Page Section: Centre Content Column
Residential
Feeling secure
in a rest home
Learning from a
complaint
Respectful
language
Understanding of Enduring Power of
Attorney
Confidence to
make a complaint
Dietary needs
in a rest home
Injured in residential
care
Communication
with the family of a man with dementia
Assisting a relative
with EPoA to advocate for a resident with dementia
Effective communication in a
rest home
Sorting the consumer -
provider relationship
Rest
home care
Using interpreters
to promote dignity and independence
Supporting
Independence
Using
alternative forms of communication with consumers who are
non-verbal
Making
sure older people are included in discussions about rest home
placement
Rest
home care: Talking past each other
Quality of rest home
care
Being
independent
The
house meeting
Wanting a reasonable
life
Feeling secure in a rest
home
A consumer resident in a rest home had concerns about a resident
who was going into other people's rooms, including hers, and who
had been physically abusive to others. She felt afraid, vulnerable
and unsafe. The only response she had received from the
manager was information about how to contact her local
advocate.
The consumer chose to write a letter of complaint with the
assistance of an advocate. She sought a response to the concerns
she had raised with the manager and stated she wanted the other
resident to be stopped from approaching her. There was an immediate
response. The resident whose behaviour was of concern had his care
needs reassessed and was moved in order to receive a higher level
of care.
The consumer was pleased with the outcome and felt the
assistance of the advocacy service ensured the matter was dealt
with, and that her concerns were listened to.
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Learning from a
complaint
An elderly lady living in a retirement village, whose husband
had recently died, had concerns about his care in his final
days.
Following a request from Age Concern, an advocate contacted her,
and they discussed her concerns regarding dignity and independence.
The advocate arranged a meeting with the nurse manager and the
family which resulted in an open and frank discussion.
As a result of the meeting, the advocate was invited to the rest
home to give a presentation to the staff on the Code, with specific
reference to dignity and independence issues. The family was happy
with the outcome and pleased that further training was given to the
staff.
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Respectful language
A 50-year-old consumer with an intellectual disability who lived
in a residential flat, reported that one of her support staff had
referred to her using belittling language. She felt that this was
disrespectful and found it upsetting.
She asked for advocacy support to speak with the caregiver
about how she felt, and request an apology. At their meeting, the
caregiver apologised for her comments, and the consumer was happy
with the outcome.
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Understanding of Enduring
Power of Attorney
The daughter of a lady living in a rest home advised that her
mother had raised a number of complaints with her and that when the
daughter, had attempted to address them with management and staff
they appeared uninterested and evasive.
During a conversation with an advocate, the daughter said she
had Enduring Power of Attorney (EPoA) for her mother. When
questioned about her mother's capabilities, the daughter explained
that she was competent. It became apparent that the daughter did
not understand the meaning of EPoA, and assumed that she was
responsible for her mother. After clearing up this
misunderstanding, and with her mother's permission, the daughter
met with the manager of the home, with the support of an
advocate.
The manager was able to detail how active her mother's social
life was at the rest home and had photos of the outings she'd been
on over the last year. It was very evident how happy her mother
was. A visible weight lifted off the woman's shoulders. She
realised why staff had appeared evasive - they knew her mother was
competent and to them the daughter was behaving inappropriately.
The manager now emails photos to the daughter to keep her informed
of her mother's activities, as appropriate.
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Confidence to make a
complaint
The daughter of a blind man who lived in a rest home had a
number of concerns about the care and treatment he was receiving.
She felt that he was treated with a lack of respect, was handled
roughly particularly during preparations for bed and for toileting.
The family felt their verbal concerns were not listened to by the
manager and the response to their written complaint did not meet
their expectations.
Following a discussion on the Code of Rights and the role the
advocacy service could have in supporting the family through the
complaint process, the family felt happy to pursue the matter
without active advocacy support. They reported that the matter was
resolved to their satisfaction.
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Dietary needs in a
rest home
A resident of a rest home for those aged under sixty-five years
contacted advocacy. He was unhappy with the food being offered and
was often hungry during the night so was having to pay for
additional food. A meeting was arranged with the manager and the
resident with the support of an advocate.
