms DI.

In early August 2017, a palliative care nurse visited Mrs DE and created an end of life plan for her, however, Bupa never contacted the daughters about it or helped organise a meeting with the palliative care nurse.

On August 15, the daughters went to the nursing home after receiving a concerning phone call from a nurse who couldn’t explain the condition of their mother but wanted to transfer her to a hospital.

Ms DI says when they arrived at the nursing home, “It was so disconcerting and scary. It sounded like an engine of a truck or lawnmower was going. We ran to mum’s room, we could hear that was where it was coming from. No one was there. She was fighting to breathe, it sounded like her lungs were full of fluid.”

For half an hour, the sisters looking for staff to help. Eventually, they found a nurse who had poor English and wasn’t able to explain what care was being provided to their mother.

An in-house GP was called, Ms DI says, “This man came in, was in the room for less than one minute, muttered something to [the nurse] and walked out. He said “This isn’t my area of expertise”, and walked out. We couldn’t believe what was happening.”

In a desperate bid for help, the daughters contacted the palliative care nurse, who wasn’t available, however the nurse who picked up the phone gave direction to the daughters on what to do and what to ask. The extra outside help didn’t solve the situation and Mrs DE died.

The daughters contacted the Aged Care Complaints Commissioner over what they believed to be poor care and complete disregard for their complaints by Bupa.

The investigation found inadequate care had been provided to Mrs DE.

Ms DJ says, “The whole evening of mums passing was a farce and honestly an absolute disgrace. There was not enough staff, the staff who were there didn’t seem to know what was going on, and we were in the dark the entire time.”

“They did not want to admit they were at fault. For an organisation that says they want to care for people, it seemed like they had no compassion for us at all.”

Commissioner Richard Tracey says in relation to this case study, that, “Maybe, unfortunately, [this is] typical of what is often going on in this sector. We are hearing more and more stories of like effect.”

Maureen Mary Berry, Executive Clinical Advisor for Bupa Aged Care, took to the stand and seemed unable to provide information Assisting Counsel was asking for.

Ms Berry, at times, disagreed with her own statement or was unsure whether certain people involved in the actual incident were still employed or not.

Senior Assisting Counsel, Peter Gray QC, mentioned the lack of statements from individuals directly involved in the incident with Ms ME.

Mr Gray says “The royal commission is deprived of their accounts in their assessment of Mrs DE.”

Mr Gray had to hear Ms Berry’s statement from reviewed documentation she had looked over.

Ms Berry refused to admit that the Bupa facility had provided substandard care, which the Complaints Commission had found.

Ms Berry suggested that some areas may have been lacking but it didn’t impact Mrs DE’s care.

She also admitted that she agreed with Mr Gray’s assertion, and the Complaints Commission report, that clinical supervision and leadership was lacking.

Ms Gray asked about documentation, which, throughout the hearing, suggested poor communication and note-taking by the facility, and asked if Ms Berry agreed it resulted in poor care.

She says it was, “Not a serious lack in care, just a serious gap in documentation, to which Mr Gray responded, “This goes beyond a gap in documentation”.

Compared to previous studies investigated by the Commission, this is the first time there hasn’t been a witness taking the stand directly involved with the incident.

Two more witnesses went to the stand, including Glenn Rees, Chair of Alzheimer’s Disease International, and Amy Tinley, Care manager at an aged care facility giving a statement in regards to a previous case study last week.

The hearings will recommence on Tuesday, May 14.

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