Maddington WA complaint & result

[Susanna]

I've just recieved a reply from the ministers office with the result of a complaint about a Maddington WA aged care facility.
The issue was staff cuts leaving 2 staff to feed more than 20 residents.
Result: After discussions with residents no concerns were expressed and residents were not at risk
The residents in question are incapable of any reasonable discussion as all have advanced dementia in this dementia specific facility.
The Aged Care Complaints Scheme is a joke..... a sick joke.

[Administrator]

Hi there Susanna,

With your letter back from the scheme, they usually outline the "elements" of the complaint - ie, "Statement of reasons" of the alleged breaches - can you provide some details about the statement of reasons for the breaches outlined in your correspondence back from the department? Their reasons for finding no breaches in this instance would be interesting.

[Susanna]

The elements of the complaint were concerns that reduced staffing was putting residents at risk as more than 20 residents were requiring close to full assistance with meals and just 2 hands on staff for this task.
However the reply stated there were "discussions with residents" to which "no concerns were expressed" I feel the result is far from satisfactory as the residents in question have advanced dementia and unable to effectively express concerns.
One has to wonder about the objectives of the Complaint Scheme if a conclusion was reached because of discussions with these residents, there was no mention of discussions with staff or management.
There have been other complaints about quality of staff at this facility however little is done, probably due to difficulty in obtaining staff.
As a professional I have a "duty of care" to residents and other staff and will use forums such as this to express my views in future.

[peta]

Is it a high care home Susanna where most residents need to be helped or fed? Coz this sort of thing is just getting too gross. After all, meals are about the only thing happening in the lives of many residents. I bet the food is often cold by the time they get to eat it. You just wish that those people who are still insisting on 'flexible' staffing could put themselves in the place of others less fortunate. Wasn't there some press coverage a while back about malnutrition in nursing homes. Well it would be a surprise if there wasn't, with only two people to feed more than 20 residents.

[Administrator]

Susannah,

Was this the main activity related to how they performed their investigations? Did they not personally observe the staff (in an unannounced visit) feeding this number of (advanced dementia) residents and base their findings on practice? Or did they base it solely on conversations with residents who have advanced dementia?

Without going into too much detail via the forums, alternatively, you can email me personally (please check your inbox - i have already done so earlier) and just reply to me directly if you feel more comfortable doing so with details.

[Susanna]

Peta
Aged care facilities now make use of nutritional supplements such as fortified milk, sustagen and 2cal etc. to keep the weight on residents so when regular weight checks are done there is little evidence of malnutrition or weight loss.
Staff shortages and cuts will continue with the blessing of the Government because they are reluctant to increase funding and some facilities need to make profits.
Maybe there requires some radical ideas and initiatives to reverse the current decline.
Until then the only ones who will suffer are the aged.

[elleb]

Hi Suzanna,

No surprise to me that this was the response you got from the complaints process - in the 8 plus years my mother was in an aged care facility I found both the provider and the complaints process nothing short of "useless". It is no secret that the complaints process supports the Provider in these matters and not the complainant and definitley not the interests of the residents! You only have to look at the number of times the complaints process has found in favour of the provider ie "no evidence of breach found". Sickens me. In the 8 years of my involvement with an aged care facility, I witnessed and was privvy to discussions with both residents and their representatives what could only be described as autrocities and in many instances blatent acts of neglect. On one occassion I was actually told by a nurse at a facility that they had been instructed by managament NOT to feed some residents - they were told only to feed those residents in danger of choking. This facility is a high dependency unit - so what about the rest of the residents who were too doped up to wake to eat, couldn't hold a knife and fork or were shaking too much to eat??? If family weren't available to be there all day to ensure their relatives were fed or weren't vigilant enough to pick this up they were left at their own mercy. It appears to be easy to pass off malnutrition and resultant weight loss brought about by lack of food as weight loss attributed to the ageing process or dimentia. They literally have a license to kill.

[At Wits End]

Hi Susanna
Re the proper number of trained people and the proper amount of time required to feed a person who needs assistance with feeding.
they just do not get it do they?
And yes the complaints system is atrocious. I am now at the point where I am NEVER going to use respite in an ACF ever again. It is not worth the trouble. And it is not worth complaining about most things. The only things one can complain about are things that can be 'checked against the documentation'
No wonder ACF owners want to reduce the amount of documenting.

