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ROYAL COMMISSION: Life behind closed doors of residential aged care facilities

On the first day of the third series of the Royal Commission in Aged Care Quality and Safety hearing held in Sydney, the Commission listened to five witnesses about what it is like living in a residential aged care, including instances of safety for residents with and without dementia, restraint practises used in aged care facilities and unacceptable staffing ratios.

Ms Darryl Melchhart believes people with dementia need to have their own seperate ward after multiple violent incidents with dementia patients in her aged care facility. [Source: Royal Commission].
Ms Darryl Melchhart believes people with dementia need to have their own seperate ward after multiple violent incidents with dementia patients in her aged care facility. [Source: Royal Commission].

Commissioner Mr Richard Tracey AM RFD QC and Commissioner Ms Lynelle Briggs AO had to battle through a multitude of technical, video and audio issues to hear statements from witnesses.

Senior Counsel Assisting Mr Peter Gray QC gave an overview of what was to be explored in today’s hearing.

While the hearing touched on quality and safety for people in residential aged care, the main focus was on the experiences of people with dementia and whether good practice care was provided to that person, as well as the prevalence of restrictive practices.

Around 46 percent of people living with dementia in the community receive informal assistance, 29 percent receive informal and formal care, 16 percent receive formal assistance only, and 5 percent receive no assistance at all.

Mr Gray said that while Australia has a generally positive attitude towards people with dementia, the knowledge around dementia and how to interact with people with dementia is very poor.

The discussed problems surrounding dementia included the level of care for dementia patients not being adequate and that dementia patients need to have their own wards with specially trained staff.

A 90-year-old resident in an aged care in Melbourne explained the need for separation from dementia patients after her own experiences of being assaulted by other residents, potentially with dementia.

Ms Darryl Hilda Melchhart lives in a wing with 90 people, together with over 10-20 people with dementia living in the same ward.

She recalled a time when she was hit continuously by a resident on her fingers and hands until she gave the resident her walker. Another situation involved a man hitting her over and over with his own walker.

Ms Melchhart also experienced a lot of privacy breaches by other residents, including a resident walking into her room and taking jewellery from her jewellery box. After being confronted, the resident attempted to throw the contents of a cup on Ms Melchhart, which was empty, and proceed to hit her with the same cup.

“People with dementia, some of them are quite vicious. It’s not very pleasant hearing these people going on. Most people are able-bodied. When they get older, they get more aggressive. They could have been different people before,” says Ms Melchhart.

She firmly believes that the patients needed to be in a separate room to prevent harm to residents who still had cognitive function.

The fourth witness, Eresha Dilum Dassanayake, outlined a case of her 87-year-old mother, who has dementia, entering a room to another resident while wandering around the facility and was pushed over by that resident.

When Ms Dassanayake asked management how this happened and what they can do to stop her mother from being injured, she was told that if she wanted 24 hour care for her mother she would have to get her own carer in to get that service.

The aged care facility had also removed Ms Dassanayake’s mother’s walker to prevent her from wandering around.

Some of the statements from witnesses showed that agitated and aggressive dementia patients were being provided with physical and chemical restraints before other means to minimise issues.

Mr Gray provided information from a study in 2009 highlighting that half of the residents between 44 facilities in Sydney were being prescribed psychotropic medication.

Ms Dassanayake had issues with her mother’s aged care home attempting to use psychotropics when she started scratching people.

Ms Dassanayake told the commission that after she was told about the scratching issue, she approached a doctor about how to address it.

However, the aged care facility decided to take matters into their own hands and prescribed Ms Dassanayake’s mother psychotropic medication.

“I was told she was on a new medication, no one asked me,” says Ms Dassanayake. She was able to stop the medication before it was administered.

Through interacting with other families of residents at the aged care facility, Ms Dassanayake says she can’t believe that so many people were scared about complaining about standards for their relatives because of what might happen to their relatives.

Fifth witness, Lillian Reeves attended to give a statement on physical restraints used on her husband with dementia at Garden View Aged Care.

The facility asked for permission to use physical restraints, a lap belt, on her husband for short periods of time.

Ms Reeves was told by a Registered Nurse that the restraints will only be on during evening meal times and change over shift for his safety.

The registered nurse, who had Ms Reeves sign the form for physical restraints, noted in her own statement that she never explained anything about when they would use restraints on her husband.

However, Ms Reeves did not change her own statement and is adamant she did have the conversation with the Registered Nurse.

Ms Reeves removed her husband from the Garden View Aged Care facility and says he left worse off and hasn’t been the same since.

Medical autonomy taken away

First witness, Ms Melchhart told a harrowing case of having her medication taken away from her by a nurse after asking for a replacement spray to replace her soon-to-be out of date medication.

The medication, glyceryl trinitrate (GTN) spray that addresses angina, has to be on her person at all times to treat her heart condition, which can come on randomly.

When Ms Melchhart realised the spray was about to expire, she approached a nurse asking if she could order in a new spray. The nurse responded, saying it wasn’t on the charts and proceeded to remove the medication from her possession.

The resident had to wait three to four days before seeing her doctor and receiving the spray back. The doctor disciplined the nurse for taking away Ms Melchhart’s spray.

On other medications that she takes, Ms Melchhart has to receive all other medications from nurses, including pain medication.

There were even cases of Ms Melchhart needing cortisone applied once a day, but not receiving it from nurses because they were too busy.

In Ms Melchhart statement, there was an instant where she was only allowed three continence pads a day.

When another resident heard of how many continence pads Ms Melchhart had received, the women said she didn’t go to happy hour at the residency because she didn’t have any continence pads and was embarrassed about heading out of her room.

“Ratios, ratios, ratios”

Second witness, Merle Valma Mitchell AM, takes aim at ratio issues at her own aged care facility, Waverley Valley Aged Care, which she says is causing harm to patients and their wellbeing,

She believes aged care facility staff were not hired or trained to take care proper care of any people in aged care.

Ms Mitchell believes only a third of the staff are actually invested in the comfort and safety of the residents, with the rest of the staff either under too much pressure or working there because of Centrelink obligations.

She explained a time when three senior people and one physiotherapist at her aged care facility told her the severe pain she was experiencing was all in her head and that nothing was wrong.

She was only transported to a hospital for the pain after a visiting friend witnessed the treatment from staff and threatened to report the facility for elder abuse.

Ms Mitchell was taken by ambulance to a hospital and found to have a crushed disc and broken back.

With lack of numbers, Ms Mitchell feels that there is no help when it comes to bereavement loss or recognition of loss, not for a death but for loss of a way of life.

“More needs to be done about the mental and emotional impact of actually moving into an aged care facility. That gets back to training and to the ratios, because the ratios are so low, nobody really has the time or inclination to actually think about what it is about they’re doing and what it is that they need to do,” says Ms Mitchell.

“There needs to be much more done in the selection of staff to do the training and work in these facilities. There are an enormous amount of people that come in here that come because Centrelink says if they do the work, they will meet their work obligations.

“There are international students can’t get the work they are qualified for, they know if they do the course, they will be able to do this work. It gets back to training and ratios, my two big things.”

One time, when Ms Mitchell attempted to access a counsellor for loss, the person visited her for a session for approximately 10 minutes, before looking at her watch, saying she had a meeting and then leaving.

She was never contacted again by the counsellor and Ms Mitchell had to set up her own counsellor session offsite, which she had to pay out of pocket for.

Hearings will recommence on Tuesday, May 7.

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