"Woman's death shines spotlight on aged care"

A New South Wales family is demanding increased staffing levels for aged care in regional Australia after a coronial inquest into the death of a 91-year-old woman.

Martha McKee died of asphyxiation at the Mid Richmond Aged Care facility at Coraki, near Lismore, on July 28, 2010.

She died on a night when there were only two staff members caring for 45 residents.

Ms McKee was treasured by her family, and her 91st birthday was another milestone in a long and contented life.

"It was happy times. She just loved that birthday party. I will never forget that," her daughter Judy Keepance said.

"We were just smiling and taking photos."

Ms McKee was known by her nickname Bub. She lived all her life in northern New South Wales and was happiest when surrounded by her family.

"I actually got to say a few times that I loved her very, very much and that she meant the world to me," Ms Keepance remembered.

But Ms McKee's 91st birthday was the last time her family would see her alive.

Ms McKee was a high-care resident at the Mid Richmond Aged Care facility.

She had very little mobility and sought comfort from little things, as her dementia deepened.

"You are trusting, you are putting your loved one in a place. You are trusting they get the best of care," Ms Keepance said.

It was the earlier hours of the morning and there were two staff on duty on Ms McKee's final night: Judith Robson, a carer, whose registration as an enrolled nurse had lapsed; and Patricia Sawtell, a 20-year-old carer, who was on her very first night shift.

The Coroner, Magistrate Robyn Denes, found "Ms Robson was effectively on her own caring for 45 residents".

Ms Robson and Ms Sawtell checked on Ms McKee at 2:50am.

She had bed poles on her bed to help pull herself up.

Ms Robson later told police she spoke with Ms McKee before leaving the room.

"It's a long time before the morning. You need to get some more sleep. I'll see you in the morning," Ms Robson told police she said.

Martha McKee's death

But some time in the early hours of the morning on July 28, 2010, Ms McKee fell out of bed.

The two carers opened the door at 5am to find Ms McKee lying on the floor.

She had fallen out of bed, taking her mattress with her. Her neck was trapped by the bed pole.

"I saw Martha and saw she was wax-work white. I turned the light on and it was absolutely horrific. I could tell that she was dead," Ms Robson said in her police statement.

But Judith Robson did not check for any signs of life. She and Patricia Sawtell closed the door and telephoned their supervisor.

Ms Keepance says her mum might have been alive.

It's very important that people know she's not a number. She was our mother, my mother. And we miss her. We miss her very much.

Judy Keepance

"Mum might have been alive. And they could not go in there and check for basic signs of life and take the bed stick off her neck. I am shocked. I am furious," she said.

Ms Robson was the president of the local Surf Lifesaving Club and was trained in first aid.

But Ms McKee was left lying on the floor for another hour, before a nurse checked if she was dead.

"So, I will always wonder. If something could be done. If she was alive, something could be done to save her life," Ms Keepance said.

The Coroner found it was unclear exactly what time Ms McKee died or how long she may have suffered.

"What I can say is that, had she still been alive, she may have been able to have been resuscitated," Magistrate Denes said.

Police were called to the nursing home and the room was sealed off.

Ms Keepance was allowed in. She said goodbye to her mother and promised to find out what happened.

"I just told her that I loved her. And sort it out, I will," she said.

Regional standards

This case reveals a series of concerns about the standards of aged care, particularly in regional areas.

The Coroner expressed concerns about the staffing levels, even though they were legal.

"One carer to the 45 residents at Mid Richmond, as it was in July 2010, is unsatisfactory even if it meets the legislative requirements," he said.

At the time of Ms McKee's death, Mid Richmond was classified as a low-care facility, and its managers were not required to have a registered nurse on duty.

But the Coroner found that about 20 of the 45 residents were in fact high-care.

Unlike child care, there are no minimum staffing ratios for aged care.

Brett Holmes from the New South Wales Nurses Association says low staffing levels can place residents at risk.

"The size of the facilities in rural areas often means that they have fairly minimal staffing. And, as in this case, have a period of time elapse before you're able to get back around the rest of the facility to check on everyone," he said.

Aged care activists, like Linda Sparrow from Aged Care Crisis, say elderly Australians deserve better.

"In fact they are just as vulnerable as very young children, who have been not so long born," she said.

"And yet we don't seem to provide the care and attention at the end of life as we do at the very start of life, and I find that very troubling.

"People in aged care homes have the right to care, protection, to have their say, all the things that the rest of us take for granted."

'Appropriate staffing'

The owner of the facility, Baptist Community Services (BCS) declined to be interviewed, but released a statement.

"Based on our extensive experience operating aged care facilities, we maintain that our staffing at Coraki on the night in question was appropriate," it read.

"We also support our staff members who were involved during the events surrounding Mrs McKee's tragic death."

The association representing aged care providers declined to discuss staffing levels in the industry. It also released a statement.

"Aged and Community Services Australia wishes to offer its sincere condolences to the family of Martha McKee," it read.

"ACSA has nothing further to add to the Coroner's report of 26 August 2011."

The Coroner also questioned why bed poles had been fitted to Ms McKee's bed.

7.30 has obtained a Department of Health and Ageing advisory, issued six weeks before Ms McKee's death, warning about their dangers.

"She couldn't do anything physically and they shouldn't have been on her bed," Ms Keepance said.

"BCS were found to have been in breach of their responsibilities under the Aged Care Act."

But Baptist Community Services defended its use of the bed pole.

"A risk assessment was conducted on Ms McKee's use of the KA524 bed pole. It was determined that this was an appropriate aid for her to continue to utilise," it said in a statement.

BCS has since removed bed poles from its facilities, and retrained its staff in first aid. 

Audio: Listen to the story (PM)   (Source : http://www.abc.net.au/news/2012-08-08/elderly-womans-death-shines-spotlight-on-aged-care/4186002)

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