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Relatives say overnight aged-care incidents prove need for 24-hour nurses

Concerned about relatives' care: Kate Mannix and Christine Macfadyen.

Concerned about relatives’ care: Kate Mannix and Christine Macfadyen. Photo: Louise Kennerley

Jacqueline Oliver was drenched and freezing when a police dog found her stuck in the fence outside her aged-care home, four hours after she went missing.

On the night of an electrical storm, Mrs Oliver had slipped out of the dementia unit and into the courtyard via the laundry door, which was normally secure but had been wedged ajar because the lock was broken.

We strongly object to linking adequate care to a building program. 

Kate Mannix, aged-care resident’s daughter

Staff at the centre called the police about 12.30am, an hour after their security firm detected the breach. But she was not found until a dog was brought to the site about 3.30am.

“She was lying in the mud with her foot caught in the fence,” daughter Janet Oliver said.

“She had hypothermia. She thought she was going to die.

“It was obvious there was nobody on the staff to take control and know what to do. The security firm rang them but they couldn’t even work out how to view the CCTV.”

Janet Oliver is among a group of aged-care relatives who have been cataloguing incidents they say might have been avoided if there was a registered nurse rostered overnight at Wesley Rayward Carlingford in Sydney’s north west.

They have recorded an episode where a resident was transferred unnecessarily to hospital and another where he should have been but was not. They have also recorded, among other incidents, the case of a resident who broke her nose and was not given any pain relief for 24 hours.

The NSW government decided in April to ditch the requirement for aged-care facilities with high-care residents to have registered nurses on site 24 hours a day, against the recommendations of a parliamentary inquiry.

Instead, it will be left to the individual operators to determine an “adequate” level of staffing.

But many centres that have residents with complex needs are already operating without registered nurses overnight. That is because they were categorised as low-care facilities before the federal government removed the distinction between high- and low-care and allowed them to take all comers.

This includes Wesley Rayward, which has 74 residents, including many with dementia, and three overnight carers, none of them registered nurses.

Kate Mannix, whose father is a resident, said relatives were recently told a registered nurse would only be employed overnight when the centre proceeded with its planned extension.

“[The manager] said they needed to be able to afford it and the one way they would be able to afford 24-hour nursing was if this extension was done,” Ms Mannix said.

“We object strongly to linking adequate care to a building program. Either the residents require 24-hour nursing or they don’t. We think they do.”

More than 90 per cent of aged-care nurses in NSW do not believe there are enough registered nurses to manage patients with high-care needs, according to a survey of 2500 people by the Australian Nurses and Midwifery Federation last month.

Two-thirds of nurses and 84.9 per cent of community members did not think the ratio of registered nurses to other staff was adequate and more than half said residents had been transferred to hospital for things that could have been treated at the centre.

One nurse said her facility, which had previously been designated low-care, now had 95 per cent high-care patients and no registered nurse rostered overnight.

“I have noticed that resident care is declining as evidenced by the increased depressive symptoms of residents, increased incontinence, increased skin tears and wounds and increased pressure injuries,” the nurse said.

NSW Nurses and Midwives’ Association general secretary Brett Holmes said carers were more likely to send residents to emergency departments if they were unsure what to do, which transferred costs back onto the public system.

“Old people do strange things in the night,” Mr Holmes said.

“They get up, they wander, they become disoriented, they wet the bed, they fall out of bed, and when the unexpected occurs the registered nurse is the person with the level of skill to make an assessment of a resident and a decision about the next response.”

Ms Mannix said her father had been unnecessarily hospitalised when he woke up breathless.

“If there had been a nurse there, they could have checked his blood, but instead they shipped him off to hospital when he wasn’t in any sort of crisis.

“I can’t understand why the government is so sanguine about the private sector using the public hospital system to save them from having adequate staff overnight.”

Wesley Mission declined to comment on specific incidents, citing patient confidentiality. But it said in a statement that Australian Aged Care Quality Agency audits in November 2015 and June 2016 found Wesley Rayward to have sufficient staffing levels and appropriately skilled staff.

“Wesley Mission seeks at all times to provide the quality of care expected of it as a provider of residential care,” the statement said.

“It takes the welfare of residents and our responsibility in this area seriously.”

Another resident’s daughter, Christine Macfadyen, said it was likely the incidents that relatives had documented at Wesley Rayward were common in other aged-care centres.

It was only after she collected relatives’ email addresses and contacted the other families that they all became aware their own experiences were not isolated.

The NSW government said in its response to the parliamentary inquiry that retaining the requirement for 24-hour nursing in the way proposed would mean expanding it to facilities to which it did not previously apply.

NSW would pursue concerns about the regulatory regime through the COAG health council, it said.

Do you know more? halexander@fairfaxmedia.com.au

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