A 69-year-old man was admitted to hospital weighing less than 39 kilograms and suffering from malnutrition after his family said he was mainly provided with a diet of canned soup and sandwiches.
Terrence ‘Sam’ Donald, who also lives with prostate cancer, was found collapsed next to his bed by his sister, Vicki Donald, and niece in August.
He was admitted to hospital, where Doctors told Ms Donald her brother was “simply malnourished” and that his weight loss was not linked to his cancer.
“It’s become our nightmare. We didn’t know whether he was going to make it,” Ms Donald told the ABC.
“In emergency [ward], we were virtually told it would be touch and go whether he would make it or not because of how malnourished he was, his stats weren’t looking good.”
The family was told changes in Mr Donald’s diet were due to concerns about him choking on food.
However, despite his family providing a selection of home-cooked frozen meals, Ms Donald said there was no consultation between family and the in-home care provider, Senior Helpers, regarding what was included in the changed diet. Carer notes revealed most meals were tinned soup and sandwiches.
“They were providing him with tinned soup which was annoying because we had homemade soup in the freezer for them which they could have quite easily thawed out and fed to him which had some nutrition in it,” said Ms Donald.
Ms Donald also said other care she was under the impression Mr Donald was receiving, including personal care and cleaning, did not seem to have been provided either.
She said Mr Donald’s clothes were “stained and disgusting” and that the house “was a disgrace” with cigarettes and rubbish littered about.
Official complaints were raised by the family with Senior Helpers and the Aged Care Quality and Safety Commission. The Commission accepted the official response from Senior Helpers.
Dr Leonie Williams, Managing Director of Senior Helpers, said the organisation has put safeguards in place to minimise the risk of repeated care failures.
“There were internal failures and we have acknowledged that, and continue to work on ensuring that this does not happen to anyone else,” said Dr Williams
“We’re happy to wear responsibility, that as Senior Helpers, we fell down internally with our communications.
“That’s what we’ve explained and shown to the Aged Care Quality and Safety Commission and given them all of the evidence and they’ve accepted our response and our evidence.
“They’ve closed the books on the complaint because we’ve put in strategies to ensure our issues are not going to be repeated.”
While concerns have been raised about malnutrition in residential aged care facilities, there are calls for greater awareness around nutritional support for older Australians receiving in-home care.
Leanne Elliston, Executive Officer Nutrition Australia ACT Division, said Mr Donald would have been in need of extra nutritional support due to his illness and this should have been a necessary consideration for care providers.
“Other chronic diseases or illnesses mean that nutritional requirements are even higher and it’s about identifying these high-risk older residents in the community and applying extra supports to make sure their carers are aware of their nutritional intake needs,” said Ms Elliston.
“When you’re dealing with an individual that has so many complicating factors affecting their life – they have to be showered, they have wounds to be dressed, have their house cleaned – it’s easy for things like meals to drop down on the priority list.
“Or it may have been an assumption that they can heat up their meals, but who knows if they’re even eating on their own.
“The root of the problem is that the staff weren’t looking out for this sort of thing and agencies need professional support and development to know what to look for.”
Ms Elliston said early intervention is crucial when nutritional needs are not being met. She suggested carers could track meals weekly via a checklist, and if issues arise, management and the family should be notified as a dietitian could be introduced to provide additional support.
“If we focus on the home situation there’s a greater risk of people falling through the cracks when it comes to meeting nutritional requirements and [missing out on] the support and assistance they need,” said Ms Elliston.
“There are many older people, especially those living on their own, that don’t have an appetite, they’re not interested in food or they don’t want to go to the effort of cooking.
“They need assistance to get a nourishing dish in front of them and support to even eat that meal.
“As soon as you reduce your intake and you’re not meeting your nutritional needs the wheels fall off very quickly for an older person’s health and wellbeing.”
One suggestion made by Ms Elliston was ensuring that a care worker takes the time to sit and eat with older people to create a positive social atmosphere.
Ms Elliston said increased education and awareness of nutritional requirements would benefit both care workers and older people living at home.
“The care personnel, there’s a risk they’re not appropriately educated to be able to identify when someone’s deteriorating,” said Ms Elliston.
“If older people are receiving in-home support, those providing it are the first to identify if there’s a problem and seek solutions.
“The solution is to have consistent and well-recognised nutritional guidelines for older Australians.
“If we have nationally consistent guidelines that address the nutritional requirements of older Australians and they’re educated appropriately to all aged care personnel then we can prevent this from occurring to help people stay in their home for longer, and stay well for longer.”
Nutrition Australia is part of the Nutrition for Older Australians Alliance which is calling on the Government to fund the development of a set of dietary guidelines for people aged over 70, to help prevent malnutrition.