Val Bird’s husband went through hell before he died. She tells reporter Nicholas Jones what went wrong.
When Rosney Bird learnt he had terminal cancer his wife of 47 years promised his remaining time would be the best.
“Silly me,” she now says.
In the following months Rosney - Ros to family and friends - endured constant, debilitating pain.
His increasingly erratic and aggressive behaviour meant he couldn’t be cared for at home, and he was sent from Tauranga Hospital to short-staffed aged care homes.
When death came his wife, Val, was relieved. That terrible pain, the loneliness and daily indignities, hallucinations and delusions: it was all, finally, over.
“He didn’t want to keep living,” she says.
“He went through hell. He begged for help all the time.”
After he died, she soon sat down at her keyboard to set out what had happened. Friends told her to grieve first, but as a writer this was therapy.
“If you’ve lived something almost surreal and you want to make it real, you put it into words,” says Val, an author.
She sent the unflinching, deeply personal account to health authorities and, later, the Weekend Herald, after reading a recent report on substandard care in aged care.
What befell Ros exposes how our health and social systems can fail older New Zealanders, in small and large ways.
Val knows it’s usual. At the rest homes she’d pass other wives - “silent warriors”, she calls them now - in the corridors, and steal a chat when their husbands were sleeping.
One woman visited from 8am to 8pm every day, to keep her husband in place, so he wouldn’t have to be restrained. Others stayed for similar shifts to make up for a lack of staff.
“Ros would have expected me to tell his story,” Val says.
“I was and still am his voice. And I hope I can help those other ladies by using it. Because I know not all of them had the words, or the power, to put it together.”
A gentle man
Ros was a civil engineer and worked for Whakatāne District Council for 30 years.
“He was known as a gentle man. People were very fond of him - he moved very easily in society,” Val says.
“He was hardworking and honest - he would never do anything that he thought was even slightly dishonest.”
Theirs was a blended family; Val had two children and Ros four.
They also took on the challenging care of Val’s intellectually handicapped brother, Ronnie.
“That was 12 years of our life we were never going to get back. I knew that, and Ros knew that. It was a tough ask.”
Ronnie died in 1996, aged 57. (Val, author of the Ozzie Kingsford children’s books, wrote about her brother’s life in an adult novel, Wednesday’s Child.)
A couple of years later Val was diagnosed with melanoma.
“I said to Ros when I finally got the all clear, ‘Right, we’ve got to start doing things.’ So we started travelling - the South Island, Australia, then Britain, all sorts of happy things.
“I’m so pleased we did that, we made memories to treasure.”
Back home, they sold the Whakatāne family home and after some years at Gate Pa, Tauranga, bought a brick and tile in neighbouring Greerton. This was where they’d put their feet up, read, do jigsaw puzzles and watch Ros’ beloved Warriors.
The first crack in that idyll appeared before the move to Greerton.
“He thought people were living in his radio clock, that they were coming out at night and were going to kill him,” Val says of that first episode.
Their doctor suggested Val get power of attorney. At times Ros couldn’t put words together and struggled to explain himself.
He would later be diagnosed with dementia, but at this time he flew through cognitive tests for signs of the disease. This and the fact an MRI (paid for privately to check for a brain tumour) came back clear ruled out a specialist referral.
In February 2021 the right side of his face developed a worsening droop. Soon his eyelid wouldn’t close, and tears dripped down his face and on to the table, jigsaw, book or whatever project he tried to work on.
The pain became impossible. His daily pill count reached 17.
Finally, on August 30 they saw a “gentle, kind and understanding” neurologist at Tauranga Hospital, who admitted Ros immediately.
Val couldn’t stop saying “thank you” - relief that vanished four days later when she was asked to arrange a family meeting.
Chairs were set out in the small room. Val and Ros held hands as a doctor outlined the discovery of four tumours, the result of skin cancer now terminal.
One growth resting on a nerve explained his eye-neuralgia (pain in a nerve pathway), and a blood clot in his jugular restricted blood flow to his brain.
He had six months to a year to live. No treatment was offered.
