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Witness gives evidence on violence against staff


Aged care staff are expected to shrug off the physical and verbal abuse they experience from residents in their care, a personal care worker has told the aged care royal commission.

The third day of the Sydney hearing of the Royal Commission into Aged Care Quality and Safety heard from Kathryn Nobes, who has been a personal care worker at a residential aged care facility in New South Wales since November 2015.

Ms Nobes, who previously worked in home care, said she has been a victim of physical and verbal abuse from residents with dementia.

Kathryn Nobes

“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,” Ms Nobes told the inquiry on Wednesday.

After documenting the assaults there were no real workplace changes, she said.

“You were just sort of expected to deal with it. 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,” Ms Nobes said.

Ms Nobes said one of the most “disturbing assaults” happened when she was working with another personal care worker to change a male resident’s incontinence pad. She said the resident put his fists into the faeces in the pad before assaulting her.

“He quickly turned towards me and punched me in the breasts. I spun around and he continued to punch me in the arm and in the back. I ended up with his faeces all over my shirt,” Ms Nobes said.

“I can’t remember if I documented it. I really didn’t want to think about it, as I was so shaken,” she said.

Ms Nobes received counselling provided by her employer.

“I have found this very helpful in dealing with the stress and psychological trauma of my job,” she said.

Ms Nobes said her daughter, who works in the community care sector, does not receive this kind of support.

She said professional counselling would benefit all staff working in aged and disability care.

Call for more staff and training

Ms Nobes said staff working with residents with dementia required more training.

“It’s very helpful to understand that this is the disease of the brain, that there can be over 100 diseases that may cause neurological dysfunction. I think we also need more training on how to de-escalate a potentially dangerous situation,” she said.

Ms Nobes said there was insufficient staff to support people with dementia.

“People with dementia lack empathy and can be very demanding. They shouldn’t be rushed, as this can aggravate aggressive behaviour. So while you attend to one resident, there are up to 17 other residents unattended.

“More staff would also improve the security and safety of other residents,” Ms Nobes said.

Medication management

Elsewhere at Wednesday’s hearing, the royal commission heard evidence from two daughters of Ms CO, an 84-year old resident at Anglicare’s Brian King Gardens facility in Sydney, in relation to the over-prescribing of the antidepressant Mirtazapine.

They told the inquiry that Ms CO was drowsy after being prescribed the drug including on her birthday when she couldn’t be woken up from her sleep when family visited her.

Mr Bolster told the royal commission that a dose of 15 milligrams of Mirtazapine is recommended for adults with a gradual increase to 30 or 45 milligrams if required. The maximum dose is 60 milligrams.

However, Ms CO was prescribed 45 milligrams of Mirtazapine from the outset for anxiety and depression from general practitioner Dr Margaret Ginger.

In response to a question from Mr Bolster on whether she was happy today about that prescription, Ms Ginger said she was not happy.

Dr Ginger said she had no explanation for why she prescribed the drug without seeking any other interventions to assist her.

“I really have no explanation why I did that,” Dr Ginger told the inquiry.

“We had tried to put her in a safe environment… We did have the pastoral care people coming to see her. Maybe we should have continued with pastoral care visitations,” Dr Ginger said.

The hearing continues next week.

To stay up to date on the latest about the Royal Commission into Aged Care and Quality go to our special coverage. We will also be issuing regular Royal Commission Roundup reports which you’ll receive in addition to your weekly e-newsletters.

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10 Responses to Witness gives evidence on violence against staff

  1. Age Care Nurse May 9, 2019 at 4:19 pm #

    As a nurse of over 30 years I have been assaulted on numerous occasions by both residents and relatives. I have never seen anyone charged or any action taken against relatives except to stop them visiting after 5pm.

    I asked my employer to put in the aggression/assault policy that any visitor who assaulted a staff member would be automatically reported to the police, they refused using the excuse that these people were often under stress.

  2. Alexander Wong May 10, 2019 at 10:39 am #

    I read all these incidents of medication mismanagement and it makes me furious… they can all be prevented and our most vulnerable end up being the victims.