The man made a list of his preferred foods and requested he have
his main meal in the evening rather than midday. The manager agreed
to this and advised the cook. The man reported that the new
arrangement was working well and there was to be another meeting
with both the cook and manager to look at the long-term options for
his meals.
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Injured in
residential care
A man had concerns about his wife sustaining significant
injuries in the rest home where she was a resident. Prior to
approaching advocacy for support the man had attempted to address
his concerns directly with the manager and was unable to obtain
satisfactory answers to his concerns.
He felt unable to write and make the request for a meeting
himself and so the advocate provided assistance with this. The man
requested that a photograph of the injuries be included, and that
the letter and photograph be copied to the Ministry of Health.
The issues as outlined in the letter were:
- the woman had a black eye and staff were unable to say how it
occurred;
- a second more serious injury required sutures and relocation of
a limb. The woman required treatment at the hospital, and she was
not accompanied by anyone from the rest home; and
- the man was given two versions of how his wife sustained a
third injury.
The rest home representatives agreed to meet with them at a
neutral venue. The man was provided the opportunity to raise his
concerns and a constructive discussion ensued. The meeting
concluded with the man satisfied with the explanations and proposed
actions.
The rest home followed up with a letter advising staff cover
would be reviewed, staff would receive education on the
vulnerability of residents, residential activities had been
increased, additional fluids would be offered on hot days, some
chairs would be fitted with soft restraints for those who agreed to
the use of restraints. The care plan for the woman would be
reviewed with input sought from her husband who was assured he
could have access to his wife's notes at any time.
The man advised that the matters had been resolved to his
satisfaction. The Ministry of Health was advised of the successful
outcome of the meeting
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Communication with the family
of a man with dementia
A resident of a rest home suffered a stroke, was admitted to the
local hospital and transferred to the rehabilitation ward. His
daughter complained to an advocate that although she held EPoA
(Enduring Power of Attorney) for her father because he had
dementia, she was not given any information on what was happening
to her father. She received a phone call about a family meeting to
discuss her father's discharge, but was not given the date or time
of the meeting.
The issues she had, included:
- Poor communication from staff at the hospital
2. Lack of information on what was happening with her father
3. Lack of information and details for the 'family meeting' eg, no
date/time/venue given.
She wanted to achieve:
1. Improved communication with staff at the
hospital.
2. Information on what was happening with her
father
3. Information on what supports would be put in place
when he was discharged from hospital.
4. The details for the family meeting.
Although the man's daughter had spoken to the staff at the
hospital she was not given the information she needed. Although she
had managed to successfully advocate for her father in the past,
she had recently been unwell and has found it difficult to keep on
top of everything. She was also responsible for her 52-year-old
disabled sister who lived in a nearby disability home.
At the meeting, with the support of the advocate, the family
expressed their concerns and asked questions about their father's
discharge from the hospital back to the rest home, as well as the
support for their father's continued rehabilitation after his
stroke.
The team explained that their father would be discharged back to
his usual rest home by non-urgent ambulance. Assurances were given
that the hospital team would provide the rest home with all
information necessary for the staff to provide him with a high
level of care.
The NASC coordinator explained that the rest home agreed to have
him back on a six-week trial to see if they could manage the level
of care that he would require. There would be a review at this time
to see if the level of support was sufficient. If not, NASC would
carry out another needs assessment to see whether he required a
higher level of care which would require a move to another
facility.
The family were very happy with the outcome. They informed the
advocate that they planned to meet with the rest home manager and
the charge nurse when their father returned to the rest home to
discuss a number of issues such as appropriate food, mobility
support, adapted cutlery and other supports he needed.
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Assisting a relative with EPoA to
advocate for a resident with dementia
An advocate was contacted by a complainant with EPoA (Enduring
Power of Attorney) for her brother, who had dementia, after he was
moved from a local rest home to a dementia unit in a different
region. The complainant felt that her brother was out of place in
the unit as his dementia didn't seem as advanced as the other
people there. She had some questions about the report and diagnosis
made by a psychiatrist, regarding the level of her brother's
dementia and whether he was to be reassessed.