“When they sent us home there was nothing - no sheet of paper saying, ‘Here’s how you can try and cope.’ No one sat us down and said, ‘This is what we need to do from now on.’”
A tearful Ros told his wife he hoped the cancer would kill him quickly.
Val later queried why he hadn’t been given an oncology appointment, and was told by an apologetic specialist that Ros’ cancer was too far advanced, but there was a private clinic who’d take him.
Their GP explained the facility was run by the same specialists in the public hospital, “and if they wouldn’t see him there, then ask yourself why”.
They heeded that advice, with difficulty.
“It is a tough one to be offered a life-money deal such as this; it’s certainly a guilt thing if you can’t find the funding to extend a life,” Val later wrote.
* Contact the reporter: nicholas.jones@nzherald.co.nz
A couple of weeks later a Hospice nurse began home visits. Ros was “determined not to be impressed”, and at times of frustration banged his fist on the table.
The nurse was unperturbed, Val recalls, having “probably seen it all - the pain and buried anger that comes with knowing your life is coming to an end”.
There were no Hospice spaces available (nationally, hospices are grappling with funding and staff shortages). He spent 18 hours a day in bed with a mask over his eyes.
“There are so many drug changes as the neuralgia pain had become intolerable,” Val wrote. “It was a pain that was driving Ros insane … a strong word to use, but he felt that way - he could no longer control his thoughts, and was more and more living in a pain-filled fantasy land.”
Val clung to what could be controlled and spent hours online ordering presents for his last Christmas - not to know that within a month those jigsaws and books would be beyond him, as would simple tasks like making a cup of tea.
“I can’t leave him alone as he gets so confused,” she wrote to their doctor.
Only food and chocolates brought comfort, as did his beloved cat, Callie, who snuggled up with him through sleepless nights.
Ros spent most of Christmas Day in bed. He challenged everything his wife said, with traces of uncharacteristic aggression in his voice.
The break happened two days before New Year. Ros accused Val of stealing his money and then turned his frustrations on a visiting friend.
A distressed Val called for help. The paramedics found Ros on the bedroom floor and gently coaxed him to their vehicle. When Val tried to accompany him, he pushed her away.
The room of ‘lost hopes’
Because of violent behaviour (aggression can result from dementia, but Val also thinks the restricted blood flow to his brain and pain played a part) Ros was put on 24-hour watch in Tauranga Hospital’s admission planning unit.
His anger towards her was gone. She arrived early each day, so he didn’t fret - a pattern continued later in the aged care homes.
Ros asked her to contact his doctor and anyone else who might break him out.
“His brain was working overtime, plotting, planning, it wouldn’t give him peace, it wouldn’t allow him to switch off and sleep,” Val wrote.
After some days, he was shifted to a secure room, shared by three others.
Val felt it a place of “lost hopes”.
“The ladies who sit with their men wear a heavy spirit of acceptance,” she wrote. “They are realists.”
All the same, the daily routine calmed him.
“He became very entertaining, in an endearing way. He had plenty to say regarding the running of the ward, the meals, and fellow inmates - and even more to say about the creatures that wandered around the place, the cats, dogs, rabbits and ducks,” she wrote.
From his bed, he commanded a force of submarines. At night he visited a secret inland Navy base at Murupara, and returned via Matatā Beach, to walk or have a beer with the boys.
He roamed as far as the South Island but was always back in his hospital bed by daybreak.
Real estate was another pursuit. An amused Val was informed he’d sold their home and she had two days before settlement.
The doctors prescribed antipsychotic drugs, which didn’t seem to touch the sides. He was deemed calm enough to be discharged, anyway.
Val wanted him home, but was told that was impossible: her husband was much stronger, even with his cancer, and his behaviour erratic. What if, for instance, he woke in the night and mistook her for an intruder?
A social worker talked a reluctant local rest home and hospital, “Home One”, into taking him.
Ros was transferred on January 12, 2022.
He had an end room, far from the social area. Val was told the much-too-small bed was, essentially, one size fits all (later she’d learn he often slept on the floor).
The residents who didn’t spend their days dozing didn’t want anything to do with the new arrival. He’d provoke them by using the wrong name or getting too close, behaviour Val saw as his mischievous way of trying to make friends.
