Improvement needed throughout process

Aged care assessments

We had an ACAT done for my father and then when we required additional services. A second service provider called on us and we had to go through everything again, distressing to my father, and the 2 ACAT documents caused confusion.

There should be one document and, if another service provider is brought into the mix, the previous document should be continued with. It would be preferable to deal with one service provider, rather than two.

Staff ratios

The ratio of staff to residents in nursing homes needs a serious overhaul. The aged care facility my father landed in had 18 rooms per ward and some of the rooms had a two residents per room.

At night, after 8.45pm, there was one person on duty until 7am the following morning. That one person was not capable of turning patients, particularly those incapable of walking. This resulted in my father developing 8 severe bedsores.

With the shortage of staff, one of the residents had an episode after dinner – staff often disappeared off the floor after dinner but I’m not sure if they had duties elsewhere in the facility – and managed to draw the attention of one of the kitchen staff passing by.

They called me out of my father’s room, where I was getting him ready for bed, and asked for my assistance.

The kitchen staff member mentioned she had never been in one of the rooms before and didn’t know how to call for assistance.

I showed her where the call button was – I had to retrieve it as it was tucked deep into the made up bed, buried under the bedding. How the resident was supposed to reach it in the position it was in was beyond me!

Medication management

Medication was dished out during meals in the dining room. Not all nurses or dispensers knew the patients properly. I caught them on more than one occasion providing the wrong medication at dinner time – what happened on the occasions when I wasn’t around at breakfast/lunch?

Why are these medications not kept in the top drawer of their lockable bedside cabinets and administered from there?

The nursing home kept trying to get control of my father’s medication but I refused because who knows what they would order! I insisted on purchasing his medication in blister packs. On more than one occasion, when I arrived in the late afternoon, my father would say: “My child, I am so confused today, not sure what is going on but my head is turning. I can’t think clearly today.”

I was going to take a sample from his urine bag and get a tox screen done but my elder sister insisted that she would but didn’t. I told the night staff that, if I arrived there again and my father was in that state, I was going to do exactly that. He was never in that state again.

Were they purposely giving him other medication to try to sedate him?

On another occasion, we requested doctor-prescribed Bactroban be administered around the catheter area that was never administered, so my father continuously had red sores and tenderness around the catheter insertion point, which were septic sores by the time of his admission to hospital.

He was allergic to shellfish, iodine and they were given food on special birthday lunches that contained iodine. Not only was my father refused the medication prescribed “as required” because it was not written up on his charts as daily medication but – when I asked for a list of residents and their food allergies to be placed in the dining area – I was told that the kitchen was in charge of that and they determined who got what food, no list could be placed in the dining area.

I watched the kitchen and carer staff dishing up meals and they asked the residents what they wanted to eat – most chose sandwiches every night – and often the carers dished up the food so the kitchen was not controlling who was given what food.

I had to visit with medications to give my father and I have photographs of his face following his eating food containing iodine. Nursing staff refused to give him (any anti-histamine), even though they had that medication with his name and details and “as required” on the label.

Personal care

At the nursing home, one elderly lady was permanently plonked in a chair in the dining room. Now and again they took her to the toilet. Sometimes they did not feed her unless a lady at the table adjacent to my father’s table said to them: “What about (name) tonight? Are you not giving her dinner?” The staff would glare at her and begrudgingly feed her.

On very rare occasions, (name) would stand up and look around. On one occasion I saw her walk to a wall and feel the wallpaper. Soon after, we arrived there at night and she was tied to the chair with curtain ties. The lady at the adjacent table stopped leaving her room for meals and one evening I sent her a note to ask if she was OK and she let me know that she couldn’t go into the dining room because she couldn’t bear to see (name) tied to the chair, so she rather stayed in her room for weeks on end.

Lack of disclosure

The nursing home staff appeared too scared to admit fault. At lunchtime on the last day  my father was in the nursing home, someone pulled my father’s catheter while transferring him from his bed to his wheelchair to take him to lunch. He screamed in pain and they simply bundled him into his wheelchair and took him to lunch.

When I arrived at the home at 4 pm they were busy in his room for 30 minutes. The nurse told me that there was a lot of blood in his catheter bag and she had flushed his catheter and, if there was still blood after dinner, she would replace the catheter. I took him for his walk around the garden. He told me how the girls had hurt him at lunchtime and then they giggled about it when they bundled him off.

They should have told the nurse, but didn’t. After his catheter was replaced that night, the bleeding continued and they decided to send him to hospital. He was turned away from two hospitals and eventually sent to the furthest one and aspirated 5 minutes away from the hospital.

When he was eventually admitted to the emergency room his legs were pulled up to his chest and I asked the doctor on duty to please scan his bladder. That was not my Dad’s normal posture. When they did the scan, they saw that the catheter had pulled down into my father’s urethra, hence the bleeding. His bladder was enormous, filled with all the urine that was blocked and unable to drain.

