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ROYAL COMMISSION: Pressure wounds, contractures and dietary inconsistencies

Day 2 of the Darwin hearings for the Royal Commission into Aged Care Quality and Safety observed a case study of a 92 year-old resident whose mismanagement of care resulted in the development of pressure wounds so severe that bone was exposed and contractures in her legs, as well as issues with dietary requirements being met by her nursing home.

Lyndall Fowler provided evidence of poor care provided to her mother including pressure sore and contracture development in her feet and legs. [Source: Aged Care Royal Commission]
Lyndall Fowler provided evidence of poor care provided to her mother including pressure sore and contracture development in her feet and legs. [Source: Aged Care Royal Commission]

Lyndall Fowler, the daughter of Shirley Fowler, took to the stand outlining the poor quality of care and lack of dignity provided to her mother, along with constant advocacy from herself to make sure her mother was receiving the right services, food and care.

In her statement, Ms Fowler believes that cost pressures and staffing issues is what caused her mother to fall through the cracks.

Mrs Fowler moved into IRT William Beach Garden, New South Wales, in 2013 and over that time she developed a number of preventable conditions including pressures sores on her feet along with contractures of the legs, particularly her right leg. 

Contractures is a freezing of the limbs, generally in a crooked position due to the atrophy and shrinkage of muscles and tendons.

The pressure sores were so serious that the pressure sore on the left foot became infected and resulted in bone exposure.

The contractures also meant that Mrs Fowler was losing movement and mobility in the lower half of her body and was often found huddling in the fetal position in her bed.

Along with the issues of quality of care, IRT seemed to have difficulty meeting all of Mrs Fowler’s dietary requirements, including her lactose intolerance and allergy to the colour 102, yellow food colouring.

Over the last six years, Ms Fowler says she had to constantly advocate for suitable food to be provided to her mother, but on some occasions, Mrs Fowler was still provided with food she couldn’t or shouldn’t eat.

Additionally, Mrs Fowler was still independent and able to feed herself, however, it took a very long time to feed herself.

On many occasions, Ms Fowler would find her mother in clothes that were covered in food spills and she had to go out of her way to provide Mrs Fowler with bibs and aprons to prevent messes.

Ms Fowler says she was really disappointed with the constant advocacy she had to provide on behalf of her mother to receive quality of care, independence and dignity in her living. 

“The cost pressures in residential aged care are significant, again, across the sector. My concerns are that if things like the severity of my mother’s contracture and the seriousness of these pressure ulcers can happen in a well-regarded facility that meets quality standards, then there has to be system problems,” says Ms Fowler.

“It’s very stressful. So not only to have to witness her deterioration and loss of independence and dignity, but to have to, time and time again, bring things up that I think it shouldn’t have been my role. However, I have been doggedly determined to do the best I can to assist my mother.

“I would like to see that the quality system has a much stronger focus on prevention: prevention of falls, prevention of pressure ulcers, minimisation or prevention of contractures, oral health and prevention of dependence on staff. 

“And I would like to see that those things I just mentioned be regarded as indicators of poor quality care with consequences and monitoring actual practice of facilities and not just what facilities say they do.”

Following Ms Fowler’s evidence was the Care Manager at IRT William Beach Gardens, Kristy Taylor, who admitted that on many occasions, there wasn’t adequate documentation or care provided to Mrs Fowler during the time between 2013-2018.

Since all the issues with Mrs Fowler’s care, Ms Taylor says there has been a lot of education, new processes and training provided to their staff to rectify the problems, which she has observed and monitored during her time at the facility.

Counsel Assisting Mr Grey asked whether the staff were worked off their feet, as Ms Fowler had suggested in her statement.

Ms Taylor explained, “I believe that the staff are busy, the job is busy. It’s been a job that I have done for nearly 20 years and I have never done a day of nursing that hasn’t been busy.”

Hearings will continue today, Wednesday, July 10, in Darwin, NT.

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