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Standard of care provided to incontinent rest home resident with pressure sores (96HDC3695)

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(96HDC3695, 9 June 1997)

Right to services of an appropriate standard ~ Reasonable care and skill ~ Compliance with professional and other standards ~ Services provided in a manner consistent with resident's needs ~ Minimising potential harm ~ Right to cooperation among providers ~ Rest home ~ Manager ~ Incontinence ~ Pressure sores ~ Communication ~ Elder care ~ Right 4(1) ~ Right 4(2) ~ Right 4(3) ~ Right 4(4)

A complaint was made by a woman about the services provided to her father by a rest home. The complaint was on the basis that the hospital section of the rest home (1) used padding for her father's incontinence management and did not use a catheter or urodome; (2) her father had broken pressure areas on his buttocks and a weeping ulcer on his left leg above the ankle; (3) he was left sitting idle in his chair, half asleep, during occasions when there were visitors at the rest home; (4) on one occasion when she visited the rest home, she found her father slumped in his chair with dry crusty food in his mouth, his eyes full of yellow dry matter and an appearance of neglect; (5) he was found by his wife lying flat on his back with a cup of tea left beside his bed; (6) an armrest was missing from his wheelchair and had not been replaced; (7) information concerning his condition was never offered by staff; and (8) the registered nurse cover at the rest home and the training of staff were of concern.

The investigation report notes that:

(1) for this resident, incontinence pads were considered more appropriate than a urodome or indwelling urinary catheter;

(2) the resident has sensitive skin, which requires particular care. Staff expressed a desire to try to manage the resident in bed more frequently, to take pressure off his sacral area. The ankle ulcer was dressed daily and a 'Spenco' mattress was used to reduce the risk of pressure sores developing;

(3) the resident was reported to enjoy a number of provided recreational activities;

(4) the resident has chronically inflamed eyes despite treatment with eye drops;

(5) the manager accepted responsibility for the arm rest not being replaced;

(6) the manager communicated regularly with the resident's wife, but following this complaint arrangements were put in place to keep other family members informed; and

(7) there is regular in-service training of staff.

The Commissioner held that the manager and staff at the rest home did not breach Rights 4(1), 4(2), 4(3), and 4(4) of the Code because the overall care and treatment of the resident was reasonable in the circumstances. The decline in the resident's condition did not appear to be related to the care provided by the rest home. Some suggestions were made about alterations in the care provided, and in communication with the family and between the staff and manager.