    “Dr Ginger said she had no explanation for why she prescribed the drug without seeking any other interventions to assist her.

    “I really have no explanation why I did that,” Dr Ginger told the inquiry.”

    Prescribing 45mg straight is purely bad practice. Consultant pharmacists need a bigger role to prevent medication errors and mismanagement in all facilities! Instead of residential medication management reviews, pharmacists should be funded to be available ON site. Providing advice, rounding with the doctors, medication chart checks etc.

    Alexander Wong (Mederev Consultant Pharmacist)

  3. Tony Schumacher-Jones May 10, 2019 at 11:37 am #

    Initial response is to agree with Alexander Wong re. the Mirtazapine. ‘Start low and go slow’ is a useful axiom.

    Mind you, the use of ‘pastoral care visitations’ as front line treatment for depression seems an odd one. I’m not aware of any hard evidence suggesting that pastoral care workers have specialist expertise in treatment of depression – but the article is not forthcoming on this.

  4. Country carer May 10, 2019 at 11:44 am #

    Are these doctors really that indifferent to their patients? Does it matter whether it’s a patient at their clinic or in a residential facility? If you don’t care about your job, maybe you need to do something that will not directly impact the health and life of people…like stacking shelves in the supermarket.

  5. Dan May 10, 2019 at 6:08 pm #

    There is just too much to respond to here, except to point out that is incredibly problematic if staff think that all “people with dementia lack empathy”.

    How might this belief influence ‘in-the-moment’ interactions in daily care and support?

    The most important de-escalation ‘training’ is to respect the verbal and non-verbal expressions of “no” in reference to any personal bodily care. No means no.

  6. Ellen Bucello May 11, 2019 at 2:49 pm #

    In regards to Alexander Wong it is not just aged this happens to. At a Private hospital my Pychiatrist took me of the 2mg Clonazepam I have been on for 20 years. It was a Friday, he changed my meds on admission to a private facility on the Central Coast. At 9am when I realised by staff on what he had done, staff replied cannot do anything now he has gone home. At 2.00am I started taking Petit Mal fits. Pleaded with a Doctor to assist was scared I was heading for Grand Mal seizure. Nurse said their are no Drs until after 7am. I layed in bed jumping till 7am. Gross mismanagement. I am 68

  7. Erin May 11, 2019 at 3:54 pm #

    I think if you ask 10 RN’s you will find that 9 of them have either been assaulted by patients (in hospital) residents and or family visitors to an aged care home. I am a qualified health care professional and was told by a family member after they assaulted me in an aged care home…. “your word against mine. See how you go reporting that”. Police were informed but alas no charges could be raised. Couldn’t even prevent the perpetrator from coming back to the home. All I could think was ” what is wrong with these people”. The industry is losing good people because of abuse on them.

    Yes, improvements need to happen in aged care, but behaviour of families also needs to improve.

  8. Will sullivan May 13, 2019 at 9:28 am #

    These days, It seems that whenever governments encounter a problem that is too costly to fix properly they “send in the clowns” instead. By which I mean the army of counsellors, innovation experts, community engagement people, web developers, academic researchers and other parasites, all wanting to get a slice of the action

  9. Suzanna May 14, 2019 at 6:28 pm #

    Erin is exactly right, the industry is losing good people in large numbers, i know of a large number in the past 12 months, I am one of them also, because of the abuse and intimidation from families, not because of bad care in my experience, just because it seems to be the norm in today’s society, and it exacerbates when you throw in negative press, guilt and grief. Something needs to be done to ensure that strong rules are placed on visitors/ families which has the backing of government, it is a big Workplace Health and Safety issue which seems to be left behind sometimes, especially with families who threaten to complain to the Quality Agency if you challenge them on anything, only to bog you down in paperwork as a vindictive measure, it is a jungle out there in aged care, I hope the Royal Commission puts some focus on this also in view of change, or the challenge of finding good people to work in sector will only get harder.

  10. Janet Pearce May 15, 2019 at 8:20 pm #

    Improved staff:patient ratios and regular training for de-escalation when confronted with patient confusion, verbal or physical aggression (which may be a manifestation of fear)

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