Dec 12, 2019

Aged care facility was “woefully ill-prepared” for resident’s death


The aged care facility where Kate Davis’s mother lived was not equipped to cope with the resident’s death, the royal commission has heard.

This week the royal commission is examining the interfaces between the health system and aged care system and access to specialist services, such as palliative care.

Ms Davis told the royal commission her mother, Noeline Taylor, was a loving mother but developed chronic schizophrenia after the birth of her second child. 

In August 2011, at the age of 79, Ms Taylor moved into residential aged care after her psychiatric condition worsened, and she began to experience paranoia, while also developing the early signs of dementia.

Ms Davis said some of the staff at the facility found it difficult to cope with Ms Taylor’s behaviour, and began to resort to sending her to hospital in an ambulance, particularly at night. 

In March 2014, Ms Taylor was diagnosed with a brain tumour and was treated with steroids to reduce the swelling in her brain.

Ms Davis said her mother’s access to specialist medical care at the facility was limited and could have improved her quality of life.

In October 2014, Ms David was introduced to Nikki Johnston from Clare Holland House, who helped Ms Davis and Ms Taylor develop an advance care plan.

Ms Johnston was instrumental in ensuring Ms Taylor received the care she needed as she approached the end of her life, because the aged care facility was not equipped to deliver palliative, Ms Davis told the royal commission.

For example, a geriatrician prescribed pain management for Ms Taylor, but the syringe driver that was used to administer the medication did not work because there were not enough registered nurses on duty. 

At the time, there was only one registered nurse on duty spread between four to six facilities all around Canberra. Fortunately, Ms Johnston was able to get the help needed to use the syringe driver.

There “needs to be more registered nurses and more ability to make sure that this pain medication is administered correctly at the correct time,” Ms Davis told the royal commission.

Death should be part of aged care facilities’ “core business”

“I think everyone assumes that when someone is in an aged care facility that death is part of their core business,” Ms Davis told the royal commission. “You don’t… think that they’re a separate entity. You think that they are a joined entity, but that sadly is not the case, in my situation, anyway,” she said.

Care staff did not understand needs of dying person

Ms Davis said it was a multitude of small things that made her feel the care staff did not understand the needs of someone who is dying. People responsible for personal care would leave a cup of tea and biscuit on Ms Taylor’s bedside table, when she was clearly not awake or able to move, and not not been out of bed for weeks.

“They were still coming in, leaving a cup of tea and biscuit. ‘She must eat.’ ‘No. She’s beyond the point of eating now’, and just this sort of look of horror.”

“It was like they were shocked that someone was dying,” Ms Davis explained.

Personal-care attendants would also come into her room and say they were going to get Ms Taylor up and shower her.

“I had some of the staff there were visibly distressed when they saw Mum. They would be very upset; they would cry and say ‘This is so sad, so terrible for you’.”

It “became obvious to me, that they were not equipped for this part of Mum’s life,” Ms Davis said.

Ms Davis told the royal commission she did not think her mother’s aged care facility met quality standard three, which requires that an organisation demonstrate the needs, goals and preferences of a consumer nearing the end of life are recognised and addressed.

Hospice was able to deliver palliative care

In August 2015, Ms Taylor was moved to the hospice at Clare Holland House. Ms Davis said it was only then that her mother’s palliative care improved. Staff communicated clearly and professionally with her and effectively managed Ms Taylor’s pain.

“From the moment mum got there (to Clare Holland House), she seemed at peace. There was a relaxed nature. The pain medication was adequate and on time and pre-emptive almost. She was in a comfortable bed. They washed her hair. They put on a clean nightie. She had a – rosy cheeks almost… There was a visible relaxation. There was a divan for me to sleep on, and you just felt enveloped in this support and care.”

“It seemed like there were people everywhere all the time. But they were very discreet and very quiet. Everything just happened. There was never any… looking out the door to see if the registered nurse was around or to see what staff was around. They just came. They just turned up,” Ms Davis said.

Ms Taylor’s stay at the hospice was publicly funded. “There was never any talk of money at all at this point. I have no idea, how it was funded. But the level of care was – I’m not sure, you could put a value on it. It was so immense,” Ms Davis said.

The hospice was “filling in” for the “inadequacies” of the aged care facility, Ms Davis told the royal commission.

Commissioner proposes nurse to provide continuity of care

Ms Davis said she’s like to see a higher ratio of staff to residents and improved palliative care services in aged care facilities. “If you have any kind of extenuating or extended death, they are woefully ill-prepared,” she said.

Commissioner Briggs asked Ms Davis if she thought a dedicated nurse should be employed in aged care facilities to communicate and manage the care and support of residents. Ms Davis replied yes, she thought that would be “ideal”, “that continuity of care was integral,” she said.

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