If those young girls had told the nurse what had happened, my father could have been transferred to hospital that afternoon and probably would have been admitted to the nearest hospital, rather than waiting to be transferred around 9pm at night when all the emergency rooms were apparently full.

Substandard medical visits

Proper medical doctors should be available at the nursing homes, not old doctors close to retirement who openly display disdain for the elderly. We had to resort to using the doctor associated with the nursing home, due to their bullying, and he left a lot to be desired. He would generally call on a Friday afternoon, at dinnertime, hang around for an hour and then leave.

I wonder how many Medicare Bulk Billings he claimed in that period? He would sit in the Nurses’ station and plug his laptop into the network. He took personal calls walking around the dining room tables speaking in another language at the top of his voice, disturbing the quiet mealtime.

Sometimes, after probably checking messages regarding the residents, he would drift over to a resident and speak to them about their medical condition in public (no privacy) and often checked their vitals while in the dining area, in full view of other residents.

On one occasion, he drifted over to my father because he’d been trying for weeks to get him to take a flu vaccine and asked him loudly, looking at my sister very disdainfully, whether it was HIS decision or his family’s decision not to take the flu vaccine.

My sister was sitting with my father and said: “Dad, please tell the doctor why you do not want a flu vaccine” and my father told him that he had decided not to take a flu vaccine because he generally did not get the flu (hadn’t done in years) and on a previous occasion when he had, he got a very bad bout of the flu. Ever since that he has not had one.

On another occasion my father had thrush in his mouth on a Tuesday and I asked the nurse to get the doctor to authorise some Nilstat for my father so that they could administer it. They did nothing, they told me when I arrived on the Wednesday that they had phoned the doctor and he would look at it on Friday. I immediately went to the chemist and got some and administered it.

My sister and I took turns going to the Nursing home and doctoring my Dad’s thrush in his mouth. Thrush in your mouth is rather painful. On the Friday, the doctor came over to my father and I told him that we had taken care of it. I asked him why he hadn’t prescribed it for the staff to administer it and he said to me “old people get thick yellow coating in their mouth” and he asked my father to open his mouth.

I told him that my father had white spots all over inside his throat, mouth and tongue, it was thrush, not some yellow coating. I said we had been giving my father Nilstat and he was almost totally well. He just grunted and walked off.

Communication challenges

It was difficult getting the nursing home staff to understand what you were saying, even when you spoke slowly. We had to take care of my Dad every night – I went every night, with a little relief from my younger sister now and then because she worked shifts and often worked at night herself.

My Dad was very particular about his hygiene and the one night they got him ready for bed they threw his partial dentures in the dish I provided but would not brush the teeth in his mouth. He would not go to bed without brushing his teeth, so I got a dish and a glass of water and let him brush his teeth.

The staff had no concept of Polident – usually they had not put enough in the morning and his teeth slid around on his gums when he was chewing his dinner, or they left his dentures out completely. I’d get there at night and he’d have no partial dentures in. He’d say the staff rushed him out of his room in the morning and he didn’t have a chance to remind them. On other occasions, they had used so much Polident that his partial dentures were stuck and I would struggle for 20 minutes or more to get his teeth out.

Documentation mismanagement

The wrong ACAT file was put on my father’s file. I discovered this because I received telephone calls about my father’s poor kidney condition. I fought with the medical person in charge at the nursing home and said my father’s kidneys were very healthy.

Eventually, one day I asked them whose ACAT they were reading and the name read out was the same surname but a different first name. I requested that they remove that ACAT form off my father’s file immediately.

I’m not sure if they ever did but they definitely left it on their electronic records. When he was in hospital with his disgusting bedsores they were again referring to the wrong ACAT form and medical condition in deciding on the path of ‘end-of-life palliative care’.

I had to fight to get a copy of his file and, eventually, paid for a copy after his death and the medical information was wrong – dementia, diabetic, kidney disease, etc. My father did not have any of those illnesses.

The palliative care team told me that he would pass by the next day when they put the Nikki Pump on. My father was on that pump and passed on the fifth morning because he was not as ill as they assumed, because they had been referring to the WRONG notes held by the nursing home.

Nobody bothered to correct the electronic records – I wonder if they even bothered to correct the paper records. Why would they bother in the nursing home?

End-of-life care

When my father arrived in hospital he was quickly put onto an “end of life” palliative care program with a Nikki Pump. Was this to avoid his death from toxic shock that would eventuate from the bedsores and require a coroner investigation? It appeared easier to write him off with a Nikki Pump under the pre-text that he had no quality of life.

In closing

We had looked after my dad at home until it became really difficult, using a hoist to get him in and out of bed. I wish that we had struggled on, rather than putting him in that hell hole. It will haunt me for the rest of my life.

Logan, Qld