Rest homes

Robert’s mother, Freda, died in February. For much of the last 6 months of her life, she lived at the St Kilda Care Home in Cambridge. Robert paid an extra $52 a night for Freda to have a premium room, believing she would receive a higher standard of care. That proved not to be the case.

St Kilda is owned by Bupa, which operates about 60 aged-care facilities. When Robert complained to the company about finding his 92-year-old mother in urine-soaked bedding, it apologised and blamed the problem on new caregivers, who it conceded should have been supervised by the nurse on duty.

Despite the apology, problems persisted over the following months. It proved to be the first of several apologies Robert would receive from the home.

A “premium” service

Freda Love required hospital-level care. She couldn’t speak and relied on Robert, who had enduring power of attorney, to act on her behalf.

Robert visited St Kilda regularly. Several times, he found his mother lying in a wet bed because her catheter was leaking and staff didn’t have the expertise to fix the problem. More than once, she was admitted to Waikato Hospital where the catheter was replaced.

Freda’s frailty also meant she needed 2 caregivers to lift her. However, the home’s premium room staffing ratio of one caregiver for every 10 residents meant she sometimes had to wait hours for assistance. Robert says the family was told staff couldn’t attend to her at all during mealtimes.

After one instance where his mother waited more than 2 hours to be taken to the bathroom, Robert wrote to Bupa expressing his concerns about her care. More than a month later, the company sent him a letter apologising.

Robert says he also complained about the care of his mother’s pressure wound and the temperature of her room. During the day, the north-facing room could reach 33°C. He ended up spending $1400 on a fan and a portable air conditioning unit in an effort to bring down the temperature to a comfortable level.

Frustrated with the ongoing problems, Robert complained to the Waikato District Health Board (DHB). Shortly after, Freda’s deteriorating health meant she had to be transferred to Waikato Hospital and Robert says Bupa informed him it could no longer provide care.

Freda died several weeks later.

After her death, the DHB told Robert it had requested evidence from Bupa that shortfalls at the home, including staff training on catheter management, had been addressed. It also said the issues he’d raised would be flagged with auditors ahead of the home’s next surveillance audit, due in the next 3 months.

Robert has since complained to the Health and Disability Commissioner about the care provided to his mother. He is also taking Bupa to the Disputes Tribunal seeking recovery of the premium room fee and other costs incurred. Bupa declined to respond to our questions about the case. It said its premium service didn’t provide a higher level of care but related to the “hotel-type” services available, such as Sky TV.

Falling short

Three years ago, we reported on shortfalls in care at another home owned by Bupa, Elizabeth R Rest Home and Hospital in Taranaki. An unannounced inspection of the home in 2013 found an elderly male resident had been strapped to a chair to restrain him because the facility was short-staffed.

The Ministry of Health inspection found inadequate staffing levels and the home’s staffing policy wasn’t being followed.

In March this year, Bupa was criticised by Deputy Health and Disability Commissioner Rose Wall for substandard care provided to a 74-year-old man suffering from cancer. The man was a resident at a Bupa facility in 2013. Ms Wall’s report found staff made multiple medication errors and failed to provide adequate pain relief.

In 2016, Bupa was the subject of another adverse report by the commissioner’s office. The report concluded Bupa had failed to provide services with reasonable care and skill to a 77-year-old man receiving respite care. Bupa was required to apologise to the family and arrange additional staff training.

Bupa isn’t the only major rest home provider to be criticised by the commissioner’s office in the past year.

Oceania Care, which operates 43 aged-care facilities, was named in a 2016 report for failings in care provided to an elderly woman at its Gracelands Lifestyle Care home in Hastings. The 77-year-old, a resident at the facility in 2014, had lung cancer and a painful skin condition, which the home failed to manage with adequate pain relief.

Another 2016 report by the deputy commissioner found fault with medical care provided to an 89-year-old woman at Rita Angus Retirement Village, owned by Ryman Healthcare, in Wellington. The woman was given drugs prescribed for a different resident and staff failed to follow the village’s policy for dealing with medication errors.

Like Bupa, both Oceania and Ryman were required to apologise to the families and arrange additional staff training.

Staffing levels

Since 2009, we’ve been reporting on rest home complaints. Inadequate staffing has continued to be a major issue in homes where shortfalls are found.

Rest homes are expected to have sufficient staff to meet residents’ needs. However, minimum staff-to-resident ratios set in funding contracts between district health boards and rest homes remain low. A home with 50 residents is only required to have 2 caregivers on duty.

For Robert Love, there’s no question the quality of his mother’s remaining months of life would have been significantly improved if staffing levels had been higher and staff were adequately trained.

Per resident, this level of staffing allows an average of 6.7 hours of care a week, well below the 12-hour minimum recommended in Indicators for Safe Aged-care and Dementia-care for Consumers, voluntary guidelines produced by the Ministry of Health and Standards New Zealand in 2005.

We’ve previously called for the staff-to-resident ratios in the guidelines to be mandatory. Former Human Rights Commissioner Judy McGregor made the same recommendation in her 2012 report on aged care, which also called for wages of the predominantly female workforce to be raised.

The government has moved to increase wages following the successful pay equity case brought by rest home worker Kristine Bartlett and the E Tu union. A $2 billion government settlement rolled out last month saw caregivers’ pay increase by at least 15%. However, there are no plans to boost staffing levels.

Higher staff-to-resident ratios continue to be opposed by the industry. Simon Wallace, chief executive of industry body the New Zealand Aged Care Association, believes the sector is “well regulated” and higher staffing isn’t required. Mr Wallace declined to provide data on average care hours in the industry.

The weight of evidence from systematic reviews suggests homes with higher staffing levels, typically not-for-profit facilities, deliver better care.

The authors of a 2016 review published in the journal PLOS Medicine commented there was a “well-established association” between higher levels of nursing staff and better care. They reported higher staffing levels were not only linked to lower staff turnover but also improved outcomes for residents, including less time in bed, incontinence care, exercise and lower rates of pressure injuries.

For Robert Love, there’s no question the quality of his mother’s last months of life would have been significantly improved if staffing levels had been higher and staff were adequately trained.

“Bupa represented both itself and its staff as being well trained and highly competent. This does not reconcile to the many occasions when there were serious failures in the provision of essential care for my mother,” he says. He remains hopeful his complaint to the Health and Disability Commissioner will be investigated.