At home with my Family member (FM) I allow the following for one on one assistance for all meals/fluid consumed at any time, for my FM.

First make sure is sitting up at 90 degrees and in a comfortable position. With a towel draped over to catch any spills. Talk about what the meal contains. Ask what my FM would like to start with (often dessert - which is fine. Who cares if dessert is the start of the meal? The aim is to help get some nutrition and some hydration going)
Here is the routine:
one spoonful, praise and well done for taking the spoonful.
encourage swallowing, praise and well done for the swallow
sometimes more encouragement for the second swallow before it happens
then the second swallow - more praise, try to use different words for the second swallow.
Allow a little rest before the second spoonful.
And I have comments like, 'Wow, that was a beautiful swallow' 'Very good, that a world class swallow'
Because some of the swallow noises are different. Some better than others.
Now number two spoonful
and so on.
And then at the end I have to use the mouth swabs (like giant cotton buds) to clean the mouth and check for any pocketing.
On very rare occasions I have to resort to the suction machine (yes I have had training on how to use it and clean it) if there is a problem. Though I am pleased to say I use it rarely, but in hospital it was being used every second day on my FM, which was scary. The suction machine is always plugged in and ready beside the wall.
Then I need to put a light dab of moisturiser on the lips
And then the sitting up for 20 minutes starts.
And I always stay sitting beside my FM during that very important 20 minutes and we talk or I switch the TV which is on the wall adjacent to my FM. I switch it over from the music channel over to something my FM thinks would be nice to watch
And if an extra swallow happens during the 20 minutes I give praise for that too.
But I always stay for the full 20 minutes rather than return to the kitchen to clean up.

I have no idea how any ACF actually manage to feed/hydrate clients (who need someone to help them feed/drink) adequately when the person has dysphagia, with so few staff to do it and so little time to do it. .
Because I allow one hour minimum for breakfast which includes the 20 minutes sitting upright at the completion of any food or fluid consumed. Sometimes breakfast takes longer, where my FM is eating well I continue longer. And if is feeding less well then I encourage, but never force. I never make a fuss if one meal is more inadequate than the last one.
Being judgmental will not help if my FM eats less at one meal. Being critical would be counter-productive. I know my FM is doing the very best that is possible in the circumstances. My role is to be positive and encouraging, no matter what. Though of course I do worry sometimes if there is a day when not much is consumed. But it does not help to voice those concerns to my FM . And not to get bothered if one meal results in less than the last meal. All people feel less hungry sometimes. I just write up in the book what was consumed. And make a mental note to spend more time on the next meal.
And in the evening the feeding process starts all over again.
I make the food,
I have to ensure no lumps and that the consistency is right for level 2 thickened fluids
I try to make it varied and attractive, though that is not easy.
I really make sure things are lump free.
And I am sad that some foods will never taste the same again, even though cooked they are the same thing, but then I have to get the consistency right. Which means, sadly, that they may not taste the same. Or the lack of the familiar texture is probably very upsetting for a person .
So once again I also allow another one hour minimum for the evening meal
Before the carers were allowed to do any food/beverage feeding at my FM's home I also arranged for a one hour visit from a speech pathologist to visit my FM's home (and give all the current carers and the two spare carers who will be used if any of the regulars cannot continue ) - a full demonstration and lesson on the right way to feed a person with dysphagia. The carers told me they appreciated that as feeding a person with dysphagia is a specialised job. Also it was impressed on them that it is not a contest to see who can feed the most spoonfuls. And less spoonfuls safely fed represents more success that more spoonfuls that, if rushed, could lead to worse problems for my FM if they go down the wrong way.
The carers in the day use less time at lunch time (than I do for breakfast and the evening meal), as often that is just thickened soup and thickened fruit juices at lunch time. But the carers still know that they also have to allow a full 20 minutes sitting upright after the consumption of any food/fluid intake
products I love to help with feeding include the product that pushes more calories into any food/juice that i put it into. I will not mention the brand, but it is brilliant.

So how can any Minister expect people to get proper nutrition and hydration, when they need help with feeding, if they will not allow enough time and enough trained people to do it.