She also felt her brother was unhappy where he was and that he
would prefer to be receiving regular rest home care. She was unable
to visit as often as before since he had been relocated so far
away, and was worried that he was not being stimulated enough. She
wanted to know more about how he was being occupied during the day
and what he had done to warrant being sent to a dementia unit.
After considering the ways an advocate could assist her, the
complainant decided to use advocacy support to send a letter to the
rest home manager outlining her concerns and requesting a meeting.
When the manager agreed to meet, she advised that she would take
her daughter for support so didn't require an advocate at the
meeting.
Following the meeting, the complainant advised the advocate that
her brother had had a reassessment, and it was found that he was in
need of dementia-level care. She was sad to hear the news that he
was beyond the care of regular rest home care, but reassured that
he was in the right place. She is awaiting a bed to become free in
a nearby dementia unit so he can be closer to family and
friends.
She said the communication between herself and the rest home was
significantly improved and she was regularly informed about how her
brother was getting on.
An example of how well this worked for all involved was when
rest home staff rang to say her brother seemed quite down and was
having a bad day. She was able to explain that her brother had been
back to the family farm for the first time since moving to the rest
home. He was upset that his dog had not recognised him and that the
house had been renovated by the new occupants. She felt this was
important information to help explain her brother's mood and was
pleased to have been able to share this with the rest home
staff.
She was very happy with the results and appreciated the advocacy
guidance through the complaint process as well as having someone on
her side.
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Effective communication in a rest
home
A woman contacted an advocate after first making a complaint to
the DHB about a rest home. The DHB were organising a meeting for
her with the management of the home and suggested she may like to
have advocacy support.
Her complaint was about the standard of hygiene and attitude of
staff at the rest home where her mother was a resident. The
daughter was upset her mother had been infected during a recent out
break of scabies because the home had not quarantined those
affected. They also failed to advise visitors of the outbreak.
A number of her mother's personal items had also gone missing.
When she raised her concerns with staff she felt they had been
flippant and negative in the way they responded and that they had
been deliberately avoiding her.
The advocate met with the daughter to discuss what she wanted to
achieve at the meeting so this information could be passed in
advance to those attending.
At the meeting it was agreed that as soon as items went missing
staff would carry out an immediate thorough search and that a sign
would be put up if there were any incidents visitors needed to be
aware of. In addition, staff would receive further training on
hygiene and cleanliness as required in the health and safety OSH
regulations. The daughter was very happy with this outcome.
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Sorting the consumer - provider
relationship
A man in his mid twenties contacted the advocacy services with
concerns about being spoken to by his community support worker "as
if he was a child". He had lived with a disability all his life and
until recently, lived with his parents.
He said the support worker made reference to him making a friend
"that may not be suitable" and he felt it sounded "just like his
mother". He had lived in supported housing for two years and felt
able to pick his own friends.
A meeting was held with the consumer, advocate, support worker
and supervisor. The consumer was able to articulate how he felt
when he was spoken to like a child. He agreed that he would
continue with the same support worker because he "got on most of
the time" and the situation would be reviewed in three months time
to see if things had improved.
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Rest home
care
Rest home ~ Appropriate standards ~ Third party
complaint
An advocate was approached by a family member with concerns
about a parent in rest home care. When the advocate met with the
consumer and complainant it was clear the consumer did not want to
make a fuss. However, he did authorise the complainant to pursue
the issues after his death. A few months later, after he had passed
away, the family contacted the advocate for help with their
complaint. They had concerns about the care provided,
record-keeping, staff training in clinical procedures and the use
of alternative therapies without consent.
The complaint was taken very seriously. The national manager of
the rest home syndicate made a special trip to meet with the
complainant. The complainant and other family members felt that the
responses were detailed, investigations were thorough, the two
levels of follow up were appropriate and that changes had occurred
as a result of the complaint. They were grateful the advocate had
met the consumer and for ongoing support including during the
resolution meeting. The family felt heard and were able to
move on.
