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Nurses horrified by ‘weeks of neglect’ of woman from Covid-hit Melbourne nursing home

An elderly care home resident who was transferred to hospital from a facility that was beleaguered with Covid-19 died with 18 sores on her body and was suffering from “pure neglect”, a nurse who treated her has told the Guardian.

The woman in her 90s was transferred to St Vincent’s private hospital in East Melbourne from the Kalyna Care aged care facility after she was found in her room with infected wounds on her leg.

The nurse involved with her care at St Vincent’s said when the woman arrived she and other nurses were “absolutely horrified” by the state she was in, and that the patient was delirious. The woman died last week.

Kalyna Care in Delahey was taken over by the Victorian government along with Glenlyn aged care facility in Glenroy and Florence aged care facility in Altona North almost two weeks ago due to the homes being unable to cope with coronavirus outbreaks.

The director of Kalyna Care told Guardian Australia last week that the home was well-run until the first case of Covid emerged in a staff member on 26 July, before spreading throughout the home’s workers, placing the home under immense pressure as residents became infected too.

But Guardian Australia can reveal the home failed an audit conducted by the aged care regulator three weeks earlier, on 5 and 6 July, which found the wounds of residents were not properly treated and that “management of pain does not ensure consumers are as free from pain as possible”.

An Aged Care Quality and Safety Commission assessment team found Kalyna Care flunked all five requirements on which it was tested. The commission found staff at the home “do not have the knowledge and competency to perform their roles effectively”.

Timeline

Coronavirus outbreak at Kalyna Care


Regulator audit

Aged Care Quality and Safety Commission (ACQSC) audits Kalyna Care. Finds staff are not recognising deteriorating wounds and not responding to pain in a timely manner. 

Federal health department notified

The federal health department is notified of the positive case and assigns a case manager to the home.

Regular testing begins

Sonic Healthcare begins regular testing for Covid-19 at Kalyna Care after a request from the federal health department. Kalyna Care makes first contact with the Victorian health department.

State health department visit

A Victorian Department of Health and Human Services squad visits Kalyna Care to give advice on infection control.

Kalyna Care asks for help

Kalyna Care management asks the federal and state health departments for help, in the shape of additional workers, to manage the outbreak.

Seventh resident tests positive

Another resident tests positive, bringing the total to seven; Kalyna Care says seven staff are also positive.

Audit finalised

ACQSC finalises its audit report after receiving a response from Kalyna Care management. The regulator says the home fails all five requirements covered in the audit. Kalyna Care agrees to address the failings. Federal health care minister Richard Colbeck is notified of the findings and Kalyna Care’s response.

Victorian government takeover

Following a request from the federal government, Victorian government health service Djerriwarrh Health Services takes control of Kalyna Care.

Thirty-five test positive

 More than 20 residents and about 15 staff have tested positive for the virus, according to Kalyna Care management. Guardian Australia reveals shocking details of a resident’s wounds when they were admitted to hospital.

The commission said there was evidence that “the deterioration [of] consumers’ wounds are not recognised and responded to in a timely manner” and that “changes in consumers’ pain is not recognised and responded to in a timely manner”.

The elderly woman who died was the subject of a previous Guardian report on Kalyna Care. She had long been suffering from several complex health conditions. But a nurse involved with her care at St Vincent’s said when the woman arrived, nurses were “absolutely horrified” by the state she was in.

“She was delirious, due to her wounds being infected,” the nurse said. “When an old person has an infection they are quite confused. We found multiple wounds all over her body. It wasn’t just one. We were stunned at how neglected she was. Someone attempted to wash her before she came over to us, but it was obvious her hair hadn’t been washed in a while.”

The nurse told Guardian Australia that the nurses at St Vincent’s were well resourced and highly supported by management, and several nurses began immediately working to make the woman as comfortable as possible. But nurses were also under immense pressure, receiving aged care residents from multiple facilities, many of whom did not speak English, and did not always have time to extensively brief families, she said.

Exacerbating issues is that many nurses in private facilities are used to working with patients who come in for elective surgeries, such as ear, nose and throat surgery or plastic surgeries, and do not necessarily have experience working extensively with complex aged care cases, the nurse said. But she said the nurses immediately recognised the need to give urgent care to the woman and began to manage her pain and change her dressings.

“As the day went on we spent an hour-and-a-half to two hours redoing just her dressings,” the nurse said. “We started a morphine infusion. The whole day, everyone was distressed. This was pure neglect. It was really obvious she had been left in a room to rot. Someone said there was about 18 sores on her body. The worst was on her sacrum [the bone at the base of the spine]. It was roughly two centimetres, maybe three centimetres deep and necrotic.”

The nurse said the wounds ranged in severity. Some were recent, and mild, she said, the result of not being rotated and skin pressing against the bone. But other wounds were deep and infected, she said, and had been exposed for prolonged periods to moisture.

