The retirement village was found to have failed to adequately communicate with the dying woman's family and update her end-of-life care plan.
The retirement village was found to have failed to adequately communicate with the dying woman's family and update her end-of-life care plan.
A retirement village manager who made nurses feel “bullied and unsafe” under her leadership refused to let a woman see her dying mother, stating she was the only staff member who could decide if a resident was dying.
The woman was deeply shocked to see her mother with a blackened tongue and hands, in pain and distressed, stating she wasn’t prepared to see her in such a condition.
Now, the health watchdog has criticised Edmund Hillary Retirement Village and its clinical manager for failing to initiate an end-of-life care plan for the elderly woman and not communicating with her family adequately.
Ryman Healthcare, which owns the Auckland retirement village, has accepted the findings, telling NZME the staff member no longer works there and changes have been made.
“We make no excuses, we should have done better,” said a spokesperson in a statement.
Mrs A, in her nineties, moved to the retirement village to receive hospital-level care, a Health and Disability Commissioner report released today states.
Her medical history included congestive heart failure. Hospice nurses had been visiting Mrs A monthly, noting she was in the “End Stage of HF [heart failure]”, and needed “completely palliative and comfort cares”.
After four months, Mrs A was suffering from nausea, vomiting and light-headedness. Her pain had also significantly increased, and her appetite had decreased. Her condition continued to deteriorate until her death.
An end-of-life care plan was never initiated for Mrs A, despite her being assessed as “completely palliative” by the hospice and her declining condition during this month.
Aged Care Commissioner Carolyn Cooper found the retirement village failed to communicate adequately with the resident's family.
Mrs A’s daughter Mrs B and her family went to visit Mrs A that month, during Covid-19 restrictions, which allowed families to visit residents who were receiving palliative care.
Mrs B spoke with the village manager who apologised for Mrs A not being on the palliative care list and arranged for the clinical manager to take Mrs B to see her mother.
While Mrs B was waiting in the reception area, she received a phone call from one of the nurses caring for her mother who was unaware she was already at the village, encouraging her to visit due to Mrs A’s declining state.
The decision says that shortly after the clinical manager came to the reception area and “confronted” Mrs B, speaking “very aggressively” to her and making her feel as though she was unwelcome and in the wrong for trying to visit her mother.
A nurse who witnessed the interaction said the clinical manager acted ‘rudely and very unprofessionally” towards Mrs B.
The clinical manager then took that nurse and another to the nurses’ station and told them that she was the only member of staff who could decide whether a resident was dying. She said Mrs A was not “actively dying’ and could “live for another ten years”.
One of the nurses said she felt “intimidated, overwhelmed and bullied” by the clinical manager and lost confidence in her own clinical judgement for some time afterwards. The second nurse said she did not feel safe under the clinical manager’s leadership.
Following the discussion at the nurses’ station Mrs B was allowed to visit her mother. Later that day she made a complaint to the village manager about the clinical manager’s behaviour and was told they would contact her about this but never did.
Several days later a nurse contacted Mrs B, encouraging her to visit her mother. Mrs B was “deeply shocked’ to see her mother with a blackened tongue and hands, in pain and distressed, had laboured breathing and was unable to understand.
Mrs B said she felt inadequately prepared to see her mother in the state she was in. Mrs A passed away later that day.
Aged Care Commissioner Carolyn Cooper was critical of the failure to commence end-of-life care planning for Mrs A following the hospice assessment and GP assessment.
She was also critical of the failure to update the woman’s care plans when she experienced deterioration in the last days of her life, even as her needs changed significantly, finding that the village breached their obligation to provide services with reasonable skill and care.
Cooper also found that the communication from the village to Mrs A’s family was not up to standard and the clinical manager behaved “poorly”. She was contacted for comment during the HDC investigation but did not respond.
The village told HDC that a contributing factor to Mrs A’s care plan not being updated was due to the nursing team being influenced by the clinical manager’s view that she was not in the end stages of her life.
The village also said that staff were under pressure due to the Covid-19 restrictions in place during this time.
“I accept that these were difficult circumstances, but this does not excuse the poor interaction that occurred with the family members whose loved one was nearing the end of life.
“This report highlights the importance of timely end-of-life care planning, in partnership with family, and the importance of updating care plans in accordance with palliative and end-of-life needs, and ensuring an environment where staff feel comfortable questioning or correcting the views of those senior to them,” Cooper said.
The village said Mrs A’s experience was “pivotal” in improving the end-of-life care at the facility and has since implemented a variety of changes such as improved recognition of the signs of early deterioration and involving family at the earliest point possible.
Palliative care training and safety guidelines have also been improved.
A spokesperson for the retirement village confirmed that the clinical manager no longer works there and there have been “substantial learnings” gained from the remaining team members.
”The care provided to our resident in this instance was not up to our usual standards, and we apologise unreservedly. We have taken the HDC’s recommendations on board and we have made changes to the way we operate.
“As well as additional staff training and improved communication, the team carries out regular audits to confirm that residents are receiving appropriate planning for end-of-life care and conducts regular assessments for symptoms near the end of life”, the spokesperson said.
Emily Moorhouse is a Christchurch-based Open Justice journalist at NZME. She joined NZME in 2022. Before that, she was at the Christchurch Star.
