We received a call from our mother’s aged care facility around breakfast time one Friday that she was on her way to hospital after having breathing difficulties overnight. She passed away late the next day, in early November 2016. The emergency department doctors said the likely cause of her admission to hospital the day prior was “aspiration pneumonia”. (This condition occurs when food, saliva, liquids, or vomit is breathed into the lungs or airways leading to the lungs, instead of being swallowed into the oesophagus and stomach.)
But it’s how we got to that point that should concern others in the same boat as well as those who claim to be reforming aged care in Australia. Our family knew very little about the aged care industry when our fiercely independent elderly mother had a nasty fall in her retirement village unit in 2011 and, during her hospital rehabilitation, was assessed as requiring around-the-clock care. That wasn’t something that her retirement village provided.
So, before she was discharged from the hospital, we searched far and wide and placed her name on several waiting lists. As time came close to her mandatory discharge date (yes, there is a limit) and she was once again mobile, we’d still not received an offer of a suitable place. The hospital helped us find her a facility that could take her. However, it 30km from her nearest relative. All her belongings that she was taking into care were moved there, only for a more suitable place, 15 km from her family, to become available a week later – for which she and the rest of the family were grateful.
When she settled into her permanent aged care facility on Brisbane’s northside, we were all pleased that she would be getting the services and attention she required, even if she wasn’t too thrilled with the hot meals on offer because, she claimed, they were “bathed in gravy”. We continued to visit her regularly and, whenever it was practical, take her out for a meal or picnic.
Initially, all seemed positive in most other respects. Sure, there were repeated trips required every couple of months for her hearing aids to be repaired because she or the staff attending to her had been too heavy-handed and broken the battery door or shoved the battery in back-to-front, jamming the thing shut or cutting an internal wire. And, despite having all her clothing – including underwear – marked, things would periodically go missing, with only the occasional item finding its way back to her room.
But, slowly at first and then more noticeably over the following years, things began to change. We first really noticed it about the time when the original general manager moved on. With Mother having been there a couple of years by then, we knew most of the RNs and ENs as well as the regular food and cleaning crews. Suddenly there were new faces and staff seemed a lot busier. Many regulars had left.
Mother had a fall in her bathroom in the early hours one day and wasn’t found until just before breakfast. She was unable to get up from the cold floor without assistance and, consequently, was in pain and quite scared. Months later she had another fall, this time more serious: dual fractures in her pelvis, requiring another hospital admission. After recovering from this she walked far less and was pretty much restricted to her bed or her electric-lift chair, with any movement beyond these requiring a stand-up rollator plus staff to assist her. Her outings in the car ended, too, closing her world down that bit more.
It was about this time that we noted that staff shortages had really became obvious. Mother would buzz for someone to help her to the toilet, but it would take ages until anyone replied. We even saw this for ourselves. A proud woman, she was mortified if she soiled herself or had “an accident” on the way to the toilet from an over-full bladder or upset bowels. Sometimes, particularly at night, no one would respond if she buzzed. So the aged care facility put her in adult nappies, not because she was incontinent, but because they didn’t have enough people on deck to attend to her toileting needs.
One former RN, who bumped into us a few weeks after she’d resigned, told us she had departed because of the unrealistic workload. We respected her care and Mother thought a good deal of her. She told us the breaking point was when she was assigned responsibility for 70+ residents on her overnight shifts. Given the number of elderly residents requiring nurisng attention overnight, sometimes for serious medical reasons that would require constant care until an ambulance arrived, it was easy to understand why this nursing professional found that situation intolerable.
When our Mother first went into full-time care, she would join a small group of other residents at a central dining table for her meals. After her falls, she eschewed that, preferring to dine in her room where she’d spend most of her days in her electric-lift chair beside her bed. However, sitting for long periods led to painful bedsores developing on her tailbone and a nasty lesion appeared on the underside of one ankle because her leg had been resting over the end of her elevated footrest, cutting off the circulation to her foot. These should have been avoided with basic nursing care.
Mother never really adjusted to the food on offer, finding most of it too bland and tasteless. So we would bring her the occasional hot meal (fish and chips were a favourite but not on the facility’s menu, other times it might be a roast with veges) or some of her favourite baked treats. Whenever we brought a meal, we’d ensure we stayed until it was consumed and tidy up afterwards. Over the years, it was obvious to us that the standard of food – and quantities served – had slipped markedly. Mother’s weight fell, too, a sure sign she either wasn’t getting sufficient calories or wasn’t eating what was put in front of her.
What we began to notice when we visited, and repeatedly alerted staff about, was that her fingernails would have food stuck underneath them. Clearly she was past using utensils for most things, so would scrape up food with her fingers. Given she was supposed to be receiving personal care, we were astounded that her hand hygiene wasn’t being attended to nor, apparently, was she being assisted when eating alone in her room.
The diagnosis, then, of aspiration pneumonia could well have been the consequence of such oversights. We will never know. What we do know is that the level of care in a once highly reputable facility fell to well below an acceptable standard. Our mother was there to receive care and attention. Indeed, when she entered the facility in her early 90s, we were assured that she would, if needed, receive end-of-life care in situ. She had signed an advanced care plan and had indicated in no uncertain terms to her family that she did not wish to have any other interventions beyond pain relief if she were to have a major medical episode. We were grateful for having that documented when her time came but will always wonder whether sub-standard care sped up her departure.
Ultimately there was no end-of-life care offered by her aged care facility when she eventually needed it five years later. It was, however, expertly provided in a public hospital. We have wondered whether a sign that there was a certain level of guilt on the part of the aged care facility was that they didn’t even extend their condolences after her passing. They merely told us we had 24 hours to vacate her room and remove her possessions.
EM & KE