Aged care: call for stricter regulation after woman forced from home

Margaret Brown during her time at Julia Wallace Ryman retirement home in Palmerston North. - Photo: Supplied / Sue Brown

A woman whose mother was forced out of her retirement home on Christmas Eve wants a law change to better protect elderly transitioning to hospital-level care.

Margaret Brown lived in her Palmerston North Julia Wallace Ryman serviced apartment for six years before being assessed as needing hospital-level care.

There was no room at Ryman's hospital wing however, so she was forced to move indefinitely to Palmerston North Hospital.

Her daughter, Sue Brown, said the whole ordeal traumatised her mum and should not have been allowed.

"On the 24th of December Mum was evicted. They said 'we haven't got room, we can't look after her'.

"We said to Ryman 'okay, we'll go, can you ring the ambulance in the afternoon so she can have her last day in her apartment' - because she's been there for six years, it was her home - they say they asked it to come in the afternoon but it came in half an hour, and so Mum just up and out of her room that she'd been in for six years. It was just heartbreaking.

"I wish I could put into words the raw emotion and distress that Mum and the family were under. Mum had lost total control of all aspects of her life and felt totally helpless."

Ryman spokesperson David King said they found her a bed as soon as they could, but there was a period of two to three days where one was unavailable.

"We are disappointed there was a delay to secure a bed after she was ready for discharge, and she had to stay on. We could not move another resident who needed the bed, and we knew she was in good hands at Palmerston North Hospital.

"We apologised to the family for this."

He said she was not evicted.

Peace of mind

Ms Brown said the experience was in total contrast to Ryman's "Peace of Mind" guarantee which stated that if the need arose residents could stay living in the village community and remain in close contact with their spouse and friends.

"We told her in 2010 that if she shifted to Ryman she would never have to worry about her care again. Especially, if Dad went before her, and we were so wrong - totally wrong.

"Mum and Dad believed there would be no issues regarding their continuing care - it's one of the reasons they decided to purchase a Ryman apartment."

She said the event distressed her mother and she stopped communicating for a time. She said she felt abandoned and homeless.

Mr King said Ryman stood by its Peace of Mind Guarantee and said it was rare that a resident moving into care could not be accommodated immediately.

"We are constantly managing demand. We do this by giving our residents priority and we are constantly talking to our residents and their families about how they are doing, whether they need more help, and what we can do. We are happy to hold beds empty for our residents who are waiting on assessments so there is a bed ready if they need it.

"On this occasion there was not a bed ready, and we regret that we got it wrong."

Ms Brown said there were a number of problems with her mother's treatment after she was returned to the provider's hospital wing.

These included being left in bed 18 times in one month for more than 20 hours of the day and frequently waiting for up to an hour for help to get out of bed to use the toilet or sit in a chair, she said.

At one stage Mrs Brown was left with a fist-sized skin flap, which had been caused after slipping in the hoist, and another time Ms Brown walked in to find her mother distressed and crying because she had been left sitting on the toilet for too long.

Ms Brown had also previously filed a bullying complaint against a staff member who she said was "overbearing and confrontational" when her mother wanted to get back into bed.

She said other basic needs were constantly not met such as opening her curtains in the morning, leaving her phone, water and TV remote within reach, and diarrhoea left on the floor and bedding.

After her mother died in April 2017, Ms Brown decided to formally complain to the Health and Disability Commissioner, filing four separate complaints over her mother's care, the transition process and lack of communication.

The complaints were all responded to under one case number, with much of the specific detail unanswered.

The Deputy Commissioner found there had not been any breaches of the Code of Health and Disability Services Consumers' Rights, though there had been deficiencies in Mrs Brown's care, and asked Ryman to apologise.

Mr King said Ryman acknowledged its communication could have been better, but said overall it stood by its staff's actions.

He denied Margaret Brown had been neglected and delivered sub-standard care.

"We investigated all of these issues as part of the HDC investigation, and the care we provided was found not to be in breach of the code. However, we do apologise for where we fell short of a family member's expectations.

"The care notes show that her mum's health was in decline and the periods in bed were for her comfort and at her request. When a patient is in hospital care and is exhausted our team will not make them get out of bed if they do not wish to."

HDC response

Health and Disability Commissioner Anthony Hill said he was disappointed Ms Brown was unhappy with the outcome but was confident in the way it had handled her complaints.

"HDC has a range of actions available to it following the assessment of a complaint. For example, we may decide that a provider's actions were reasonable in the circumstances or that they have already taken action to address the matters at issue in the complaint. In other cases, we may determine that the issues can be appropriately addressed by HDC making recommendations for change.

"In aged care complaints we often also bring matters to the attention of the regulator, HealthCERT, who has responsibility for audit and compliance with service standards, and the relevant funding DHB. This ensures both regulator and funder are aware of concerns raised and helps maintain oversight and visibility of the aged care sector."

In Deputy Commissioner Rose Wall's final decision to Ms Brown she said she was concerned there were differing recollections of events between Ms Brown and Ryman, but that further assessment was unlikely to clarify things.

Ms Brown said it was concerning the commissioner did not want to clarify matters, and it was equally concerning that Ryman appeared to be apologising for not meeting her expectations - not for letting her mother down.

She had kept a detailed logbook of her mother's care and was confident her recollections were correct.

She was surprised the commissioner had not found any code breaches.

She had planned to take her concerns to the Disputes Tribunal, hoping to get a legal ruling against Ryman, but it paid her compensation meaning that was no longer an option.

She said it was not good enough that - apart from an appeal to the Ombudsman - there were no more options available to her, and it was not fair on others who deserved to know what had gone on.

"How do the general public know what's going on? How do you build up a history of these providers and the complaints that are being received?

"As a consumer shouldn't I be able to go to the Health and Disability website and do a search on Ryman and see what kind of feedback they're getting? If it's not published it's completely being swept under the table."

She wanted stricter oversight of care home providers, particularly when residents were transitioning from self-living to hospital care.