“This was the culmination of six to eight weeks of neglect,” the nurse said. “I’ve never seen anyone so neglected before. She did not die of natural causes. Her case should be referred to the coroner.”





The exterior of the Kalyna Care home in Melbourne



The Aged Care Quality and Safety Commission’s audit found the wounds of Kalyna Care residents were not properly treated

A spokeswoman for Victoria’s coroner’s court said: “At this stage, no deaths from Kalyna aged care in Delahey have been reported for inclusion in the state coroner’s investigation into aged care deaths.” A spokesman from St Vincent’s Private East Melbourne said the hospital was “confident our staff gave the patient’s family an accurate description of her physical health, both at admission and throughout her stay, via regular contact”.

Since the beginning of Victoria’s second wave of Covid-19, St Vincent’s Private has admitted more than 50 people from aged care facilities for care and treatment, the spokesman said.

While the commission conducted its audit of Kalyna Care in early July, its final report was not delivered until 5 August, when the regulator instructed Kalyna Care to agree to make changes to improve care for residents. A commission spokeswoman said the regulator then became aware of a case of Covid-19 at Kalyna Care on 27 July.

“The situation at Kalyna Care has been very challenging for everyone involved,” the spokeswoman said. Kalyna Care was previously audited in September 2019. It passed with flying colours and the commission relicensed it for another three years.

But when an assessment team visited again less than a year later, and before the home first reported any Covid-19 cases, they discovered Kalyna Care failed licensing requirements including making sure that “consumers receive safe and effective personal and clinical care”, properly managing medical risks, and ensuring staff were skilled in recognising when the medical condition of residents was declining.

“Management have not adequately identified deficits in staff competency, knowledge and practice,” the commission said in the audit report.

“Consumer representatives interviewed indicated that when requested staff are responsive to consumers care needs, while a representative described how she must ‘push everything’ in relation to her father’s care.”

The regulator said Kalyna Care acknowledged the problems and agreed it had to improve. “The assessment contact conducted in July was not in response to a Covid-19 outbreak,” a commission spokeswoman said.

“There was no outbreak at this time. The commission does not provide information about the findings of assessment contacts to the minister or other government authorities in advance of making a decision about the service’s compliance. The findings of the assessment contact were taken into account in issuing the ‘notice to agree’ to the provider on 5 August 2020.”

She said the federal aged care minister, Richard Colbeck, was aware of the commission’s work in monitoring and supporting Kalyna Care’s efforts to manage its outbreak, alongside multiple other agencies. The commission advised the minister that it had issued the notice to agree on the day it was issued.





A sign at the Kalyna care home in Melbourne



Kalyna Care says it made repeated and desperate staffing requests and couldn’t immediately get help. Photograph: Sandra Sanders/Reuters

Colbeck told Guardian Australia Kalyna Care first requested workforce assistance from the department on 30 July, four days after the first case in a staff member.

“From 30 July 2020 the department worked with the Victorian Aged Care Response Centre and the Victorian Department of Health and Human Services and sourced staff for the service,” Colbeck said. He said he did not know about the commission’s audit of the home in July until it had finalised its report in August.

“The reason for this is that, in making a decision about a service’s compliance with the Aged Care Quality Standards, the commission considers a range of information including evidence gathered during an assessment contact, the approved provider’s response to the assessment team’s report resulting from the contact, and other information available to it about the service,” he sad.

“It is vital that this process is undertaken objectively and independently.”

Victoria’s Department of Health and Human Services first had contact with Kalyna Care on 28 July, at which time they only had a single confirmed case linked to the facility. The department advised on operational changes required during an active outbreak.

A DHHS ‘outbreak squad’ visited the facility the next day to offer on-the-ground infection prevention and control advice. However, the commission is a federal agency, and the outcomes of its audits are communicated to the facilities it audits, but not to the state government.

A Victorian government spokeswoman said the federal government only requested help managing the facility last week. “A dedicated health team and management team from Djerriwarrh Health Services took charge last Thursday to provide on-site support and staffing at Kalyna Care, including infection prevention control advice, and is in daily contact with families,” she said.

The chair of the board of Kalyna Care, Halja Bryndzia, said she would not be answering further questions from Guardian Australia.

But previously she had described the situation at the care home as “gut-wrenching”. She said the home had asked for help, which was not immediately forthcoming. “We made repeated and desperate staffing requests and we couldn’t get them, and those requests started from the end of July,” she said.

“But Victoria, generally, has a problem with infected aged care staff and healthcare workers, and so they needed to start sourcing workers from interstate. Eventually, we had people from Queensland and New South Wales come in to help us this week. In the meantime, we are a Ukrainian facility and so we called out to that community for anyone trained and willing to help. We are just one of about 100 places in Victoria that lost staff through no fault of their own.”

Read the original article at The Guardian

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