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ROYAL COMMISSION: “I was no longer a daughter, I had become a supervisor”

The first day of the Cairns hearings for the Royal Commission into Aged Care Quality and Safety heard a case study of poor communication of injury severity to family members about their mother, along with inadequate pressure wound management and substandard nutrition.

Johanna Aalberts Henderson described the horror of seeing the severity of her mother's injury wounds, which she says wasn't communicated properly by the facility. [Source: Aged Care Royal Commission].
Johanna Aalberts Henderson described the horror of seeing the severity of her mother's injury wounds, which she says wasn't communicated properly by the facility. [Source: Aged Care Royal Commission].

Johanna Aalberts Henderson told the Royal Commission her mother was buried three months to the day after she walked into her nursing home.

The Avondrust Lodge, operated by MiCare in Melbourne, Victoria, was a Dutch-influenced aged care facility, which suited Bertha Aalberts heritage, however, her daughter says placing her mother at the facility resulted in her death from infection of wounds and skin.

Ms Aalberts Henderson believes over Mrs Aalberts’ stay, she developed multiple severe pressure wounds, dropped in weight, lost her mobility and was fed food lacking in nutrition.

Ms Aalberts Henderson described her mother's decline as “rapid” from the day she entered the facility where she was mobile with her walker and “cognisant and continent”.

Her mother had had a number of falls, one of which resulted in a broken arm, taking away a huge amount of mobility and independence from Mrs Aalberts.

She became dependent on staff for feeding, getting out of bed and toileting, due to the break in her dominant arm and hand.

Ms Aalberts Henderson described the food provided to her mother as not having much nutritional value and was brought into the facility from an outside provider.

“It was just appalling, how you feed someone that food and expect them to get sustenance out of it, I don’t know,” says Ms Aalberts Henderson.

She recalled one instance when a staff member had looked at her mother’s dietary requirement chart and realised she was vegetarian.

Ms Aalberts Henderson says once the staff member mentioned it to her and then laughed because the staff had been feeding her pork.

Mrs Aalberts was also prescribed dietary supplements, which her daughter never saw administered.

Near the end of Mrs Aalberts’ life at Avondrust, her family had to constantly watch their mother to make sure she was being provided appropriate care, which shouldn’t have been their job.

“I was no longer a daughter, I became a supervisor. It is not the way I wanted to spend my time with my mother. I wanted to be the daughter and I wanted her to be my parent,” says Ms Aalberts Henderson.

Avondrust had told the family Mrs Aalberts had pressure wounds, but Ms Aalberts Henderson says the severity of the injuries was never communicated to them.

The first time the family saw the pressure wound severity was during a stint at the hospital when the gauze on the wound was revealed, eliciting huge gasps from even the medical staff at the hospital.

“I was shocked to see the black blister. It was size of a palm on her heel. I was shocked to see the size of the pressure sore and the attending redness on her sacral area and buttocks, but it’s when they took down the dressing on her leg – it was covered with gauze; so, they took the gauze off, and there was more gauze, but they pulled this gauze out of this hole. There's no other way to describe it,” says Ms Aalberts Henderson.

“I have worked in an operating theatre, I’ve been a nurse, but everybody in that room went [gasp]. It was unbelievable to see.

“As I said in my statement, I was in an icy cold rage. How dare they.”

One of the wounds was around 14 centimetres long, infected, deep and had areas that were green in colour.

Ms Aalberts Henderson doesn’t believe the facility provided appropriate wound management or turned her mother often enough, because she remembered constantly finding her in a wheelchair crying because her back and bottom was sore.

Believing the facility had not been turning her mother nor helping her get out of the bed, Ms Aalberts Henderson says they had put her mother in adult diapers even though she was continent.

Ms Aalberts Henderson even witnessed one staff member telling her mother to “poo in your pants”, which she found incredibly “undignified for my very dignified mother”, as well as inhumane.

“We all die, and Mum was dying, but my anger and sorrow is in the manner of her death, which could have been much more dignified,” says Ms Aalberts Henderson.

General Manager Residential Services of MiCare, Robert van Duuren took to the stand, where he admitted that staffing has been insufficient at the Avondrust facility during Mrs Aalberts’ stay.

Senior Counsel Assisting Peter Rozen queried why the facility only had registered nurses (RN) available at the facility for seven and a half hours a day but not overnight and only on-call duties.

Mr van Duuren says the facilities model of care is a Dutch-based care plan, which has been that way since 2007 and is a non-clinical focussed home rather than clinically focussed. 

Mr Rozen responded, “You can’t have a non-clinical focussed home when you've got 65 high care needs residents there, can you?”

Mr van Duuren admitted that a few more RN hours may have been useful and the facility has since increased their RN areas significantly.

At the time of Mrs Aalberts’ residency, RNs only worked 55 hours per week, which equated to less than seven minutes for each resident per day, Mr Rozen suggested this resulted in barriers to providing care and meeting the needs of residents.

Additionally, Mr van Duuren believes they should have implemented a fluid and food chart to make sure Mrs Aalberts was eating and drinking properly and says they shouldn’t have taken her back after one of her hospital visits for a fall.

‘In hindsight, MiCare may have considered not accepting Mrs Aalberts back to the facility... based on the continued acute care required,” says Mr van Duuren.

"Aged care facilities are not acute settings, and in that regard can't always supply the services that are required, the clinical services. And the support, the clinical support, the clinical expertise that a hospital can provide."

He also admitted that, in his opinion, there should have been a pressure area care chart in place to manage her injuries and they should’ve engaged a wound specialist more quickly.

Hearings continue today, July 16, in Cairns, QLD.

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