A rest home nurse acknowledged gaps in a woman's care – but cited a "96 per cent" likelihood she would die soon anyway.
The email between the registered nurse and manager at Gisborne's Dunblane Rest Home and Village was forwarded to the resident's alarmed daughter.
It's now included in Leigh Morrow's complaint to the Health and Disability Commissioner, and has been provided to the Weekend Herald.
To see someone you love so much gasping, and trying to get some moisture on her lips
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The facility, owned by aged care giant Oceania Healthcare, has apologised for oversights leading to a serious accident that Alison Jackson never recovered from, and acknowledged delays in rehabilitation for a broken femur.
Morrow believes the latter ultimately killed her mother.
"She spent six unnecessary weeks lying on her back, which without doubt was either the cause of or hugely contributed to her chest infection."
The local DHB has completed its own review on how its physiotherapy service communicated with the rest home.
Alison was living in Dunblane's dementia wing when she fell after exiting a van on October 16 last year. There was one staffer helping residents disembark, no walking frame available or place to sit, and the van was further than normal from the building.
While another resident was being offloaded Alison, who weighed 47kg and normally used a walker under supervision, took a few steps and fell heavily to the ground, smacking her head and breaking her pelvis.
After a week in the local hospital she returned to Dunblane's hospital wing, and the next month a DHB physiotherapist set up a rehabilitation plan, including use of a standing hoist and to be mobilised as pain allowed.
In mid-January – and having not heard any updates despite ringing almost daily – Morrow chased-up Dunblane's manager, who forwarded an email he received from the senior registered nurse.
"Just reviewing Alison Jackson's file now," the nurse wrote. "The physio also stated in their notes that once Alison was tolerating standing for longer periods that the physio would follow up and see if it was appropriate to trial walking, I don't believe that this has happened."
The nurse said her background meant she had plenty of experience with older patients with pelvic fractures, who mostly didn't get back to their pre-fall abilities.
"The statistics for survival post-injuries have never been good. When I worked at the DHB most patients survived the surgery and the first 6 months but something like 96 per cent of those went on to die. I'm not sure of the current statistics but I can't imagine they would be very different."
When she read the email Morrow said she thought, "'Oh yeah, so 96 per cent die anyway so what do you care?'
"But I don't believe that lack of rehab was motivated by the fact she probably wouldn't survive anyway. I think it slipped through the cracks."
When the hospital physio eventually returned, Morrow said, she got Alison to walk across her room.
But four days later a doctor called to say Alison had deteriorated after developing a chest infection.
End-of-life care was started and she died in the early hours of January 28.
"If people knew..." Morrow recalled.
"I sat and held my mother's hand for days.
"To see someone you love so much gasping, and trying to get some moisture on her lips… for six days."
In an initial response to the Health and Disability Commissioner, Oceania Healthcare apologised for the oversights that enabled Alison's accident.
The group, which operates 49 aged-care and retirement village facilities, acknowledged there was no physiotherapy provided until intervention by its senior operations manager, which "clearly does not meet Oceania standards in rehabilitation".
Staff got Alison up on occasion and she managed to take a few steps, Oceania stated.
Changes made since the accident include ensuring two staff members help residents from the van, and using a closer entrance.
Oceania's chief executive Earl Gasparich declined to comment, given the matter was before the Health and Disability Commissioner.
"We take complaints of this nature extremely seriously and will be working with the Commission to ensure that the matter is appropriately investigated."
Kate Mather, clinical care manager for the DHB, Hauora Tairāwhiti, said it was aware of concerns about communication between Dunblane and the physiotherapy service.
The HDC would report on whether the DHB's processes around rest home residents needing physiotherapy could be improved.
"While we await the Commissioner's feedback we have completed our own review. We extend our condolences to Mrs Jackson's family."
Morrow decided to speak out after a Weekend Herald investigation found a third of the country's 651 aged care facilities have had recent shortcomings related to resident care. These shortfalls can be viewed in a special interactive.
Dunblane's daily care staff were fantastic, she said, but her concern was with management and processes – and she backed calls from Age Concern, Grey Power and others for reform in the sector.
"The number of people who don't have family to advocate for them… her death can't be in vain. I can't let that happen."