Deputy commissioner Rose Wall said while boundary issues, by their very nature, involve two people, “when the relationship involves an at-risk consumer, the onus is on the support worker to behave in a professional manner”.
The issues came to light after the elderly woman died. She had been receiving support from her carer for five years, and her daughters hadn’t seen her for three years before she was admitted to hospital following a fall.
They visited her in hospital before she died, and during the HDC inquiry told the commissioner their mother had all but cut contact with them.
Following her mother’s death, one of the daughters discovered the carer had her mother’s car – the carer initially denied knowing where the car was.
The carer told Access Community Health the elderly woman had sold the car six months previously and she did not know to whom she had sold it.
However, the daughter later saw her driving around in it. She checked her mother’s bank statement and found no payment had been made for the car.
It then came to lightownership of the car had been transferred to the carer in mid-2020. The woman died in early 2021.
The daughter discovered text messages in which the carer told her mother “car is now in my name and covered under my insurance”. The woman replied: “Well done sunshine – I can now cancel my one.”
The carer told the HDC the elderly woman insisted she had the car.
She said: “[Mrs A] came up with the amount of $3000 and said I could pay her off weekly at $10. I wanted to pay more, but Mrs A wouldn’t take more than $10.”
The deputy commissioner said, given the carer’s initial dishonesty about the whereabouts of the car, it suggested she knew she shouldn’t have taken it.
“[The carer] produced a copy of a handwritten sheet of paper ostensibly indicating that she had made some payments for the car,” Wall said.
“I consider that it is irrelevant whether it was a sale or a gift – it was inappropriate for [the carer] to enter into this arrangement... it was a breach of professional boundaries.”
Eftpos card and purchases
When the woman could no longer leave the house, because of decreased mobility, the carer would take her Eftpos card to do grocery shopping and purchase requested items outside supermarket purchases.
The carer was there to help with basic household tasks such as cleaning and grocery shopping.
The arrangement had been that the woman would withdraw cash, which would be used to do supermarket shopping.
The carer was supposed to check the items purchased against the shopping list and against the receipt, the total amount, and the change received. She was then required to enter the details in the client’s notebook, attach the receipt to that page, sign the page, and ensure the client also signed the page.
Under the terms of the plan, and Access Community Health’s policy, she wasn’t supposed to use a debit or credit card, or have knowledge of the Pin, unless a specific form had been filled out.
But the carer had not told Access about the new arrangement.
During the inquiry, the carer acknowledged she had contact with the elderly woman outside her employment, purchased items other than groceries, used the Eftpos card to buy groceries and takeaway food, and withdrew cash using the Eftpos card, all without authorisation by Access.
The deputy commissioner was not able to determine whether the carer had “misappropriated any money or used the card to purchase items for herself, such as [a] laptop computer or takeaway food for herself. Nevertheless, it is not disputed [the carer] used [the elderly woman’s] money to purchase items that should not have been purchased, which is a serious breach of standards”.
A warning to care providers and families
The deputy commissioner said the case served to “highlight the difficulties that can arise in situations where a consumer is relatively isolated and becomes increasingly reliant on social contact and the personal relationship they establish with their community support worker, not only to maintain their independence with aspects of daily living, but also to provide emotional support and possibly companionship”.
Appropriate training was needed so the support worker was equipped to both recognise the situation and to manage and respond to it appropriately, she said.
When the elderly woman first began receiving assistance from the home care support worker, she was living in a house owned by her daughter and had regular family contact.
However the daughter decided to sell the home and after that, contact between the elderly woman and her two daughters was greatly reduced.
In a statement to the HDC, the home carer said: “This is where the lines of professional and personal boundaries began to get crossed. [Mrs A] was all alone with no family help or support now”.
The HDC noted there was no evidence the carer had neglected the elderly woman’s needs, nor had she treated her unkindly. The tone of the text messages between the pair was warm and affectionate.
However, the elderly woman had been trying to maintain her independence – insisting on clearing out her own fridge and managing her own personal hygiene.
But after she died, her daughter said her house had been in a “disgusting condition”.
The deputy commissioner said “respecting the dignity and independence of the individual is paramount, and there is a delicate balance between maintaining a person’s choice and control in their life with upholding their ongoing safety and wellbeing on a day-to-day basis”.
Wall also noted that “on this occasion, however, it is concerning that a neighbour referred to there being unpleasant smells from the kitchen and to the unkempt state of the home. In my view, [the carer] should have been aware that if there were such issues, she needed to alert Access...”.
The deputy commissioner found Access should have provided greater support and oversight to the carer and more scrutiny of the plans in place for the elderly woman.
In October 2020, when the elderly woman reported to them that she was now housebound, “ongoing processes should have been instituted to ensure that she was receiving adequate care and was not being abused, exploited or neglected [by her carer]”, Wall said.
In particular, it should have recognised the existing plan for paying for groceries would no longer work, given she was housebound.
Access Community Health said it had been under “immense stress” during the Covid-19 pandemic and Government alerts and lockdown periods, which is why some regular reviews with staff and clients may have been more limited or condensed than usual.
Access asked that the “valid technical point” about grocery payment be considered “in light of the wider sector circumstances at that time and what was realistic within the general pragmatic approach that service providers were being asked to take by the Government”.
It also said it didn’t believe “the current funding for home and community support services allows for any additional monitoring and supervision, or detailed performance appraisals” for care workers.
The deputy commissioner did not accept this and said Access was responsible for the actions of its staff.
Wall said the carer appeared to have worked alone with minimal oversight and did not do performance appraisals.
While acknowledging the unprecedented events of Covid-19, she said the lockdown would have meant the woman was “even more isolated, it necessitated appropriate protections being put in place, and therefore I remain of the view that Access was responsible and should have considered whether she was being supported adequately”.
The HDC made recommendations that included changes to training, including managing boundary issues and developing a consumer feedback mechanism, with different methods for feedback.
It also recommended annual refresher training and voluntary quarterly meetings for support workers.
It would also develop a policy on performance reviews and get external expertise to review and audit consumers’ individual support and/or care plans, policies and procedures, to ensure they were consistent with best practice.
The HDC also recommended both the carer and Access Community Health apologise to the family of the elderly woman.
The deputy commissioner noted the carer was now working with “vulnerable people with dementia”.
“Given the circumstances of this case, which suggest that [the carer] lacked insight into appropriate professional conduct while working as a support worker for Access Community Health, I intend to inform [her] current employer about my decision in this matter.”
Statement from Access Community Health
Access Community Health chief executive Androulla Kotrotsos said they had sent their condolences to the family involved and, in respecting their privacy, there were “certain aspects of this situation that we are unable to discuss further”.
She said while they were disappointed with the outcome of the HDC findings, they acknowledged there were improvements they could have made and they had “moved quickly to implement those”.
The Covid-19 pandemic was an “incredibly difficult time for the health sector”.
“Regardless of the added complexity these circumstances placed on the management of our mobile care and support worker workforce, I want to stress that Access Community Health insists on, and has always followed, strict processes and procedures in the delivery of exemplary care to our clients,” she said.
“Working in people’s homes requires a huge amount of trust, care, and respect. This is something we, and our staff, take extremely seriously.”
Hannah Bartlett is a Tauranga-based Open Justice reporter at NZME. She previously covered court and local government for the Nelson Mail, and before that was a radio reporter at Newstalk ZB.
