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Management Of End-of-life Care

Deputy Health and Disability Commissioner Rose Wall today released a report finding Heritage Lifecare Limited and one of its staff in breach of the Code of Health and Disability Services Consumers’ Rights (the Code) for failures relating to the palliative care provided to a rest home resident.

The man required hospital-level care and was admitted to the rest home for palliative care. He was admitted with wounds on his legs but his dressings were changed infrequently, he reported pain during dressing changes, and experienced three falls. During his time at the rest home he became increasingly unwell. He lost weight and this was not monitored by staff. He was not offered regular showers, his room was found to be dirty, and maggots were found on his toes. There were delays in arranging reviews by a GP and podiatrist. In his final days at the rest home, his family raised concerns that his condition had deteriorated, and made a formal complaint, but there was no review or adequate response by senior staff.

Ms Wall said basic care the man should have received was lacking.

"[The man] was for end-of-life care, with significant co-morbidities, and it was unacceptable that he suffered unnecessarily in his last months. His family had stressed to staff their wish that he be comfortable in his final days… [He] should not have had to rely on his family to advocate on his behalf for such a fundamental component of his end-of-life care," Ms Wall said.

She said the case highlighted the need to ensure that palliative care is appropriately planned to meet a person’s end-of-life care needs. She considered that the number of failings by the rest home and its staff pointed to an environment that did not sufficiently assist staff to do what was required of them and found the rest home in breach of the Code.

Ms Wall was critical that the rest home’s clinical services manager did not provide appropriate oversight of the nursing documentation and care planning, and was concerned that she did not comply with the complaints policy, and accordingly also found her in breach of the Code.

Ms Wall recommended that the Nursing Council of New Zealand carry out a competence review of the manager, and that she apologise to the man’s family. Ms Wall further recommended that the rest home owner report back to HDC on the implementation of its own action plan developed in light of this case; audit its compliance with protocols and review its palliative care policies; use this report as a basis for staff training and learning; and provide a formal written apology to the family.

The full report for case 18HDC00700 is available on the HDC website.

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