Effective care planning and communication vital in fundamentals of aged care

Deputy Health and Disability Commissioner Rose Wall today released a report finding a rest home in breach of the Code of Health and Disability Services Consumers’ Rights (the Code) for not providing the fundamentals of care to an elderly man in his nineties with dementia.

The report concerns the level of care a resident of a CHT Healthcare Trust rest home received in the last ten months of his life. It highlights the importance of aged care facilities delivering the fundamentals of care to vulnerable consumers – in this case, the management of the man’s weight loss, his nutritional care planning, the monitoring of his food and fluid intake, and the communication with the man’s daughter, who held his Enduring Power of Attorney (EPOA). The failure to deliver those fundamentals meant that staff did not recognise that his condition was deteriorating and sadly he passed away.

In her report Deputy Commissioner, Rose Wall, said that effective care planning for aged-care residents is vital to capture the needs of the residents and ensure that appropriate person-centred services are provided.

Despite receiving two-yearly training, the nurses involved in the man’s care failed to think critically and adhere to the internal policies in place at the rest home.

“In my view, it is the responsibility of the rest home to ensure that its staff are aware of their obligations and are providing services consistent with accepted practice.

“While I am concerned about the lack of oversight of the man’s care plans, I am also of the view that it is the responsibility of all staff involved in a resident’s day-to-day care to be observant and alert to subtle, or not so subtle, signs of deterioration in the resident’s general condition, and be ready to escalate matters of concern,” said Ms Wall.

Ms Wall also emphasised the importance of communication with the man’s EPOA at critical decision-making points. The lack of engagement with the man’s EPOA meant that the EPOA, as the legal representative, was not made aware of her father’s altering state of health, including his blood test results, and was not given the opportunity to participate in decisions relating to her father’s care.

Ms Wall recommended the rest home undertake an audit to confirm that the “Weight Loss Procedure” is being followed; provide training to all nursing staff on care planning, weight loss monitoring, and food and fluid intake. She recommended that the rest home share an anonymised summary of this case with all CHT Health Care Trust care staff (healthcare assistants and registered nurses) and consider whether its two-yearly mandatory training for registered nurses on the Nursing Council Procedures should happen more frequently. She also recommended the rest home provide a written apology to the man’s family.