The country's top health watchdog is investigating a rest home's Covid-19 lockdown after workers reported floors dirtied with "stinking" urine and faeces, overflowing bins and residents suffering falls and needing feeding and toileting.
The Health & Disability Commissioner took the extraordinary step of alerting director general of health Dr Ashley Bloomfield and Auckland DHB to a complaint by a colleague of workers at Ellerslie Gardens Lifecare.
The situation has spurred renewed calls for reform of a sector looking after 36,000, and come after an ongoing Herald investigation revealed failures at other rest homes including one where 12 residents died after catching Covid-19.
A hospitalised Ellerslie Gardens resident tested positive for the coronavirus on Good Friday, April 10. Most rest home workers went into quarantine, and Auckland DHB sent in staff to help care for 75 residents, most of whom were confined to their rooms.
The HDC complainant alleged residents suffered without proper care, including no regular toileting, feeding or turning, amidst general confusion and as new workers struggled without support.
"Having carefully reviewed the complaint, I am concerned that it raises issues about a deterioration in the quality of care provided and the possible impact on the immediate welfare and safety of elderly residents," deputy health and disability commissioner Rose Wall wrote in an April 23 letter to Auckland DHB chief executive Ailsa Claire.
In an initial response, Auckland DHB assured the HDC residents were "provided safe and appropriate care".
However, correspondence obtained by the Herald on Sunday reveals several members of staff voiced their own concerns in separate feedback to their DHB bosses.
One nurse reported there was no cleaner during an eight-hour shift, leaving toilets dirty, with urine and soiled toilet paper on the floors. Rubbish bins overflowed with used tissues, gowns, gloves and masks, they wrote, and there weren't medical-grade wipes to clean equipment between patients.
"We could be spreading germs rather than containing it. I believe the standard of care is very poor ... I was asked to work there again ... I declined."
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Another nurse said they were in tears after a shift because an area hadn't been cleaned, a resident was upset about the stink, and that he was unable to leave his room not even for a short walk because of the lack of staff who could come with him for fresh air.
"I really feel sorry for those residents who have to wait for a very long time because there is not enough HCA [health care assistants] who could take them to the toilet, change nappies or feed them on time or without rushing.
"The standard of nursing care in this place is very poor," they reported, with a resident's colostomy bag "looking like it was not changed for a very long time" and a high number of residents suffering falls.
Infection controls were "absolutely poor", and one nurse wrote: "In the five days I have been in [Ellerslie Gardens], I have concluded that our elderly deserved a better standard of care."
A third nurse who'd worked there for two weeks acknowledged it had been a challenging situation. Concerns included mess from incontinent residents left on carpets because of a lack of cleaners - with multiple rooms "stinking".
A lack of documentation meant residents with indwelling urinary catheters who needed them changed could have been missed, the nurse warned. Isolated residents would benefit from video calls or other human contact.
"These residents do need someone to talk to and vent their feelings ... any amount of quality time would be helpful."
Collation of feedback from deployed staff showed positivity about some aspects including the supply of PPE and orientation, but worries including over unsafe staffing levels on night shifts, a lack of equipment and general confusion.
Heritage Lifecare runs 48 care homes and villages, including Ellerslie Gardens. A spokesman said the documents and emails "show the challenge we faced and the steps needed to contain such a highly infectious virus".
Initially, 67 of 75 staff stood down. While replacements from the DHB and agencies were trained and inducted daily, they were mostly not experienced in aged care, he said.
Residents were kept in their rooms, contact with staff was minimised to contain viral spread, and staff did additional tasks such as general cleaning in rooms, ensuites and surrounding areas, and emptying bins.
Daily meetings allowed issues to be raised and acted on quickly, the spokesman said.
"At all times the welfare of our staff and residents was paramount. We believe the fact the cluster was contained, and there were no further positive tests shows the effectiveness of the protocols put in place."
DHB staff were at the facility for about five weeks.
Alex Pimm, of Auckland DHB's incident management team, said an early task was assessing what was working and what wasn't.
"The documents you have received reflect the frank conversations that are a necessary part of this robust assessment ... the majority of the issues raised in the documents were real, and were assessed and appropriately addressed so that residents received quality care throughout the outbreak.
"There is a significant difference, in New Zealand and around the world, between the standards of care that are usually required in aged residential care facilities, and the specific infection prevention and control processes that are required in a Covid-19 pandemic.
"Our joint response proved effective, with only a small number of staff testing positive. There were no deaths. None of the DHB staff caught Covid-19."
The Herald has revealed problems at other facilities, including Rosewood rest home in Christchurch, which had 12 deaths and was found in breach of its obligations including cleanliness and food and laundry services.
Nurses sent to St Margaret's rest home in West Auckland reported "poor or non-existent" orientations and a lack of gowns and eye protection. There was also a need for bins for PPE disposal and equipment.
Grey Power national president Mac Welch said the problems underlined the urgent need for an aged care commissioner, something Labour campaigned on but hadn't actioned.
"Oversight is divvied up between a mass of different people, and no one is policing it effectively - a lot of it falls through the cracks."
However, Simon Wallace, chief executive of the Aged Care Association said the oversight was adequate, with various reviews and investigations taking place concerning Covid-19 and acknowledging the work by the sector, including around PPE and testing.
"The outbreak [at Ellerslie Gardens] was contained in the facility. However, as with some other clusters where staff were stood down, and DHB staff brought in who were unfamiliar with aged care and with the facility, this can be very challenging.
"Having a so-called 'surge' workforce ... who can be called in at a moment's notice is one of the learnings we will take forward."
The Ellerslie Gardens outbreak may have begun after a nurse returned from overseas and tested positive on March 21. The first resident tested positive on April 10, with 13 cases eventually linked to the now-closed cluster, including four other residents considered probable cases.
The daughter of an 86-year-old resident who was in Auckland Hospital for weeks with Covid said she found another rest home for him to be discharged to, given her concerns about infection control, care and cleanliness.
He'd since put on weight, was happier and a painful bedsore had healed: "He looks better now than before he got Covid."