One day she watched her “loner” husband approach a man reading a newspaper and touch his walker. He did it again after being shooed away, and was kicked.
Ros caused problems: roaming at night, entering other rooms, destroying property, flooding bathrooms.
Staff preferred him seated during the day, Val believes, and his physical ability fell away - he soon struggled to get out of a chair, and needed a walker.
Family visitors worried he wasn’t eating enough. Ros complained of a staff member hitting him and other cruelties. Val felt lost in the woods; was there any truth to this? His bruising was attributed to frequent falls.
A doctor visited residents once a week and found Ros in tears of anguish.
“People reckon neuralgia is one of the worst pains there is. His wouldn’t stop, because that tumour was sitting on the nerve,” Val says.
One morning in early February she arrived to find her husband gone. He’d been moved to hospital after attempting to attack a staff member, but nobody had phoned her.
Back in his old hospital room, Ros was soon walking unaided. An amazed Val wondered what to credit: care, expectations, or encouragement.
He talked and talked, and bonded with his roommates. When one left, he and Ros shook hands, called each other “mate”, and promised to meet again.
His real estate business picked up, and Val learned he also worked undercover for the police - “hush-hush stuff, and I’m not to worry if he’s home late”.
In the real world, their daughter Melissa moved down from Waiheke to support her mum.
On fine days they took Ros for a circuit in a wheelchair. He was nervous, until Melissa explained the chair was actually “voice-controlled”, after which he called out directions: “straight ahead-left-right-left-backwards”.
Those rare moments of fun were punctured when a social worker told them Ros would have to move on.
His violence ruled out the geriatric ward. The move to aged care would be more carefully planned this time, she promised.
Val phoned Hospice about bringing him home but was talked out of it. Omicron was sweeping the country and could leave her isolated as his only caregiver.
Their 48th wedding anniversary arrived. Val and Melissa wheeled Ros to a cafe and fetched him a long black and chocolate brownie with whipped cream.
“Rising to the occasion he was so perfectly behaved, and we were both so proud of him,” she later wrote.
“After a short walk, it was back to the hospital, by which time he was exhausted, and we left him happily, soundly, sleeping.”
Home 2
Soon afterwards, Val was told “Home 2″ had a spot for Ros, with a catch - it was a premium room, with ensuite, meaning an extra charge of $55.40 a day.
That would be additional to Ros’ superannuation, which was paid directly to the home.
Such charges are a growing revenue stream for the largely for-profit aged care sector. Government funding covers only a standard 11-square-metre room with shared bathroom facilities.
Paying would leave Val with $50 a fortnight to live on, but the options for Ros were limited, given he needed both dementia and hospital-level care, in a facility Val could reach by bus.
“To put that to someone, when it’s their mum, or their husband, or wife … there’s guilt involved,” she says of the charges.
She was called a week after declining the room and told he could have it anyway.
That’s because of a rule that allows a premium room charge for a new resident only when the facility has found another aged care home within 10km with a standard room available.
They hadn’t, so Ros got the room - in a secure ward called Happy Home - at no extra charge.
Covid restrictions allowed only one visitor into an entire ward, for up to 30 minutes.
Val was uneasy; why was Ros considered unsuitable for the hospital geriatric ward but okay for an aged care home with fewer staff, among other vulnerable residents?
That feeling intensified after her first visit.
She found Ros inconsolable, asking where his wife was, why was he there, could someone fix his eye?
“My heart slipped down to the bottom of my toes, and even after an extended visit I came away with anxiety clouds hanging about my head,” she later wrote.
The next day he wandered the corridors from 4am, looking for Val or an exit. She found him in tears.
During the following visit, a nurse pulled her aside - Covid was in the facility. She felt sick. How would Ros cope without her visits, only interacting with masked and goggled staff in full PPE?
Not well, it turned out; he refused to take his medications and smashed a window while desperately searching for a way home.
“The Covid lockdown is for seven days; I sincerely hope during this time that he forgets we exist so he can find some peace of mind living in his own world,” Val wrote.