[linda_m]

The detailed description of your family member's meal regime, 'Wits End', well illustrates how low staffing levels makes it very hard for staff at aged care homes to provide quality care. I have been made aware of how a 30 bed facility near where I live is currently struggling at meal times. 27 residents require full help with meals and there are 4 people to do the feeds. All food trays have to be returned to the kitchen within a hour - because of health regs. This is because the meals have been frozen and then thawed. Thus the meals are hurried and often residents cannot be given the food in the set time. And have absolutely no hope of enjoying the food. I think that this is one of the worst things that is currently happening in aged care. Meals are to be enjoyed - even when one is in a nursing home. Having food shoved down your throat at full speed is hardly the thing.

[Sally]

This really upsets me... I (and my family) still believe this is what contributed greatly to our mother's death. She would have spoons of food pushed in her mouth before she finished the one before. Even while she coughed it would still be shoved in. 'Aspiration Pneumonia'... all the symptoms were evident !!!
I can't get it out of my head and it hurts.
There day will surely come !!!

Sally

[Sally]

I meant to say, "Their day will surely come". Tears got in the way.

Sally

[Snappo]

All the above is very true, I have first hand experience of it. The beautiful, new, expensive, ACF I worked at (where I suffered an MI from work stress, due to lack of staff), had me doing 'feeds' on my return to work. I told them I had never had any experience in this area as I had always worked in low care. I was looked at like I was a moron!! What's hard about feeding? You just put food in the mouth....OK, so I went to 'put food in the mouths'. I soon learned, purely by practice, that there was a 'little' more to it.

I was assisting a lady with her breakfast, a non verbal lady I was told 'eats nothing. so it won't take you long'. I was feeding, encouraging, chatting, and we were doing great. Small spoonsful, wait for the swallow, a little wipe, a little rest, lovely smiles, then start again. A fairly lengthy process, but we were both proud that the lady who eats nothing, had finished her porridge, and was half way through her yoghurt. Then the person in charge came in, said 'are you STILL in here', told me we didn't have time to spend 35 minutes with one resident, told me to 'finish up' as there were beds to make and showers to do!! I took a further 15 minutes to 'finish up', and was soundly castigated for wasting time, I was never asked to feed that lady again and she went back to 'eating nothing'. It's actually criminal, it's nothing short of elder abuse. Food is shoveled in, if they turn their heads away and refuse a mouthful because they already have their mouthful, staff say 'see, she's had enough, she's refusing the food'!!!

Most of it is due to short staffing, but some of it is due to lack of compassion and understanding on behalf of the carer. The ACF is culpable for placing staff in roles they have never performed, nor had any training in. The whole system stinks.

[Sally]

Snappo, you've summed it up perfectly. Now you've made me cry again.
Yes, it is 'criminal' and there should be punishment. Just more proof that the system STINKS and there are people who just DON'T CARE because these people are elderly !!
I have an elderly friend who has just had both legs amputated and she has been sent to one of the Hospitals (while she waits a NH placement) that my mum was in and treated very badly (we had to rescue her). I really fear for this poor soul !
Where are we supposed to go from here seeing we are getting NO encouraging results??

Sally

[Heather]

It IS time the Federal government came clean.
They can either resource Aged Care to the level it needs, and call to account the greedy Aged Care Facility owners who fail to put on enough staff, or the Federal Government can insist that anyone over 80 years old be given a lethal injection at the Doctors. What IS happening in some Aged Care Facilities is murder. So what is the difference? The ACF owners do not care. The MONEY is what matters to the ACF. The government does not care because the people in ACF are not likely to be able to mount a viable protest. There is limited action the staff in an ACF can do, if they want to keep their jobs.
By the way before anyone starts, I DO NOT SUPPORT the lethal injection option.
All I am saying is that by not resourcing these ACF the owners and the government are sanctioning (no pun intended) a slow and miserable existence and invariably a painful death for these poor people who will end up with food in their lungs and then death from the infection that follows, if the Government and the ACF owners are not allowing the right amount of time and trained personnel to feed these people.
Alternatively the Government can announce major resource loading to help more people stay at home, with adequate support. But that does not work for everyone, especially those with dementia who wander and are a threat to themselves.
But people's last days in the world should not be days of misery.
The truth needs to come out.