Alzhiemer’s patient sent home from hospital despite warnings she wouldn’t cope

A woman with advancing Alzheimer’s disease was sent home from hospital twice without referral to an older person's service for help with her declining cognitive function. Photo / 123RF

A confused and disoriented woman with Alzheimer’s disease was twice discharged from North Shore Hospital with no support to monitor her food and medication intake, and in one instance she was taken home by taxi with no keys to her home.

The woman was also not referred to an older person’s service despite the concerns of friends and family that she was not coping at home alone.

Aged Care Commissioner Carolyn Cooper has criticised Te Whatu Ora Waitematā in Auckland for the failures and ordered the former district health board to apologise.

The woman was in her 80s at the time of the discharges in September and October 2020.

Identified only as Mrs A, the woman was living alone in the community with Alzheimer’s and was supported by her elderly sister, a friend - who also had dementia - and the friend’s daughter-in-law.

The woman’s daughter, who held enduring power of attorney, was living overseas at the time.

In her investigation findings, released today, Cooper said the woman was first admitted on September 6, 2020 with a urinary tract infection.

She underwent two assessments which both cleared her for discharge home.

This was despite the woman being unable to recall what day it was and her support group raising concerns about how she was coping at home.

On the afternoon of the first discharge, the woman returned home by taxi and had no keys to get inside her house.

The night of the second discharge, Mrs A’s friend reported she was disorientated and agitated when she again arrived home by taxi.

She was re-admitted to hospital as a “failed discharge” and remained there for two weeks, a situation known as “bed blocking”, before being discharged to aged residential care.

Aged Care Commissioner Carylon Cooper was critical of Te Whatu Ora Waitematā for its care of an elderly woman with dementia. Photo / Supplied

Cooper found Te Whatu Ora Waitematā failed to comply with core health and disability standards and the failings amounted to a breach of the Code of Health and Disability Services Consumers’ Rights (the Code).

The failings included not making a referral to a specialist older person’s health service during both admissions.

“During the second admission, the deterioration in cognitive function was clear and the occupational therapist identified that this would likely be the woman’s last chance to live independently at home.”

Cooper noted the decision to discharge the woman the second time, given her clear decline in cognitive function from the first admission, was inappropriate, particularly given the decision was made prior to the occupational therapy assessment and the woman’s daughter was not made aware of the results of that assessment.

The hospital also failed to contact the woman’s GP for more information about her cognitive function and failed to appropriately act on information supplied by the woman’s support people, Cooper said.

The woman’s friend said she wanted others living with dementia in New Zealand to be well cared for in hospital.

”Families shouldn’t have to rant or complain to receive safe and appropriate care for their loved ones,” she said.

Cooper also found Te Whatu Ora Waitematā breached Right 4(5) of the Code, which gave consumers the right to co-operation among providers to ensure quality and continuity of services.

“Te Whatu Ora Waitematā had a responsibility to ensure that the woman was provided with services that complied with the Code, and for ensuring that it planned and coordinated the woman’s discharge from hospital appropriately and safely.”

Cooper recommended Te Whatu Ora Waitematā provide a written apology to the woman, her whānau, and her friend, update the Referral to Specialist for Advice and Care Review guideline to include a definition of “complex needs”, and update the Entry Criteria and Referral Process - Mental Health Services for Older Adults (MHSOA) guideline to include further guidance for staff on how to proceed when a specialist referral has been declined.

Alzheimer’s NZ chief executive Catherine Hall said people living with dementia were being let down by the health system every day.

“The situation that’s described in that Health and Disability Commissioner decision is not uncommon.”

Hall said people were struggling to get a diagnosis of dementia, get the help and support they needed when they presented urgently and ended up in hospital, get referrals to specialist services, and also get help at home.

“Dementia is a pretty tough condition to live with and people are mostly not getting the help and support they need and we end up with tragedies as a result.”

Alzheimer’s NZ had written a plan to address the gaps but Hall said it had not been implemented.

In a statement, Te Whatu Ora Waitematā said it had apologised for the failings.

“While the inpatient care this patient received was of a high standard, we acknowledge the clinical decision-making that led to her being discharged home following a second admission last October was not of the standard we would expect.

“Our aim at all times was to protect the dignity and decision-making rights of the patient but agree aspects of her care could have been improved upon. We are addressing each of the Commissioner’s recommendations and believe this will reduce the potential for the same scenario to occur with another patient.”

Natalie Akoorie is the Open Justice deputy editor, based in Waikato and covering crime and justice nationally. Natalie first joined the Herald in 2011 and has been a journalist in New Zealand and overseas for 27 years, recently covering health, social issues, local government, and the regions.