The main focus of the day was the case study of a resident of Brian King Gardens in NSW, who was prescribed medication and switched to higher pain therapy treatment without the consent of the family.
The 84-year-old woman with dementia, named Mrs. CO, was placed on mirtazapine, a strong antidepressant and anti-anxiety medication.
Ms CO’s daughters, Ms DM and Ms DL, made statements saying that they had never been aware of any medication their mother was taking before giving their consent and that their mother’s GP, the Doctor Margaret Ginger, had never explained what the drug would do or its side effects. .
Ms DL said: âWe realized it was a strong drug, I felt I was not a doctor, so I trusted what was happening on their side and they knew what they were doing. ”
The drug itself was not administered by the facility until two days after it was prescribed by Dr. Ginger.
Brian King Gardens was only given permission to use the drug after it was administered to Ms CO.
The reason the resident was prescribed the antidepressant was due to a pastoral worker’s concern for Ms. CO’s emotional well-being.
Ms. CO constantly wandered in a restless state, often crying and reliving traumatic childhood memories of abuse as well as the death of her baby.
After administering the medication to Ms. CO, she experienced moments of non-responsiveness, not opening her eyes or responding to a verbal command, and responding only to pain.
On one particular occasion, Dr Ginger assessed Ms CO for what she believed to be a mini-stroke, but assured Ms DL that there was no medical reason to take her to the hospital.
Other concerns the girls had about Ms CO’s care related to her inability to eat her food and the decay of her teeth, which was highly unusual for their mother who was strict about dental hygiene.
There was even a case where the facility did not provide dental hygiene to Ms. CO for four months.
Richard Farmilo, Resident Manager of Brian King Gardens, spoke following Ms CO’s daughters. care or if he saw Mrs. CO himself to determine it.
Charges have been brought against the establishment that Brian King Gardens was an “ACFI game” in providing high level treatment to residents. This would give the senior care facility more funds to use for that resident.
Counsel Assisting, Paul Bolster also questioned the use of psychotropic drugs used on patients at Brian King Gardens, reading statistics from July 1, 2018.
At the time, out of 197 residents, 112 of those residents, or 59 percent, were prescribed psychotropic drugs.
Mr Farmilo said he was not concerned about the use of psychotropic drugs on so many residents of the facility and did not think that number was too high.
Mr. Farmilo also confirmed that Angliare, which operates the Brian King Gardens site, does not have a consent policy for the administration of psychotropic drugs.
Following Mr. Farmilo’s testimony, Dr. Ginger spoke up and explained his reasoning behind prescribing antidepressants to Ms. Co.
She admitted that there are tests to diagnose depression in older people with dementia, however, she did not do this test with Ms. CO. Instead, she gave him medication directly.
Since there was no note to use in the future from a depression test, Mr Bolster said there would be no way to check if the antidepressant drugs were working on Ms CO anyway.
Another problem pointed out by Mr. Bolster was the prescribed amount. Dr Ginger had initially requested that the drug be used at night at a rate of 15 milligrams (mg) and increased to 45 mg with a maximum of 60 mg.
Mr Bolster asked Dr Ginger if a more suitable starting dose for someone over 80 would have been 15 milligrams of mirtazapine, which Dr Ginger agreed with.
Dr Ginger seemed upset when she admitted she was unsure why she had provided the 85-year-old with such a high dose of antidepressants and regretted the prescription.
Dr Ginger admitted that she had no explanation for prescribing 45 mg of mirtazapine without first using another intervention to help with Ms CO’s behavior and that she was not satisfied with her decision. medical.
Assault is ‘the norm’ for older social workers
After the day’s first case study ended, Kathryn Jill Nobes, currently an elderly care worker at a New South Wales facility, testified about her own situation in the industry.
Ms. Nobes explained the post-traumatic stress disorder (PTSD) she suffered as a result of assaults by residents in her care in a dementia unit, as well as the trauma associated with working at the facility where one resident killed another.
His statement and evidence was provided in the hope that it would help improve the safety of older social workers.
In many cases, when she spoke to senior management about verbal, physical and sexual abuse, she was expected to be content to deal with the abuse and ignore.
âWhen I informed my manager that I had been assaulted by a resident, the manager shrugged and said ‘this is dementia,’ says Ms. Nobes.
âThis has happened on different occasions. I think there was a dominant culture in senior care of just ignoring this. ”
Ms Nobes described cases of punching, kicking, threats and inappropriate sexual behavior by residents of the dementia unit.
In one case, she attempted to clean a male resident, who “dipped” his fists in his own stool and then hit her with fists covered in excrement.
The incident that caused her to suffer from PTSD came after she was approached by a resident who had recently killed another resident.
At the time, they were unaware that he had killed another resident and assumed from his blood-covered knees that he had fallen. Ms Nobes said: âThe resident was holding a cane in his right hand, like it was a club. I saw the resident wearing dark shorts and had blood on his knees.
âHe was looking intently into space and his body looked very rigid. I remember thinking that was typical of his behaviorâ¦ This particular resident had a history of staff abuse.
While Ms Nobes still works at the facility, she says the working conditions have a serious effect on the quality of care and safety provided to residents as well as a huge emotional effect on older care workers.
Difficult calls to make around residents with “difficult” dementia
A third case study was covered at the end of the day at the hearing, describing assault and sexual assault among residents of Columbia nursing homes in Oberon Village, New South Wales.
Mr. Peter Gray QC, Senior Assistant Lawyer, addressed the Panel regarding the complexity of dementia issues in senior care facilities.
“This is a case study that we are submitting to you to illustrate the complexity of the problems
relating to the behavior management of certain residents in retirement homes
care that has what are sometimes called challenging behaviors, âsays Gray.
The case study allowing freedom of movement for people with difficult behavior as the possibilities of danger or injury increase for a person with dementia.
The Oberon facility has seen several incidents of assault by the same residents, including an altercation that left a resident in hospital.
The resident’s daughter, Ms DF, said she found her mother, Ms CA, with a bruise on her lip on June 24 last year after feeding her cake.
It was only after talking to her sister, Ms DG, that she discovered that her mother had touched the clothes of another resident, who hit her in the mouth.
There was another case where Ms. CA was assaulted by another patient and ended up in the hospital.
Marian Anderson, general manager of operations at Columbia Nursing Homes, was the last witness today to testify about the latest case study.
She pointed out that the facility had carried out extensive rehabilitation and retraining regarding the dementia behavior management issues identified in March 2018.
Ms Anderson admitted that direct staff and caregivers provided inconsistent documentation and demonstrated a lack of understanding of policies, which is why the facility took action to address it.
Mr Gray spoke about the procedures for recording violent behavior by residents with dementia, and whether more is being done to ensure repeat offenders do not continue to have incidents.
Ms. Anderson says, âI think residents living with dementia can be very unpredictable, and there was an incident which, although all strategies were in place, did not prevent it.
Regarding Ms CA’s assault, Ms Anderson said it is difficult to know when the triggers occurred for a resident because they can be unexpected and spontaneous.
Mr. Gray questioned the reasoning behind placing Ms. CA’s bedroom in close proximity to two known aggressive residents.
Ms. Anderson continued her position by saying, âThere is a lot of unpredictability with residents with dementia. We try to minimize the risk, but I don’t think we can totally prevent the risk.
Incidents of assault at the facility, while better equipped to handle, were not always able to mitigate risk due to the unpredictability of residents with dementia.
The Royal Commission on the Care of the Elderly will return for hearings next week, Monday, May 13.