Rest Home Recommended To Complete Staff Training In Identification And Management Of Infection In Elderly

Deputy Health and Disability Commissioner Rose Wall today released a report finding a rest home in breach of the Code of Health and Disability Services Consumers’ Rights (the Code) for failing to systematically investigate and critically think about a woman’s symptoms, leading to painful cellulitis in the woman’s legs.

A woman in her nineties was moved to the hospital wing of an aged residential care facility in 2020. She had a number of complex health issues including asthma, heart disease, osteoarthritis, a shoulder injury and suffered from chronic pain, hypertension and was at risk of falling.

The woman’s initial care plan made special note of her risk of falling and that she required assistance for toileting and transfer to a wheelchair, which she preferred to use to get around due to pain in her legs. Special note was also made in the plan to respond to any changes in her mood or behaviour over the next six months.

Over the course of the next few months the woman became increasingly frail with days of restlessness, low mood and confusion. Nurses noted that she was eating and drinking well over the period, so didn’t feel the need to investigate the woman’s distress any further.

After her pain levels increased, and her legs became red and hot to touch, a visit from the woman’s doctor led to a diagnosis of cellulitis. She was admitted to hospital for intravenous antibiotics. However, she failed to respond to these, and a decision was made with the woman’s family and medical staff to stop active treatment, and palliative care begun.

The woman returned to the rest home, and sadly passed away 5 days later.

"The rest home had a duty to provide the woman with reasonable care and skill, which included being responsible for the actions of its staff at the rest home," said Rose Wall.

"The woman’s medical history indicated she was likely to experience a progressive decline. In particular, she was noted to be at risk of having a decline in her mood, and to experience high levels of pain in her legs.

"In light of this, the various nursing staff involved in her care should have been alert to a deterioration in her condition, and intervened as required, including seeking medical attention when warranted. Staff should have ensured the woman was well supported in an environment conducive to keeping her calm and comfortable."

Rose Wall recommended that the rest home provide a written apology to the family for deficiencies in the woman’s care outlined in the report.

She also recommended that the nursing staff be given training on the new "Assessment & Management of the Acutely Unwell Resident" policy. In addition she recommended that the rest home provide all staff with training on the identification and management of infection in elderly; assessment and management of general decline in the elderly, informed consent; supported decision-making; EOPAs; palliative care; and the implementation of the "Last Days of Life" policy care planning throughout the rest home company’s facilities.

The full report on case 20HDC00424 is available on the HDC website.

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