AWW SPECIAL INVESTIGATION: the silent epidemic of elder abuse

Elderly Australians are being neglected, abused and murdered. In the irst part of a Women’s Weekly special investigation, Susan Chenery meets the families, carers and advocates ighting for a better deal for our elders in institutional “care”.

On the morning of October 18, 2013, Gwendolyne Fowler, 83, had eaten all of her breakfast at the SummitCare aged facility at Wallsend, Newcastle. She’d been married for 55 years before her husband passed away in 2005. A mother of three daughters, she now had Alzheimer’s disease. For the rest of the day, staff said, she was her usual self. But when daughter Julie Ross visited her at 4pm she found her cold, clammy and unresponsive in her room.

Gwendolyne passed away at 12.15pm the next day.

That morning, Saturday 19th,

Ryan Kelly, 80, a widower with two daughters, was described by assistant nursing aid Jordan Franks as “absolutely ne” when she gave him his breakfast. Even though he had Alzheimer’s, she said he was “mentally with it”. Staff checking on him throughout the day noted that he was sleepy but by 5pm, when a student nurse brought his evening meal, he was passed out in a cold sweat and drooling.

Like Gwendolyne, he was found to be hypoglycaemic and hypothermic when taken to John Hunter Hospital. He died on October 29.

On the same morning, October 19, Audrey Manual, 91, was in good spirits. “She was always happy,” said Franks, who assisted her with breakfast. Before she had become ill with Alzheimer’s, her grandson Paul told The Weekly, “she would run around doing everything with us. She was this busy beaver.”

After breakfast on the 19th, she took her usual stroll on her walking frame around the ward. At 11.30, a visitor to another resident who stopped to chat to her noticed that her tea and cake were untouched, then her hand started to shake. Maintained on a glucose infusion at John Hunter Hospital, it was touch and go for ve days. She survived but never attained the same level of functioning and died of unrelated causes in January.

Dr Tuan Minh Quach, a specialist endocrinologist at John Hunter

Hospital, became suspicious. All three had been given lethally high doses of insulin. None of them was diabetic, so there was no medical need for it to be administered. Someone was killing the old people at the SummitCare home. A person among them was preying on the ageing, the ill, the demented.

Garry Davis, now 33, a team leader at the nursing home, had texted colleagues, accurately predicting who would die next. Speaking of death in a series of texts to a friend, he said, “Adrenalin kicks in. Best feeling.” Syringes and needles were found at his home, as well as detailed medical literature about insulin. Davis fought back tears on September 28, 2016, when Justice Robert Hulme said he “was left in no doubt” of his guilt, after his trial at the Newcastle Supreme Court. Davis was sentenced to 40 years in jail.

Every day, Australians make painful decisions about the care of their parents in old age, and it seems like every week stories emerge of the frailest and most defenceless members of our society being mistreated, neglected and abused. It is estimated that one in 10 elderly people will experience abuse, though experts believe it could be even higher.

On November 3, 2016, nurse Megan Haines was found guilty of the same crime, injecting two elderly women with insulin at the St Andrews Village at Ballina, where she had been working for less than a month. They were Isabella Spencer, 77, and Marie Darragh, 82. In their daily phone calls, Marie had told her daughter, Charli Matterson, that Megan had refused to take her to the toilet and deliberately left her in her own faeces. Towards the end of her shift she had thrown Marie in a cold shower and said, “If you tell anyone, I will kill you.” Charli told her mother she had to report it. The next day Marie was dead.

In addition to the striking similarities of method, both these cases highlighted an ongoing failure of screening staff in nursing homes. Haines, who was sentenced to 36 years in jail, had had her nurses’ registration suspended in Victoria after she was the subject of three misconduct investigations, and the prosecutor told the court she had a “dislike and intolerance” for elderly people. Davis had lost jobs in other nursing homes and was known for his lack of empathy, to the point of putting “I hate old people” on a Facebook page. Yet they were entrusted with care of our most vulnerable people.

Residential homes for the elderly are high-profit big business, with annual revenues of $14.8 billion. “They are a cash cow,” says former NSW Greens MP Jan Barham, who sat on the committee of the NSW Parliamentary Inquiry into Elder Abuse in 2015. “There is evidence that, over the last five years, there has been a reduction in staffing numbers and an increase in profits. We have seen a substantial decline in registered nurses and a substantial increase in lower skilled and lower paid personal care workers. So they are making profits out of lowering the standard of care.”

Barham recently resigned from parliament to look after her elderly mother rather than put her into a home. “People who are bright and vibrant go into a home. Two weeks later they are another person,” she says.

Greg Mahney, a former CEO of Advocare, agrees. “The situation is that people in aged care are in there 24 hours a day, 52 weeks a year. That puts quite a strain on the aged-care providers to find enough quality staff. Some people want to do that work and are good at it but because it is low paid, they often don’t get the choice of the best workers. For some people, it is the only job they can get.”

One registered nurse who gave a submission to the NSW inquiry spoke of such chronic understaffing that “residents are forced to wait for pain relief, for help to the toilet. Meals get rushed, drinks get left out, residents lose weight and become dehydrated, residents who may be continent with help become totally incontinent. Residents who could walk with assistance become bed- and chair-bound because it is easier and quicker for the staff not to walk them.” The work is hard, the pay is poor. “It is easier to sedate,” she admitted. “It costs the facility less money.” Sedated, parked

in front of a TV, no longer useful, a burden; what a grim end to the adventure of living. It’s hardly surprising so many people succumb to depression.

It’s not uncommon for just one staff member to be on a night shift with 70 or 80 patients, left alone to cope with what is known as “sundowning” – Alzheimer’s patients getting more confused, restless, and sometimes aggressive at night.