Another phone call - Ros had attacked staff with a laptop computer and was back in hospital.
Val found him “unrepentant of his Rambo-like behaviour, telling me he had been promoted to head of department, and it was his job to uncover and deal with the conspiracies that were surfacing at Home Two”.
“And then came the main reason - they wouldn’t help his pain. The only way to get their attention was to use violence. In his own mind, he was saving both himself and the world.”
A visiting mental health nurse saw the hospital’s chief psychiatrist pass by and went in pursuit.
“She brought him in. I explained what had happened. And he said, ‘It’s a pity he wasn’t my patient.’ And the darling girl said, ‘Make him your patient,’” Val remembers.
“He thought for a minute, and said, ‘Okay.’ From then on, it was as it should have happened.
“After a short stay in his ‘old ward’ they transferred him to the mental health for the elderly ward - the 10-bed ward for the whole of the Bay of Plenty - put him on a morphine pump, in a beautiful bed. He was so comfortable, he lay back and slept.
“A big problem in the past was that his mind would not let him sleep. Sometimes he wouldn’t sleep for two or three days. But when he was on the morphine pump, he started to sleep.”
Val wrote an email to the social worker, apologising for her husband’s violent outburst.
“This is the man I have seen cry and beg for help from doctors since February last year, so if pain can drive you mad, maybe this is the case.
“He is happy in hospital with sides on his bed and his morphine pump ... I’ve been able to have a direct question-and-answer conversation with him (also talk of the cats, and the league and how the kids are doing), which has not been the case for quite some time.”
A psychiatrist visited Ros, now in the mental health ward, and as the patient drifted into sleep Val described his restless brain, the dreadful pain, the hallucinations and despair.
Ros opened his eyes wide: “That man you’re talking about, he’s got the same thing as me.”
After further tests, Val was told he had two weeks to live, maybe less.
On March 27 last year, Ros told his wife he thought he was dying.
“I’d been told about ‘giving permission to die’,” she says of that moment.
“He had always been a big family tree man - he was dotty over genealogy. So I said to him, ‘That’s okay, it’s time you went to meet your ancestors, they’re all waiting for you up there, so you go and walk in their footsteps, it’s okay, you go and see them.’”
Visiting hours ended, and around 9.30pm the hospital rang to say he’d passed. He was 81.
“You couldn’t feel sad about it. He had finally found peace,” Val says.
“I know he wanted to die.”
Under-funded, over-counted
Services that focus on the mental health of older New Zealanders like Ros are severely under-resourced, and officials have over-counted the number of beds actually available.
That’s the conclusion of damning new research, published this month in Australasian Psychiatry, the Journal of the Royal Australian and NZ College of Psychiatrists.
“Psychiatry of old age” services include inpatient public hospital beds and psychogeriatric beds, which are publicly funded but generally located in private aged care facilities.
Clinicians in this specialty meet annually, and ahead of that happening last September, a survey was sent to a representative from each of the country’s 20 health districts.
Information was obtained from 17 services. The mean number of inpatient old-age psychiatry beds was 1.6 per 10,000 older adults (aged 65 plus).
That’s a drop from 2.8 in 2017 - likely because of a failure to increase services as the population grows and ages, and far below the level recommended by international expert consensus.
The researchers, who include Dr Gary Cheung, associate professor in psychiatry at the University of Auckland, compared their findings to resourcing numbers given by the Government and found the latter could be significantly overstated.
“It was clear that data are either not being captured, or captured in a way that is not accurate or transparent,” they concluded.
By region, the researchers found actual inpatient beds ranged from none (Tairāwhiti, Hawke’s Bay, Wairarapa, West Coast, South Canterbury) to 4.1 per 10,000 (Canterbury), with similar variation for specialist and psychogeriatric bed numbers.
Bay of Plenty - covering Tauranga Hospital, where Ros was treated - has only 1.8 inpatient hospital beds and 0.8 old-age psychiatrists for every 10,000 older residents.
New Zealand’s 65 and over population will double by the 2050s, to about 1.4 million. The country is under-prepared, warns the College of Psychiatrists.
