Rest home death ‘can’t be in vain’

Nurse noted gaps in care of woman but cited 96% chance she’d die anyway

Nicholas Jones

A rest home nurse acknowledged gaps in a woman’s care — but cited a “96 per cent” likelihood she would die soon anyway.

The email between the registered nurse and manager at Gisborne’s Dunblane Rest Home and Village was forwarded to the resident’s alarmed daughter.

It’s now included in Leigh Morrow’s complaint to the Health and Disability Commissioner (HDC), and has been provided to the Weekend Herald.

The facility, owned by aged care giant Oceania Healthcare, has apologised for oversights leading to a bad fall that Alison Jackson never recovered from, and acknowledged delays in rehabilitation for a broken femur.

Morrow believes the latter ultimately killed her mother.

“She spent six unnecessary weeks lying on her back, which . . . was either the cause of or hugely contributed to her chest infection.”

The local DHB has completed a review on how its physiotherapy service communicated with the rest home.

Jackson was living in Dunblane’s dementia wing when she fell after exiting a van on October 16 last year. There was one staffer helping residents disembark, no walking frame available or place to sit, and the van was further than normal from the building.

While another resident was being offloaded Jackson, who normally used a walker under supervision, took a few steps and fell heavily to the ground, smacking her head and breaking her pelvis.

After a week in the local hospital she returned to Dunblane’s hospital wing, and the next month a DHB physiotherapist set up a rehabilitation plan, including use of a standing hoist and to be mobilised as pain allowed.

In mid-January — and having had no updates despite ringing almost daily — Morrow chased up Dunblane’s manager who forwarded her an email he received from the senior registered nurse. “The physio [stated] in their notes that once Jackson was tolerating standing for longer periods that the physio would follow up and see if it was appropriate to trial walking,” the nurse wrote. “I don’t believe that this has happened.”

The nurse said she had plenty of experience with older patients with pelvic fractures, who mostly didn’t get back to their pre-fall abilities.

“The statistics for survival postinjuries have never been good. When I worked at the DHB most patients survived the surgery and the first six months but something like 96 per cent of those went on to die.”

When the hospital physio eventually returned, Morrow said, she got Jackson to walk across her room.

But four days later a doctor called to say Jackson had deteriorated after developing a chest infection. She died in the early hours of January 28.

In an initial response to the HDC, Oceania Healthcare apologised for the oversights that enabled Jackson’s accident.

The group, which operates 49 aged-care and retirement village facilities, acknowledged there was no physiotherapy provided until intervention by its senior operations manager, which “clearly does not meet Oceania standards in rehabilitation”.

Oceania’s chief executive Earl Gasparich declined to comment, given the matter was before the HDC. “We take complaints of this nature extremely seriously.”

Kate Mather, clinical care manager for the DHB, Hauora Taira¯whiti, said it was aware of concerns about communication between Dunblane and the physiotherapy service. The HDC would report on whether the DHB’s processes could be improved.

“While we await the Commissioner’s feedback we have completed our own review.

“We extend our condolences to Mrs Jackson’s family.”

Morrow said Dunblane’s daily care staff were fantastic, but her concern was with management and processes — and she backed calls from Age Concern, Grey Power and others for reform in the sector.

“The number of people who don’t have family to advocate for them . . . her death can’t be in vain. I can’t let that happen.”