Most DHBs wouldn't name facilities that were subject to upheld complaints. Photo / 123rf.com
Investigations into rest home complaints have confirmed residents suffered festering wounds and unexplained bruising and leg fractures.
Nearly 100 complaints made about aged care facilities since 2020 have been fully or partially upheld by health authorities, documents obtained by the Herald on Sunday reveal - and some of the failures are life-threatening.
Most complaints were made by residents' families. Others were lodged by ambulance and hospital staff, who were alarmed at the condition of elderly patients.
The complaint findings include:
• Substandard medical treatment, including for painful bedsores, dehydration and weight loss, incontinence, scabies and after residents fell over. There were medication errors.
• Unhealthy food and cold rooms, with one complaint about cockroaches in a resident's bed. Dementia patients weren't showered or cleaned frequently enough. Renovations at one rest home created an unsafe environment, including exposed nails and disconnected call bells.
• Incorrect financial charges, including regarding the extra weekly fee rest homes often charge for so-called "premium" rooms. A Northland rest home took money from a resident's account without consent.
The Herald on Sunday obtained the information by sending Official Information Act requests to the country's 20 DHBs, and the Ministry of Health.
Four complaints concerned rest homes run by Heritage Lifecare, which runs 43 rest homes and made headlines in 2018 after a terminally-ill man had maggots hatch in his open leg wounds.
Counties Manukau DHB ordered changes at the care home, Palms Lifecare in Pukekohe. However, the information obtained by the Herald on Sunday shows another serious complaint was made in January 2020, and upheld by the DHB.
A summary released by the ministry says there was "delay in care and admission to hospital, delay in diagnosis and treatment of scabies, fluid/weight management, delay in staff noticing a foot infection". There were also "concerns about personal cares (such as showering and toileting delays)".
Other upheld complaints about Heritage Lifecare homes include Whangārei's Puriri Court Rest Home (immobile residents weren't moved frequently enough, there was poor management of incontinence, diabetes and when a resident's health rapidly deteriorated), and Cantabria Lifecare in Rotorua (failures related to wound care, dehydration, management of falls and "unexplained bruising").
Norah Barlow, chief executive of Heritage Lifecare, said no upheld complaint was acceptable to the company, which strives to provide the best care for its residents, "who are increasingly more ill as they enter our homes".
The complaints needed to be viewed in the context of Heritage caring for more than 10,000 residents since 2020, Barlow said, including through Covid-19 lockdowns.
"While we treat caring for our residents as a privilege, it cannot be denied that this can be challenging for our staff, particularly with the increasing severity of conditions," Barlow said. "We are confident that the complaints do not show systemic failings."
Other large companies to have more than one complaint upheld include Bupa NZ. Its Parklands Hospital had a February 2020 complaint substantiated, summarised by the ministry as regarding "the unexplained injury of a resident (leg fractures). No explanation provided to the family of how the injury occurred".
A Bupa spokesperson wouldn't provide more detail, citing privacy. "We carried out an extensive investigation and kept the family regularly updated of progress and its outcome."
Most DHBs refused to name the facilities involved, saying information was withheld to protect the privacy of residents, who were often unaware a complaint was made.
Those DHBs were Northland, Waikato, Bay of Plenty, Lakes, MidCentral, Taranaki, Hutt Valley, Capital & Coast, Nelson Marlborough, and Canterbury. Complaint summaries could be vague. For example, MidCentral DHB descriptions included "care and welfare concerns".
The Herald on Sunday has appealed the DHBs' lack of transparency to the Ombudsman.
The facilities that weren't named had disturbing failures in care upheld against them. For example, a Canterbury care home apologised after inadequate treatment of a bedsore and "significant excoriation in skin folds".
Another apology was from a rest home within the Lakes DHB region, after a review into how a resident's bone was fractured. Taranaki Hospital emergency department staff complained about how long it took a rest home to transfer a resident who'd suffered a fall.
A partially substantiated complaint came from Bay of Plenty DHB staff, about how an unnamed facility managed a gastro outbreak. Northland DHB upheld a complaint made by paramedics, who found a resident in "poor condition".
Grey Power opposes the secrecy over such cases. "The public have a right to know," said Roy Reid, who chairs Grey Power's retirement village and aged care committee. "The rest homes are contracted to the DHBs to provide the service. But the DHBs don't go out of their way to keep them up to scratch."
The organisation wants all audits to be carried out without advance notice (currently most audits, carried out by companies contracted by DHBs, are signalled).
"Most rest homes are trying to run as close to the [financial] margin as they can. Most of them have got shareholders, who require a dividend," Reid said. "Some of them certainly don't come up to the mark."
Grey Power has for decades lobbied for changes including an aged care commissioner, with power to take action on individual facilities and sector-wide issues like safe staffing ratios.
Labour campaigned on setting up such a watchdog ahead of the 2017 and 2020 elections, and set aside $8.1 million in Budget 2021. Further detail on the position will be announced soon.
The Aged Care Association believes current regulation is adequate, including regular audits, DHB oversight, complaints to the Health & Disability Commissioner, and inspection of dementia units by the Chief Ombudsman.
When an aged care commissioner is added to that mix it should be with the remit to advocate on wider sector issues, the association's chief executive, Simon Wallace, told the Herald on Sunday.
That includes a "workforce crisis", with more than 900 nursing vacancies, Wallace said. The association is lobbying for more government funding so aged care nurses can be paid the same as those working in hospitals.
The complaint failings were separate incidents and not indicative of wider, systemic problems, Wallace said. Rest homes are doing their best to provide care, he said, despite challenges including Covid-19, funding restrictions and border closures that worsen staffing challenges.
"While the staffing crisis does not excuse any failings in care, it does put our ability to provide beds for older New Zealanders at risk."
Some of the rest home complaints show the strain caused by Covid-19. For example, Northland DHB partially upheld a complaint by a relative of a resident with terminal cancer, who wanted to die at home. Covid-19 restrictions meant palliative care couldn't be put in place, and the resident ended up in hospital. Their loved one was forced to say goodbye over Skype.
Stories by the Herald last year revealed problems at rest homes that were hit by Covid-19, including Rosewood rest home in Christchurch, which had 12 deaths.
The Herald's previous reporting has also highlighted problems with the restraint of residents in dementia facilities, including some residents being strapped to chairs all day, with minimal movement or repositioning.
The Government gave the Ombudsman power to inspect secure dementia facilities soon after that 2018 report. The latest inspection report by Chief Ombudsman Peter Boshier was published last month, and found one resident spent more than 11 hours tied to a chair, with only minutes between a restraint being removed and reapplied.
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• There are about 35,000 people in aged residential care facilities. Of these residents, about 45 per cent are in rest home care, 40 per cent in hospital level care, 12 per cent in dementia care, and 3 per cent in psychogeriatric.
• About 64 per cent of long-term residents get a residential care subsidy, paid by the government for their care.
• About 77 per cent of facilities are run by companies, and about 22 per cent are run by charities.
• Almost all new facilities are built by major aged care companies, alongside retirement villages. Most closures are of smaller private and charitable facilities.
Source: NZ Aged Care Association industry profile report for 2019-20
The man then went on to kick a police officer while being walked to a patrol car.