“There are definitely limited services,” says Dr Hiran Thabrew, the college’s NZ chair.
“There are good people working in them, who are trying to make the best of the situation. But we have quite a bit of concern about the system’s ability to meet current as well as impending demand.”
That scarcity puts pressure on aged care homes, which are often under-staffed - the sector is short around 1000 nurses, and those left have worked double or even triple shifts to plug gaps.
Val often couldn’t find a staff member at Home Two to get Ros to the toilet, or even buzz her out at the end of a visit.
“There were maybe 25, 30 people in that wing, and you could walk around and around, and not find a staff member.
“No wonder they struggled with Ros. He needed to be in a hospital on a morphine pump. Right from the start.
“Old people are not afraid of dying, but they are afraid of how they are going to die.”
Bay of Plenty Te Whatu Ora ordered a review after receiving her account, and in February wrote to her and said: “We understand this was a very distressing time for you and Rosney, which may have been avoided if consideration had been made around his pain and symptom management, and the decision to transfer Rosney to a care facility.”
The health authority declined to comment further for ethical and privacy reasons but, speaking generally, told the Weekend Herald that acute hospital inpatient beds aren’t suitable for patients with dementia or who need palliative care, particularly as their condition worsens.
“Acute inpatient services are not designed or intended for ongoing longer-term care. Where appropriate...they would be transferred to a different setting - for example, aged residential hospital-level care, or to the mental health specialist older persons unit,” said Debbie Brown, senior advisor for governance and quality.
“Both of these facilities have access to appropriate specialist support.”
What does Val hope comes from this article?
“More mental health for the elderly wards. And for younger people, too.
“And somebody standing up to say, ‘We are putting some of this funding back into the public health system, and not into the private aged care system.’”
Ros’ superannuation was paid straight to the aged care homes. A similar transfer to public hospitals should be considered to increase capacity, Val says.
“Walking into a hospital ward, I had confidence that Ros was in the right place. I never had that feeling in either of those homes.”
A loved dad
As a child Ros played in the wildlands that were becoming Tawa, chasing cockabully fish in the local creek and paddling a corrugated iron canoe, sealed with bitumen scraped from the road.
He and his brother helped their dad build two houses. Six more siblings arrived. Ros sold newspapers, mowed lawns, bottled beer and worked for a butcher who taught him to drive.
He met Pauline aged 16 and was in his first year of university when they learnt they were pregnant with their first child.
Ros took an engineering cadetship. Three more children followed, and those early years were a juggle of work, night classes and preschoolers.
He and Pauline later divorced, and in the 1970s he met Val.
“I’m not sure how he felt taking on two more kids, but he was a cool dad to us,” Melissa told his service at Pyes Pa Memorial Park.
“Taking us blackberrying, scavenging for firewood, going for bushwalks and, after we moved to Whakatāne, long days on the beach.
“We were a big, diverse family, replete with dogs, cats and budgies, and eventually joined by a mother-in-law who needed care, and an intellectually impaired brother-in-law.”
Ros loved his job, a passion that threads through Whakatāne - he was the engineer in charge of the new main street layout, Awatapu Lagoon, Te Teko tennis courts, the walkway along the stop-banks, and much more.
Daughter Rebecca told the memorial that, growing up, he encouraged her to do all the “boy” things.
“I know how to hammer a nail and paint weatherboards because you let me … once you took the head cover off the old noddy motor, and showed me how the valves open and closed, and explained how the pistons went up and down. I was so pleased to get grease on my hands.”
Melissa remembered the vigilance, patience and restraint, and “the way he went about the house, poking things, wiggling things, tightening screws, making sure everything is ship-shape”.
“And the hours and hours on the beach, somehow defying the odds by almost never catching a fish.”
The service closed with These Hands by Johnny Cash.
A few weeks later, Val updated family and friends on Facebook. She was finally sleeping well - “even if a certain ginger cat thinks my face is for head bumping and my body for running a marathon up and down” - and had started writing again.
The final word is from that work.
“There will always, always, be a misty sorrow of loss, but please at this time I ask all concerned to give Ros a blessing for this, his last journey - the pain has gone.”
