Home | News | Symptoms of neglect seen as inevitable part of ageing: RN to royal commission
Shirley Fowler, who developed pressure ulcers on both her feet that became infected, one of which became so serious it exposed the bone while in residential aged care. Photo: AAP Image/supplied

Symptoms of neglect seen as inevitable part of ageing: RN to royal commission

Ongoing diet and nutrition problems in the care of a Wollongong aged care resident and a lack of good wound care practices point to wider underlying problems within the sector.

Those were some of the concerns raised by the resident’s daughter, Lyndall, on Tuesday’s royal commission hearing in Darwin.

Lyndall’s mother, Shirley, who has been living with Alzheimer’s disease at IRT William Beach Gardens since 2013, has special dietary needs, including a lactose intolerance.

Per counsel assisting Peter Gray’s opening address, the royal commission heard that Lyndall, a retired nurse, frequently communicated with IRT about Shirley’s diet and weight loss, as well as “the inadequacy of staff’s attention to her feeding and nutrition”.

Lyndall stressed that the issue was about whether staffing and staff training was sufficient to meet her mother’s needs, rather than deliberate misconduct.

Per her witness statement, Lyndall said that while she completed a questionnaire about her Shirley’s food intolerances and that they were noted in her care record, her mother was still given food containing lactose in the first year of residence.

“I have observed my mother regularly being given milk in her cup of tea, despite me making it clear from her admission that she drank black tea,” Lyndall wrote. “Most weeks there are at least three soups (containing milk) on the residents’ menu and IRT Catering do not provide an alternative, other than packet or commercial processed soups.”

Lyndall said alternative foods were “generally processed or insubstantial” and that even when she would supply food for her mother to be kept in the facility’s freezer, mistakes were still sometimes made.

She said that the facility has made improvements in this area. The hospitality manager has been providing lactose-free alternatives by purchasing such products from the supermarket separately but Lyndall added that she is unsure if this has been extended to other residents with unique dietary needs.

Lyndall also laid out issues she had with the way wound care was handled in her mother’s case. She said staff were not always taking a proactive role in using photographs of Shirley’s wounds.

“Normal practice would be to compare the wound with the most recent image at every dressing to assess progress and assess whether different interventions are needed,” Lyndall explained. “On occasion I would ask RNs for their assessment and was often told that they may not have seen the wound for weeks.”

She added: “Several times over this period I was told by RNs that “‘it probably isn’t going to heal in [my mother’s] lifetime. She will probably die with the pressure ulcers’ or words to that affect”.

This fed into a view Lyndall has of the way ageing and disease are approached in the sector.

“In my experience, the dominant culture in aged care accepts the complications of deteriorating health as inevitable.

“Pressure sores, contractures and tooth decay are considered part of the usual trajectory of decline rather than viewed as symptoms of neglect,” she explained.

Overall, counsel assisting Gray said the case was about proactivity in clinical care.

“It’s certainly not a case in which anybody is alleging that anybody has done anything deliberately wrong.”

Gray said if, in the end, the commissioners come to the view that there was a lack of proactivity in relation to some aspect of Shirley’s care, it might become a question of “whether this is a matter that might have systemic implications, given that this is a facility that has a 44 out of 44 expected outcome accreditation and passed its accreditation in the very period during which these events were occurring”.

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