An aged care worker has told the royal commission of the day a resident was murdered by another resident at the nursing home where she worked, and how she was later diagnosed with post traumatic stress disorder as a consequence.
Aged care worker, Kathryn Nobes, also told the royal commission of other times she was abused and assaulted at work at a nursing home.
“I was repeatedly assaulted by residents. I have received blows, kicks, headbutts, twisting of the skin on my arms, grabbing and squeezing of my hands and arms, attacks with faeces, verbal abuse and threats,” she said.
Ms Nobes said she registered her complaints but said it seemed to be just accepted at the nursing home that these types of incidents were expected.
“You were just sort of expected to deal with it,” she said. “When I informed my in-charge that I had been assaulted by a resident, the in-charge shrugged their shoulders and said, ‘That’s dementia.’”
“I think there was an overriding culture in aged care of simply shrugging it off,” she said.
Ms Nobes told the royal commission about the day when one of the residents, who was known to be violent, allegedly killed another resident.
She said she saw the man walking towards her and holding his walking stick like a club. She noticed he had blood on his knees, hands and face.
Another member of staff then appeared and told others than a resident had been murdered, and Ms Nobes said she observed police coming into the nursing home.
Ms Nobes said the nursing home needs more staff and those staff who work with dementia residents need better training.
“In my opinion, staff working with dementia residents need more training,” she said.
Ms Nobes said her employer had provided counselling for staff, which she found very helpful.
“My employer also provides a program where you can receive counselling from a qualified counsellor. I have found this very helpful in dealing with the stress and psychological trauma of my job,” she said.
Ms Nobes also described how a male resident had put his hands in his faeces, and then punched her.
“I ended up with his faeces all over my shirt,” she said.
Ms Nobes also noted incidents of racial verbal attacks from residents, residents walking into other residents’ rooms, residents trying to leave the grounds, residents taking objects that don’t belong to them, residents urinating or defecating in public spaces, and inappropriate sexual behaviour. She said the nursing home was often “just chaotic”.
Mr Paul Bolster, counsel for the Brian King Gardens case study, examined funding, consent, and medication management at the nursing home.
The royal commission heard that the family of an 85-year-old resident of Brian King Gardens, called Mrs CO during the commission, were not told their mother had been started on a new physiotherapy routine to manage pain. But Mr Farmilo, residential manager at Brian King Gardens, applied to have the resident’s ACFI increased to a higher level to accommodate a physiotherapy program.
The hearing heard that aged care facilities can receive an extra $7,000 a year if residents need significant pain treatment.
Mr Bolster asked if Brian King Gardens, which is run by Anglicare, had been “gaming” the ACFI system by using inappropriate physiotherapy for a resident to bump them up into a higher-funding category.
Mr Farmilo said he had never heard the term “ACFI gaming”.
Mr Bolster said Mrs CO’s case notes from 29 August, 5 November, 29 November made no mention of the pain.
Mr Farmilo asked a physiotherapist to assess Mrs CO for pain treatment, but no one had told him the resident had pain that needed extra management.
“At the time you sent that email you hadn’t been round to see Mrs CO and ask her how she was, had you?” Mr Bolster asked. Mr Farmilo replied that he hadn’t.
“No one had told you that Mrs CO has got a problem and needs a pain treatment, did they?” Mr Bolster asked.
Mr Farmilo said Mrs CO had “changing care needs” that had prompted a review of all areas of her treatment.
The royal commission also heard a resident was prescribed strong antidepressant medications at Brian King Gardens without being formally tested for depression and the nursing home failed to gain informed consent from her family.
The medication made the woman so sleepy that when her family came to celebrate her birthday, she could not be woken.
“She was fast asleep, fully dressed on her bed,” the woman’s daughter said.
Mr Farmilo conceded the nursing home did not have policies around gaining consent for treatment from residents or their guardians.
Mr Bolster asked, “There are no formal policies in place, is that correct?”
Mr Farmilo replied, “That’s correct. Anglicare currently doesn’t have a policy regarding resident capacity or consent.”
Mr Farmilo said it was in Mrs CO’s best interests for the drug to be administered before consent was obtained from the family.
Dr Margaret Ginger, a GP who consults at Brian King Gardens, admitted she did not know of “cautions that are in place” about administering mirtazapine and antidepressants for people living with dementia.
The royal commission heard that as of July 2018, 59% of the residents at Brian King Gardens were being administered psychotropic medications.
Mr Bolster asked Mr Farmilo if he thought that figure was “too high”? Mr Farmilo replied, “No, I don’t.”
Image: Kathryn Nobes, aged care worker.