The most common issues raised by residents or their representatives is quality of care, specifically:
Inadequate hydration and nutrition- typically identified by family members who notice significant weight loss.
Conditions going unnoticed/undiagnosed until they have reached a critical stage and hospital admission is required – Urinary Tract Infections is perhaps the most common example.
Wound care - particularly in relation to the prevention, identification and management of pressure wounds.
Oral hygiene- residents often not supported to brush teeth daily. One residential respite client did not have their teeth brushed once during a two week stay. Lack of oral hygiene leads to other health concerns.
Chemical restraint – often used as a behaviour management strategy before other less restrictive options have been explored.
Poor medication administering/management – with residents experiencing long waiting times and receiving incorrect doses or medications. Some examples are:
Undiagnosed and untreated oral thrush resulting in resident not eating resulting in significant weight loss and not taking medication resulting in hospitalisation.
Long wait time for medication for Parkinson’s Disease resulting avoidable hospitalisations.
Non-response from visual and hearing impaired resident to instruction to take medication results in medication left on bedside table and lack of monitoring of what happens to it.
Over medication of residents – including anti-psychotic and anti-depressant medications. Residents/representatives who raise questions about their medication can receive patronising responses from clinical staff to their questions, even when medication is no longer required.
Poor continence management. Rationing of pads can result in Urinary Tract Infections, scalding, and sores as well as a loss of dignity. Continence assessment may not be carried out by a qualified person. It is often family members who detect the need for a clinical response.
Mental health issues – residents are often not provided with psychological supports such as counselling or therapy for issues including grief and loss, depression, anxiety, trauma, PTSD, domestic violence, and on-going mental health disorders affecting quality of life.
Pain medication not administered over night as no qualified staff (RNs) and have to wait till morning. Not appropriate for palliative care, chronic pain, falls where severe pain may be treated by phone order.
Untrained junior staff telling residents to wait 15 minutes to see if their chest pain settles before calling the RN to review them
Graduate RNs used with no experience or supervision to plan for care of older people with complex needs
Insufficient physiotherapy to promote independence and maintain mobility, and to prevent contractures
Speech pathologists and dieticians not routinely requested to assess for swallowing and nutritional needs; supplements available but not used to address weight loss
General practitioners are reluctant to visit residents in aged care as cannot find trained staff to provide medical history and record signs and symptoms of change in condition
Medical appointments cancelled in rural areas due to lack of transport to regional hospitals and centres.
In OPAN’s experience, the underlying reasons for clinical care issues are:
inadequate staffing numbers
time constraints leading to staff taking short cuts
inadequately skilled workers unable to monitor, assess, identify and respond to clinical issues on a day to day basis
lack of accountability and supervision
poor culture – “she’ll be right” attitudes, carelessness, low standards.