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Management of a rest home resident's care during a period of transition (08HDC04291)
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(08HDC04291, 19 March 2009)
Rest home ~ Private hospital ~ Registered nurse ~ Clinical
nurse manager ~ General practitioner ~ Skin integrity ~ Nutrition ~
Standard of care ~ Documentation ~ Transition ~ Change of ownership
~ Right 4(1)
This case highlights the challenges and responsibilities faced
by a new rest home owner when taking ownership of an existing
facility. Taking on a rest home is not like any other business.
Along with buildings and staff come vulnerable residents for whom
the facility is home. Dealing with difficult circumstances, having
to introduce new policies and procedures and familiarise staff with
them, and the need to assess staff competency levels and prepare
for certification audits, does not excuse owners from the duty to
ensure that residents continue to be well cared for while changes
are implemented, and to support staff in key management positions
during the transition.
In such instances, team work, collaboration and regular
communication between all parties are vital. The lack of direct
information given to a man's family towards the end of his life was
one reason that prompted a family to complain.
An 85-year-old man was transferred to a rest home following an
admission to hospital for a left hip fracture. He had multiple
medical problems including advanced Parkinson's disease with
associated cognitive impairment, depression, postural hypotension
and compromised skin integrity. His elder daughter lived overseas,
and his younger daughter had an enduring power of attorney.
The rest home was previously owned by a company that went into
receivership. During this period, the clinical nurse manager left
and the rest home was without a clinical nurse manager for several
months. A fortnight after a new clinical nurse manager was
appointed, another company took ownership of the rest home. Over
the ensuing months, the new owner sought to introduce new policies,
procedures and systems to the rest home, and completed several
audits legally required of a new establishment. The nurse manager
was involved in this, and also covered for the facility manager,
who was unable to continue working owing to illness.
The man developed a pressure ulcer on his right hip. Nursing
care to manage his wound continued throughout the year. Although
there were occasional signs of improvement, his pressure ulcer
deteriorated and he also developed a pressure ulcer on his left
hip. Three months later the man's daughter visited and was
concerned by the severity of his pressure ulcers. Following review
by a gerontology nurse, the man was transferred to a public
hospital for surgical debridement. Following several weeks of
palliative care, he died in hospital.
The investigation found that there were deficiencies in the care
and management of the man's ulcers, his nutrition was not managed
adequately, and the deficiencies in the man's care were also
reflected in the documentation by the clinical nurse manager and
her team. The clinical nurse manager lacked insight into the level
of care the man required, and did not fulfil her responsibilities
and manage his care appropriately. Her care breached Right
It was held that the rest home did not take adequate steps to
support the clinical nurse manager and her staff, and ensure that
the man was provided with services with reasonable care and skill.
The rest home breached Right 4(1).