Sunday, 12 February 2012

Elder Abuse - Here we go again!

What happens when the simplest rules of care provision are ignored?

The answer is simple... Standards of care begin to slip, avoidable mistakes are made, lives of those that are already 'vulnerable' are potentially put at greater risk.

In short... Negligence is the end result!

In my previous posts on Elder Abuse, I introduced you to Mary, who is now 89 years old and continues to live alone; maintaining as much independence as possible, with the 'assistance' of private carers twice a day. She also relies heavily on her next-door neighbours, both of whom have acted as her advocates on many occasions over the last nine years.

She has a variety of medical conditions that reduce her ability to mobilise without the aid of a wheeled trolley. Her severe hearing loss has now progressed to total deafness, effectively causing significant social isolation.  Whilst Mary has developed the ability to lip read a little, most of her conversations take place with pen and paper, to avoid any confusion.

Over the last few weeks, her neighbours have noticed a decline in the standard of care that Mary has been receiving. This has been especially noticeable when the neighbours have been away at the weekends.

Continuity of care has been affected by a continuous stream of new carers and herein lies the issue.

Basic protocols are being ignored. They fail to read either the care plan or notes, more often than not, they fail to read both.

Mary's needs are simple.

Morning visit; Duration 30 minutes (should be done around 10.30)

She needs assistance with putting her socks on.
Her feet need to be creamed at each visit.
Medications for high blood pressure and analgesia need to be given and observed to be taken. (fresh doset box delivered weekly by Chemist)
A sandwich needs to be made for her lunch. (This is important because otherwise, Mary will not eat properly. She cannot follow the cooking instructions on ready meals, and has often eaten or thrown away food, that she has failed to cook properly)

Occasionally, she may need help to get dressed, usually when she has over slept.

Once a week the bed linen needs to be changed and the rubbish needs to be taken out. she is unable to do these things herself, without putting herself at risk of falling.

Evening visit; Duration 15 minutes (should be done after 18.30)

Assist to get ready for bed.(if Mary has not already done so)
Give evening medication and observe that it has been taken.
Draw curtains.
Check all windows and doors are closed and secure.

Things came to a head when the neighbours returned from a weekend break to discover that the morning carers had only been arriving late, going in for 10 minutes and had failed to provide a sandwich for lunch, cream her legs or put her socks on.

The evening visits had crept forward to 16.00. Not only was Mary being assisted into her night clothes, but her medication was being given far too close together, putting her at risk from a drop in blood pressure and the possibility of resultant dizziness and falls.

The neighbours complained to the head office, who made all the right noises and apologies.

Less than two days later, one of her neighbours called in to pick up Mary's shopping list only to find out that the morning carer had failed to arrive. The time was now 14.45 and Mary had not had her medication etc.

The head office was contacted again. They were advised not to send anyone now as the neighbours had  carried out the necessary care required.  The neighbour documented the incident in the care notes and advised that the evening medication should not be given by the evening carer as there would not be sufficient time between doses. He would go back at 22.00 to give the medication instead.

When he returned, he found that the evening carer had arrived at 19.00 and given the medication, despite the written request not to; the carer had also failed to sign that she had given them.

Presumably, the carer had gone in failed to read the notes before giving any care, gave the medication then when she has gone to write in the care notes, read the previous entry and deliberately omitted to sign for the medication she has given.  A deliberate act of negligence.

Her failure to disclose that she had given the medication in error could have cost Mary a trip to the hospital at best; at worst, it could have cost her life.

Lessons to be learnt from this incident are simple and should be common sense.

1. After greeting the client, especially for the first time, always read the care plan and the previous entries written in the notes. They are often the only form of communication of what has been happening with the client, available to the carer at the time.

2. ALWAYS own up to any errors, especially where medication is concerned... Steps can always be taken to remedy to situation. Failure to disclose these errors makes the carer guilty of neglect by omission.

Failure to follow these two basic protocols of care could have had dire consequences. Thankfully, this was not the case.

I began this post with a question and I shall end the same way.

I cannot help but consider who is truly at fault here.

The carer bears the initial responsibility and should be guided by their conscience, but if the relevant care agency has failed to provide adequate training and evaluation, does the ultimate culpability lie firmly at their feet?


  1. Hi Laurie.

    As someone approaching the twilight of life this is terrifying reading. It merits more exposure. If Mary lives in your local area, you could send it to your local paper and your local MP.

  2. Hello Jean,

    Thank you for reading and commenting. You have offered some valid suggestions here, I am also thinking the Area Health Authority needs to be informed.

  3. Or do they go by the title of Primary Care Trusts at the moment?