Drugging the elderly
90-year-old thrown out
Julia and Rebecca West arrived at Edenvale Home and Hospital on Christmas Day with a picnic lunch to share with their 90-year-old mother, Yvonne.
But they found her slumped in a chair at a dining table in the hospital wing of the home in the inner Auckland suburb of Mt Eden. Most of the other residents were asleep, too.
‘‘She was zonked out, I could tell she was quite heavily sedated,’’ says Julia.
‘‘I tapped her shoulder and she sort of opened her eyes and then went back to sleep.’’
It was only 11.30am. Normally Yvonne, who has Alzheimer’s disease, would have been awake and chatty.
‘‘I went up to one of the registered nurses and said ‘what’s the story with mum?’ and she said ‘oh she was banging on the table and talking really loudly at morning tea time so we had to medicate her’,’’ Julia says.
Yvonne had been given Lorazepam, a benzodiazepine used to treat anxiety disorders and sleeping problems.
‘‘I was thinking ‘that’s just so not OK’,’’ says Julia, who has power of attorney for her mother’s health and welfare. ‘‘It ruined our Christmas.’’ She is speaking out as part of the Stuff series Drugging the Elderly, which has shone a light on the use of chemical restraints in rest homes.
‘‘It’s heartbreaking that she was treated that way because I don’t think her behaviour was bad – they could have just distracted her,’’ Julia says.
‘‘I mean, they could have rung to say ‘are you coming in to see your mother, can you come in early and talk to her?’
‘‘We can always manage her behaviour, as family.’’
Edenvale, which is run by a non-profit trust affiliated to the Open Brethren Church, is the same home where resident Phil Wood died in December, sparking claims by his wife that he’d been over-sedated with antipsychotics.
Yvonne West, a mother-of-five and former physiotherapist, was diagnosed with Alzheimer’s in 2010 and lived in rest homes in Rotorua and Birkenhead before moving to Edenvale in 2016.
Her daughters say she was settled in the dementia wing for three years, before management moved her to the hospital wing against the family’s wishes.
Her behaviour deteriorated because she was left all day in a dining room with nothing to do, they say. She was prescribed the anti-depressant fluoxetine and a small dose of the anti-psychotic risperidone.
The sisters say their mother did not need hospital level care as she could still walk. They believe she was moved because a room became available in the hospital wing when a resident died, and management wanted to give her room to someone new.
‘‘I think it’s inhumane actually,’’ Julia says. ‘‘If you’ve got a 90-year-old with Alzheimer’s who’s been stable in your home for nearly four years, why wouldn’t you leave her where she is?’’
Edenvale’s general manager,
Marlene Hickmott, said ‘‘the fact is, we were only able to provide [Yvonne] hospital level care... We are confident the care and management we provided... was appropriate and was meeting her needs’’.
The West sisters say Christmas lunch was put in front of Yvonne, even though she was heavily sedated. They found a wheelchair and took their mother to her room, putting her to bed.
‘‘I said to one of the nurses ‘how long has this wiped her out for?’ and they said ‘it will be the rest of the day’,’’ Rebecca says.
Yvonne didn’t wake until late in the afternoon.
In January, Julia sent an email to the home’s clinical team leader, expressing concern about the use of tranquilisers and asking that her mother be moved back to the dementia wing.
‘‘Mum... has said repeatedly that she doesn’t know what to do when she’s sitting in the hospital room, as there’s nothing to do or to watch,’’ Julia wrote. ‘‘As a result she’s getting angry and vocal.’’
Julia says at a subsequent meeting with management, Hickmott said she’d spoken with the chairman of the board and it was agreed it was best that Yvonne move on because of the breakdown in communication with the family. ‘‘I said ‘hold on a minute, we haven’t even had a conversation yet’.
‘‘She said ‘you’ve put through complaints’. I said ‘they’re not complaints, they’re requests for a conversation’.’’
On January 29 Hickmott sent a letter terminating Yvonne’s residency agreement and giving the family 21 days to find another home.
‘‘It was apparent from the last meeting that you do not feel happy with the care that is provided to your mother so we feel it is in the best interest of all parties for you to find a home for your mother that you can feel happy with,’’ Hickmott wrote.
Hickmott said the home had sought another meeting with the family to discuss Yvonne’s care, but they ‘‘chose not to meet with us, leaving us with no alternative but to arrange for their mother to leave our care’’.
Julia says she and Rebecca weren’t able to meet on the day suggested, and the termination notice came as a surprise.
Hickmott says the home takes ‘‘great pride’’ in what it does, ‘‘and it is disturbing when family or residents have concerns’’.
She says it’s ‘‘regrettable’’ the family didn’t follow the official complaints process, by going through the District Health Board and Health and Disability Commissioner (HDC).
But Julia says when she was asking for mediation, Hickmott made no mention of the procedure for lodging a complaint.
She says she will lodge a complaint with the HDC over the decision to move her mother from the dementia wing and the unexpected termination.
Julia says the experience has been traumatic and the model for elder care needs to change.
‘‘It’s a business model where the residents have to fit into the schedule of staff. But actually the residents aren’t living in a business – the staff are working in those people’s home.’’
She and Rebecca say people with dementia are treated like children, so often their behaviour reverts to that of children.
‘‘I asked mum one day what she needed, and she said, ‘I want to be treated with respect, I want to be treated like an adult. I want to be talked to, and I want to have something to do with my time’,’’ Julia says.
‘‘When you talk about chemical restraints, why is it that staff can’t manage behaviour? It’s typical for anyone with dementia to go through a period of having aggression... there’s actually very easy ways of dealing with that behaviour if you’ve been trained.
‘‘You just divert their attention... you ask them what they’re needing. If someone is behaving badly it usually means they’re in distress, they’re in pain, they want something.’’
Julia says her mother has settled well into her new home, where management was surprised she’d previously been assessed as needing hospital-level care.
‘‘I said to [the manager] ‘mum can be a bit tricky at times’ and he said ‘that’s alright, we like people with a bit of spirit’.’’
‘‘The residents aren’t living in a business – the staff are working in those people’s home.’’ Julia West