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Using interpreters to promote dignity
and independence
A Deaf consumer requested advocacy assistance to address his
concerns about the loss of dignity and independence in the rest
home where he lived. He asked the advocate to arrange a meeting
with the manager, organise an interpreter and to support him at the
meeting.
Using the interpreter, the consumer was able to communicate his
concerns to the manager. These included the manager communicating
with his family instead of him. The meeting proved useful in that
it provided an opportunity for the consumer to raise his concerns
and discuss other matters such as medication and activities. It
also provided an insight for the manager into interpreters, how
they work, how to make a booking and how to access funding when an
interpreter is required.
Following the resolution meeting the consumer told the advocate
that he felt very empowered and said 'Just because I have a
disability, it doesn't mean I have something wrong with my
brain.'
As a result of the meeting the advocate identified there was a
need to have information available about interpreters in the area,
how to book them and information about funding. The advocate worked
with local interpreters to develop a pamphlet which is currently
being piloted.
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Supporting Independence
A resident contacted an advocate after moving into a rest home
which didn't allow her to use the laundry facilities. She had been
used to managing her own laundry and felt her independence was
being undermined. The consumer advised she had attempted to address
the matter directly with the provider but felt they were not
listening to her.
She wanted prompt action and after hearing how the advocate
could support her, requested the advocate phone the manager and
request a meeting to discuss her concerns. The manager agreed to
meet within a few days with the consumer and her advocate. At the
meeting, the consumer spoke about the importance of her
independence and the concern of others managing her laundry. The
manager acknowledged the consumer's concerns, and discussed the
need to ensure the consumer's safety and infection control
procedures. They discussed a plan for managing the situation that
would meet both the consumer's need and the home's needs. This was
documented for the consumer who was very happy that she would be
able to maintain this aspect of her independence.
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An advocate
writes about a breakthrough when using alternative forms of
communication with consumers who are non-verbal
I have been supporting a young consumer who has progressive
multiple sclerosis and is non verbal. He communicates by using a
communication board with some pictures and phrases. His
physical disability means he cannot always use his communication
board as when he is tired communication becomes much more difficult
for him. I will usually arrange a visit in the morning, when
he is less tired and better able to communicate.
I was delighted to be able to utilise my Makaton skills in
working with this consumer so I was able to support him to clarify
his main issues and his desired outcome.
I assisted this young man to write a letter to his GP,
requesting more information about his choices and stating some of
the concerns he had regarding his diagnosis.
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Making sure
older people are included in discussions about rest home
placement
Older woman ~ Assessment ~ Family meeting ~ Rest home
placement ~ Speaking up
The family of an older woman in her nineties contacted an
advocate to support them at a meeting with staff at the
rehabilitation unit where their relative had been assessed. The
staff advised against the woman returning home with support. The
advocate explained to the family that because advocates are on the
side of the consumer she would need to meet with the consumer prior
to the meeting.
The consumer advised the advocate that she had also been
thinking about her future. She felt she was becoming 'too much' for
her niece, who had also been unwell. Options for the future
were discussed. The consumer told the advocate about her friend in
a "lovely home". If she was assessed as needing care, this was the
place she would like to go. The advocate encouraged her to attend
the family meeting and speak up about her views.
The meeting with medical staff, family and the consumer was the
first time the consumer had been involved in any discussions about
her future. Assumptions that the consumer wanted to return home had
been made by her family as well as the staff who had assessed her.
It was a surprise to them all to find she was just as concerned
about the level of care she needed as they were. The meeting
provided her with the opportunity to have her say.
She is now living the 'life of a Queen' in the 'lovely rest
home' with her friend, and is enjoying being cared for 24/7.
