Issues between clinical staff and management staff at a Melbourne aged care facility impacted the quality of care received by an 87-year old Victorian woman, the inquiry has heard.
On Monday, the Royal Commission into Aged Care Quality and Safety featured a case study on the late Bertha Aalberts, who entered MiCare Avondrust Lodge in Victoria in May 2018 after being told there was a 12-month wait to receive the level 4 home care package she was assessed for.
At the time Avondrust Lodge, which is a 72-bed facility, had 65 high care residents. Mrs Aalberts, who was legally blind due to macular degeneration, was continent and cognisant when she entered the facility. She passed away three months later due to severely infected pressure ulcers.
Senior counsel assisting Peter Rozen told the inquiry that during Mrs Aalberts’ time at Avondrust she had three falls, broke her wrist, lost seven kilograms and developed a haematoma and number of pressure sores. He said Mrs Aalberts’ leg wound was not adequately attended to and developed to “over 10 centimetres long and bone deep” and caused a haematoma.
“Despite the seriousness of her leg wound at that time, Avondrust did not involve the wound consultant, Ms Rice, with the magistrate of that wound until a fortnight later,” Mr Rozen said.
“By then, and against Avondrust’s own wound management plan, requiring close and daily monitoring only by nursing staff, review of the leg wound had not occurred every day, and when it had occurred, it had been undertaken on four occasions by personal care attendants and not by qualified nurses. That task, we will ultimately submit, was plainly beyond the skills, training and expertise of the personal care attendants.”
He said personal care attendants were attending the wound due to “a direct lack of registered nurses.”
Mr Rozen questioned MiCare CEO and executive director Petronella Neeleman over her witness statement, which said “there were several times when gaps were identified and these issues were not reported through to senior managers and myself.”
Ms Neeleman told the inquiry there had been cultural and leadership issues at the facility that she and others at the organisation were unaware of.
“I talk about it is like playing tennis, we call fault, and then we go back and look at what’s causing this problem, and how can we work together to correct this,” Ms Neeleman said.
“Unfortunately, what we weren’t hearing until probably some time in February , were that there were issues between staff… the clinical staff and the management staff who were not clinicians, were having difference of opinions on how care should be delivered.”
In response, Ms Neeleman said 95 per cent of MiCare staff have recently undertaken two days of training on the principles behind the provider’s approach to care. MiCare follows the Eden Alternative, which encourages nurses to empower residents by recognising their abilities and engaging them in activities.
“Across MiCare, all of MiCare, and also staff from Avondrust attended that training. It’s being attended by managers, senior managers, the whole organisation, including our settlement-services people, which is another arm of our business, because I believe that that’s the way forward for us,” Ms Neeleman said.
“At the end of the day, relationships are the most important thing when we are delivering care, whether that’s in settlement services, residential aged care or home care, that if you have a relationship with someone, then you actually care better for them,” she said.
Mrs Neeleman said there were no excuses for inadequate care provided to Mrs Aalberts.
“No excuses can be made that will ever make up for the pain and suffering experienced by Mrs Aalberts and, because of this, her family,” Mrs Neeleman said in her witness statement.
General manager of residential services Robert van Duuren, who was not directly involved in the care of Ms Aalberts, told the hearing during Ms Aalberts’ stay, Avondrust Lodge usually had one registered nurse on site between approximately 7.30am and 3.00pm and a registered nurse on call at all other times.
“Ultimately I have input into that. It is the model of care… we’ve had at Dutch Care ever since I’ve been there, since 2007. It’s a home model, an Eden facility as described by Sally Hopkins recently. So, it’s a non-clinical-focused home essentially,” Mr van Duuren told the inquiry.
Mr van Duuren said the model aimed to balance “having quality and a home life,” however the facility has since increased its number of registered nurse hours. “I think a few more registered nurse hours would have been useful, and we have since increased our registered nurse hours significantly to reflect that,” he said.
Elsewhere at the hearing, Mrs Aalberts’ wound consultant Jan Rice, who appeared live via video, said she wasn’t surprised there was only one registered nurse on site, but said she was concerned by the practice.
“It does surprise me that we don’t have more registered nurses in aged care caring for our most vulnerable people who are admitted with complex health issues,” Ms Rice told the inquiry.
Ms Rice said she is always accompanied by a registered nurse to the bedside of the client she is seeing. She said once Mrs Aalberts’ haematoma had opened and there was a drainage and an opening at one end, a registered nurse should have undertaken the dressings.
Ms Rice said she was reliant on the staff to carry out her recommendations, and if staff wished to make any changes, such as removing a dressing, they should call her.
The hearing concludes on Wednesday.
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