Rest home audits continue to show failings in care.

The owner of the Elizabeth R Rest Home and Hospital claims it provides the best possible care and the best carers. But an unannounced inspection of the Taranaki rest home found an elderly male resident was strapped to a chair because the facility was short-staffed.

The inspection by the Ministry of Health also found the man had skin wounds which file notes indicated may have been caused by his skin rubbing against the strap used to restrain him. Antibiotics were prescribed to treat one wound which had become infected.

The ministry’s report confirmed staffing levels at the home were inadequate. The home’s staffing policy wasn’t being followed and rosters sighted during the inspection showed evidence staffing had been reduced. The home was also failing to adhere to its policy on using restraints.

The inspection of the rest home was in December 2013 but the report was only released by the ministry in July 2014. Elizabeth R Rest Home is owned by Bupa, a major provider of aged care, which earned over $240 million in operating revenue last year. As a result of the inspection, it was required to implement 10 corrective actions.

This is the second time we’ve reported on failures in care at the Elizabeth R Rest Home. It was last inspected by the ministry in October 2011 after a series of complaints, which included allegations that residents had been left in urine-soaked beds.

At the time of the 2011 inspection, the home was owned by the Oceania Group, another large provider of aged care. The 2011 inspection found a range of shortfalls and discovered problems identified in previous audits had still not been rectified. Oceania sold the home to Bupa in July last year.

Quality shortfalls

Elizabeth R Rest Home isn’t the only facility which has been failing to fully meet required healthcare standards in the past year.

In July, we reviewed surveillance audit reports for 123 rest homes. These reports have only recently begun to be published by the Ministry of Health (see "Rest home audits" below).

Of the 123 homes for which surveillance audits were available, only 14 met all the criteria they were assessed against (see our graph).

Guide to the graph: Our data are from surveillance audit reports that were available on the Ministry of Health's website in early July 2014.
Guide to the graph: Our data are from surveillance audit reports that were available on the Ministry of Health's website in early July 2014.

Some shortfalls were minor but there were many instances of disturbing failures in basic care (see "Reported shortfalls" below). The majority of homes had one or more shortfall which auditors assessed as being of “moderate risk” to residents. Thirty-nine percent of all shortfalls were classified as either “moderate” or “high” risk.

The audits also showed several facilities have had recurring problems.

Okere House in Whanganui was among them. The home has had two surveillance audits since June 2013, both of which identified failings in care. The latest audit in January showed the home was failing to fully meet 41 percent of assessed criteria. Six out of 19 shortfalls were considered to be high risk.

Among the shortfalls, the audit found there had been at least four occasions when residents left the home unwitnessed by staff and without staff knowledge. These events are required to be reported to the Ministry of Health. However, the ministry wasn’t notified on any occasion.

During the previous audit, residents had been observed exhibiting “challenging behaviour ... rattling the front door trying to leave the premises, rattling the door to the enclosed walking area, and swearing at each other”. The auditors found no evidence staff had been trained in dealing with this type of behaviour.

Despite the home being required to remedy shortfalls, problems were still evident seven months later. The report resulting from the January audit found:

  • Timeframes for initial care plans and GP assessments weren’t consistently adhered to and resident documentation wasn’t always complete.
  • Controlled drugs weren’t checked weekly and a discrepancy in prescribing an antibiotic wasn’t discovered for five days.
  • The menu plan wasn’t being followed and food was left on a trolley for over three hours before it was served.
  • Four out of five staff files didn’t have evidence to show references had been checked.
  • Infection-control data wasn’t always recorded and evaluated. The home had a norovirus outbreak in March 2013 and a suspected scabies outbreak during April and May 2013.

Complaints continue

Failings in care also continue to be seen in complaints. In the year to June 2013, the Health and Disability Commissioner received 111 complaints about rest homes, a similar number to the previous year. A total of 318 complaints were dealt with by the Health and Disability Advocacy service.

The latest investigation report released by the commissioner’s office describes deficiencies in care provided to a 95-year-old woman at Fairview Care in Albany. The woman lost 10 percent of her weight over a six-month period but the home did little to investigate the weight loss and later postponed a scheduled review by the GP. Before she was seen by the GP, her condition deteriorated and she was admitted to hospital where she was diagnosed with pneumonia.

This is the third adverse report about a rest home to be issued by the commissioner’s office this year. It comes on top of the adverse inspection report released by the Ministry of Health on the Elizabeth R Rest Home.

Two other facilities have been inspected by the ministry this year.

In January, the ministry carried out an unannounced inspection of Orewa Secure Care following an anonymous complaint about care provided to a male resident. The inspection found the home had failed to record observations of the man after a fall. The incident form stated only that “observations had been normal”. Fourteen corrective actions were required as a result of the inspection.

In the same month, an unannounced inspection of the Home of St Barnabas in Dunedin substantiated a complaint that a resident was not checked for five hours after a fall. Eleven corrective actions were required by the home.

Action needed

Evidence of continuing problems in rest homes calls into question whether the existing regulation of the sector is working. We’ve been reporting on shortfalls in rest home care since 2009. Convincing evidence has yet to emerge that quality of care is improving.

The government spends $1.5 billion on aged care each year. However, the industry claims it’s underfunded. The Aged Care Association, which represents rest home owners, is running a campaign ahead of this year’s election calling for political parties to commit to increasing funding for providers.

But we don’t think it’s simply a matter of money. Cases of sub-standard care are occurring in homes owned by large providers with multi-million dollar incomes as well as in homes owned by small operators. We’re not convinced extra funding, by itself, will fix problems.

Given the evidence of continued and serious shortfalls, we believe it’s time for an independent inquiry into the aged-care sector. An ageing population means the need for rest-home care will only increase: consumers need to be confident they can get high-quality care if they’re no longer able to stay in their own home.

The current system isn't delivering this assurance. That’s why we believe an independent inquiry is needed to investigate the regulations and funding required to ensure rest homes provide consistent high-quality care. This is what we want political parties to commit to before this year’s election.

Homes respond

Bupa, the owner of the Elizabeth R Rest Home and Hospital, says required corrective actions arising from the December 2013 inspection have been completed and there have been staff changes at the home.

The Home of St Barnabas says it’s submitted evidence to the Southern DHB that all corrective actions arising from the January 2014 inspection have been completed. It’s awaiting a response from the DHB.

Okere House says the nurse manager and registered nurses employed at the time of the last audit have resigned and it’s made significant changes to its management structure. It says it’s “worked hard” to address failings documented in the audit reports.

Orewa Secure Care says it disputes the ministry's findings and doesn't accept the rest home was failing to comply with the standards identified in the inspection report. It says the home had a certification audit in May, which found it was meeting all required criteria.

Report by Jessica Wilson.

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