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Rest home
care: Talking past each other
Rest home ~ Inappropriate use of Enduring Power of Attorney
(EPoA) ~ Restoring communication ~ Rebuilding
relationships
A woman living overseas returned to visit her elderly mother who
was living in a rest home. As her mother's Enduring Power of
Attorney (EPoA), she had assumed responsibility for her mother's
wellbeing. Over the course of her time in NZ she took it upon
herself to address concerns about her mother's care with the
manager and various staff. To her surprise everyone at the rest
home appeared evasive and disinterested. When she contacted the
advocacy service she was asked if her mother was no longer able to
make her own decisions. When she replied that she certainly was
competent, she realised that she did not understand what was
involved in being an EPoA. She had assumed that this meant she was
immediately responsible for her mother.
With the support of an advocate, and her mother's permission,
she met with both the rest home and clinical managers. The managers
were able to reassure her by telling her just how active her
mother's social life was at the rest home. They showed her photos
of the outings she'd been on over the last year where it was very
evident her mother was enjoying herself.
A visible weight lifted off the woman's shoulders. She now
understood why staff had appeared evasive. They knew her mother was
competent and to them the daughter was behaving inappropriately.
Both parties suddenly understood what had been happening.
As a follow up to this situation, the manager undertook to email
photos to the daughter and keep her informed of her mother's
activities.
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Quality of rest
home care
Rest home ~ Standard of care ~ Resolution meeting ~ Up-skill
staff ~ Rights education session
A woman complained about the rest home care provided to her
89-year-old mother that led to her admission to hospital in a poor
state. She had a number of concerns relating to the standard of
care including the dehydrated state her mother was in, the failure
of staff to identify her high temperature, difficulty locating a
thermometer and not knowing how to read it when one was finally
found. She was also unhappy about the reluctance of the staff to
call an ambulance so she had to drive her mother there in her own
car at 10.30pm.
The Manager and two staff members attended the resolution
meeting to hear the concerns of the resident's family. They
apologised to the family for what had happened. The Manager also
agreed to up-skill staff in the areas where shortcomings had been
identified and a rights presentation was provided to the rest home
staff by the advocate.
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Being independent
Independence
~ Intellectual disability ~
Residential facility ~Wheelchair ~
Self-empowerment
A man with an intellectual impairment,
who was also a wheelchair user, asked an advocate for help because
he wanted to be able to go to the chemist by himself to collect his
medication. The staff at the residential facility where he lived
wouldn't permit him to do this and were supported by authorities
higher up. However, after a meeting organised by the advocate,
where the man's wishes were discussed, there was a willingness to
let him try out his plan. This worked well, and he was able to go
to the pharmacy each week (by wheelchair) to collect his own
medication.
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The house meeting
Intellectual
disability ~ Effective
communication ~ Consumer needs
~ Residential facility
A resident in a community house for
people with an intellectual disability asked that an advocate be
with him at a meeting called by the staff of the house. He had
recently been having difficulties in the house, and had been
getting angry and frustrated with the staff, calling them names and
"being generally out of sorts". The staff complained that he had
changed and that they were finding him difficult to manage and had
reached the point where they were saying "enough is enough". The
staff coming to the meeting were intending to be "really tough"
about his behaviour so they could "sort it out".
As the meeting got underway, the
advocate posed the question, "Why now?" The advocate also asked the
staff to think about whether there might be a reason why the
resident had become so unhappy. Was he unwell or in pain, for
example? The meeting provided an opportunity for everyone to have
their say about their concerns and what they would like to see
happen. The resident was pleased to have an opportunity to say how
he was feeling and be listened to. The outcome was a specialist
assessment to ensure that his pain and anxiety were being helped in
the best possible way.
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Wanting a reasonable life
Intellectual disability ~
Residential care ~ Independence ~ Dignity
A man with an intellectual
disability living in a residential facility asked an advocate to
help him with a problem he was having with another resident. The
situation had become so distressing he wanted to move out. He felt
bullied because the other resident stopped him watching TV and
would come into his room uninvited.
The advocate organised a meeting at
the facility so the resident could discuss his concerns with the
caregivers. A plan was agreed to that would allow both
residents to have their own quiet space, to respect each other's
space, and to be able to make their own choices. Both residents
were happy with this arrangement.