Unlike cultures where age confers respect and older people are valued and live with their families, our ageist society tends to write people off, to discard them. When they’re no longer as pretty or authoritative or strong or vital as they were, they become invisible. It’s easy to lose patience when people slow down and can’t keep up, when they can be bloody annoying. There’s an underlying contempt for those who get old.

“They deserve the dignity and respect of everybody else,” says Yvonne Selir, whose father-in-law Zdenek Selir, died because of shocking neglect at Opal Aged Care on the Gold Coast.

Catherine Henry, a lawyer who specialises in aged care cases, speaks of “ghettoisation”; of the elderly being “hidden away from society”. As life expectancy rises and the population ages – projections over the next 40 years indicate the population over 65 will double to around 25 per cent – the situation is approaching critical mass and, experts believe, abuse will escalate.

When a family member visited Zdenek, 88, who was taken into care after being felled by a stroke, she noticed a foul odour coming from his room. Against the wishes of staff, she called an ambulance and he was admitted to hospital with gangrene and pressure sores. But it was too late – the infection was shutting his organs down.

“The nurses said it was the worst case of abuse and neglect they had ever seen,” says Yvonne. A man who could speak nine languages when he arrived from the Czech republic in 1956 to work on the Snowy River Scheme, Zdenek owned the first disco in Melbourne and was 58 when he married for a second time. After his wife left him, he brought up their five children on his own. “He mattered,” says a weeping Yvonne, who has become a passionate advocate for the elderly. “He was always there for his children. Everybody’s life matters. We need to protect the elderly. They have rights, they are human beings, we wouldn’t be here without them.”

Then there are the small, everyday indignities, casual callousness and heedless neglect that are hidden because people are too frightened to speak out in case they receive worse treatment from those they depend on.

Bob Spriggs was 66 when he was admitted to the government-run Older Persons Mental Health facility at Oakden, Adelaide, in 2016. He was suffering illnesses including Parkinson’s disease and Lewy body dementia, which can cause people to be violent. “It wouldn’t have been physically safe for Mum to keep him at home,” says his son Clive. “When you have someone who is that ill and vulnerable, with such a rare condition, we were told that was the only place he could go. No one else would take him.”

“People who are bright and vibrant go into a home. Two weeks later they are another person.”

Within days of Bob being admitted, his family noticed a drastic decline. He had been given 500ml of the antipsychotic drug Seroquel instead of 50ml. In the same week, his daughter found him lying on the floor when she visited, with bruises around the tops of his legs from being restrained.

The family raised concerns when he had trouble eating and drinking, but did not receive a response. When his death was unexplained, they sought answers. His wife, Barbara, wrote letters, made phone calls and applied for his records through the Freedom of Information Act. She discovered that there had been 10 years of abuse of patients in Oakden. This led to the Carnell-Paterson review of aged care, which in turn has led to sweeping changes in government policy.

The facility has since been shut down. It wasn’t until the family went public that, Clive says, “things started to happen. It’s taken so much out of the family – mentally, physically, emotionally. Our drive, after what we saw Dad go through and what we’ve been through, was that we didn’t want to see that happen to anyone else. No one should have gone through what we did.”

Elder abuse advocates had called on the federal government to develop legal and policy frameworks in cracking down on abuses. In April this year, the government said it would set up a national, independent Aged Care Quality and Safety Commission to increase transparency, starting on January 1. Aged Care Minister Ken Wyatt called it “a responsive, one-stop shop to prevent failures, highlight quality concerns and have them quickly rectified”.

Clive Spriggs says this is “a major step in the right direction ... It’s been exposed now, there is nowhere to hide anymore. There will be new models of care, new facilities, reporting and accountability; a 1800 number that people can ring if they have concerns. Those complaints go straight to the top, not filtered through like what has happened in the past.”

But Advocare CEO Deirdre Timms says it’s the implementation that counts. “I think anything the minister is doing to tighten scrutiny of the treatment of older people is excellent, but it will depend on how it’s implemented. Will this mean older people are more highly protected, particularly in residential facilities? The minister doesn’t want to talk about ratios – I don’t know if staffing ratios are the answer but it feels like it might provide some solutions if there were mandated ratios of staff to residents, which we don’t have now. We live in a very ageist society and older people aren’t treated with the dignity and respect that they deserve. That is also work we need to do.”

This year the government allocated $1.6 billion over four years to create 14,000 home care places, so older people wouldn’t have to go into residential aged care, but this was well short of the 105,000 on the national priority list for support. “Funding just 14,000 new in-home aged care packages over four years is a cruel hoax, with funding being cut from residential aged care to pay for it,” says Labor MP Justine Elliot.

The government also announced $146 million to improve access to aged care services in regional areas.

Greg Mahney says the aged care system “works pretty well” but agrees there is “a need for mandatory quality standards that are measurable” in care homes. “It can’t be enough for staff to just keep people alive. They have to be properly trained in both human and clinical rights. It is their home and you would expect to be safe and well looked after in your home.”

“These people built our country,” says Clive Spriggs. “Without them we wouldn’t have what we have today. The least we can do is make sure they’re looked after properly in their last years, so families can walk away from those facilities, leaving their loved ones and knowing they’re going to be given the best possible outcome for the last part of their lives.”

Catherine Henry agrees. “If we cannot provide for our elderly and frail, who have made a contribution to society, it is inhumane.” AWW

If you have an issue with aged care, contact the Older Persons Advocacy Network on 1800 700 600 or go to opan.com.au

In part two, Susan Chenery investigates internal family and financial abuse.