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Prior to contacting an advocate a complainant had addressed her concerns regarding her husband's care with the provider but no improvements were made. She eventually transferred her husband to another rest home where he was getting good care.

The complainant advised the provider had agreed there were significant problems that would take some time and money to address. There was a staff shortage and they relied on inexperienced carers to fill the gaps. Staff training had been lacking so that basic care had been compromised.

Despite moving her husband the complainant wanted to pursue the matter so others did not receive the same poor standard of care. The advocate assisted the complainant to put her concerns in writing.

The provider provided a comprehensive response and had completed the resolution agreement form. The complainant was very satisfied with the response and was pleased to have all the actions and improvements documented so that they could be referred to and monitored.

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Help to send a complaint to HDC

Rest Home Care ~ Right 4 ~ appropriate standards

A daughter contacted the advocacy service because she was unhappy about the care her mother had received in a rest home. She said she had visited her mother daily and had observed the poor quality of care her mother was receiving. Her mother had since died and she wanted an advocate to assist her to write to the Health and Disability Commissioner.

Despite meeting with the staff in the home as well as the doctor attending to her mother nothing had changed. She felt the care and treatment of her mother's bed sore had been inadequate.

The staff were poorly trained and did not seem to know what to do to meet her mother's needs.

Although her mother was not being given the nutritional requirements required to meet her needs, family members had no difficulty in giving their mother the food and fluid she needed.

The family had to insist and demand that action be taken by the staff to call in a doctor to visit their mother when she became ill and to get her taken to hospital, where she died a week later.

The daughter's desired outcome was to receive assistance from the advocate to take the matter to HDC as the police had suggested this was the appropriate course of action. After considering the various options the family advised they still wanted the matter to go to the Commissioner. They all felt the care their mother had received warranted an investigation. They had previously tried to address their concerns directly with the provider and felt they had not been listened to and as a result nothing had changed.

The advocate assisted the family with drafting the letter which required a number of rewrites before it was sent to the Commissioner. The family were happy with the support they had received from advocacy in sending the matter to HDC.

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Advocating for a family member in a dementia unit

Rest home ~ Right 4 ~ appropriate standards ~ dementia unit

A man visited an advocacy office to discuss the options open to him to address the concerns about his wife. He was not happy about the quality of care she was receiving in the dementia unit at an elderly residential care facility. An advocate assisted the man to write his letter of complaint. He wrote the background to his complaint, what his main concerns were, what it was he wanted to achieve as an outcome of making this complaint and that he would like to meet with the manager and regional manager of the organisation at the advocate's office to discuss his concerns.

One of the man's main concerns was the staff cut backs within the dementia unit. He felt this was unreasonable, as there was a high level of need in that particular unit. He visited his wife every day, and would stay from early in the morning until tea time. He would look after his wife as much as he could and helped the staff. However, whilst there he observed other things that he was not happy with. For example, residents left in their pyjamas till later in the day, a caregiver feeding two people at the same time.

He believed this was due to the staff cut backs, and that the cut backs were contributing to the quality of the care his wife and others were receiving.

The regional manager advised that the staff cuts were in line with requirements and they were meeting his wife's needs. He was not happy with this so following the meeting he told the advocate that some of his concerns had been addressed. He was happy for the file to be closed as he had decided to take the outstanding matters to the Commissioner. The advocate offered assistance however the man declined on the basis he felt he could advocate himself having had advocacy support up to and including his meeting with the provider.

Some months later the man contacted the advocate to say he had continued to advocate for his wife and there was a new manager at the facility. Although it had taken time she had now reinstated the extra staff and care had much improved. He expressed gratitude for the support the advocacy service had provided.

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Using Interpreters to promote dignity and independence

Rest home ~ Right 3 ~ Dignity and independence ~ Right 5 ~ fully informed ~ Improving services

While networking at an agency, a consumer approached an advocate about worrying issues at their rest home. The issues were around dignity and independence.

The advocate made a time to meet with the consumer to discuss the concerns. After finding out how the advocate could help, the consumer opted for a meeting with the manager. The consumer requested the advocate arrange the meeting and provide support at the meeting, along with an interpreter.

Using the interpreter the consumer was able to communicate with the manager what the concerns were. These included communication occurring with his family instead of the consumer. The meeting was very useful in that it provided an opportunity for the consumer to raise his concerns and also discuss things such as medication, activities etc. It also provided an opportunity for the manager to learn about interpreters, how they work, can be booked and how to access funding when an interpreter is required.

Following the resolution meeting the consumer told the advocate that they 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 who the interpreters are in the area, how to book them and information about funding. The advocate worked with the local interpreters to develop a pamphlet.

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Education session provides solution for resident

Rest home ~ Right 1 ~ respect ~ Right 4 ~ appropriate standards ~ Right 5 ~ effective communication ~ paralysed leg ~ education session

Following an education session at a rest home a resident contacted the advocate.

The resident relayed a past experience where she had fallen in an ambulance as a result of not being properly strapped in and said she had an ongoing anxiety about falling from things as a result. She said she had advised staff at the home of this and repeatedly requested they erect the sides of her bed when rolling her over, when attending to her personal cares. They ignored her request providing verbal reassurance she would not fall. Ambulance staff had done the same so she did not find this at all reassuring.

The resident also explained that as her left side was paralysed, that leg was like a dead weight. When staff would roll her over, the heavy leg often ended up lying across her right leg. She said because it was so heavy, it was quite painful for her.

The advocate asked the resident what she thought the solution to the problem could be. The consumer said she thought staff could raise the sides of the beds but had previously been told this was impossible as they could not have access to her, so she thought they could lower her bed. This solution also meant she was closer to the floor which was reassuring. This option also meant the sides could be put up and the staff could have the access they needed. The advocate asked if this had been tried but the resident said she had been told it wasn't possible to do this. She did not know why.

Issues:

1) The fear of falling from her bed when rolled with the sides down

2) Staff are not taking her fears seriously and as a result she felt she was not being listened to

3) A solution that met her needs and not just those of the staff

The advocate was due to provide an education session to staff later that same day. With the resident's permission her concerns were raised as part of the session to see if a solution could be found that would work for all concerned.

The advocate was to contact the consumer following the session to determine whether any suggested solutions had been discussed and trialed.

The advocate explained that a resident of the rest home had permitted her to use her story as a case study for the session. Many of the staff were aware of the issue but not all were aware of the circumstances causing her anxiety and fear.

They discussed at length how they were managing the consumer's care and came to the conclusion that by positioning a staff member on either side of the consumer's bed during care it may alleviate her anxiety. They said they had tried again and again to reassure her that the position they were standing in would prevent her from falling from her bed. The advocate was able to point out that verbal reassurance was not helpful as the ambulance staff had also provided this prior to her fall.

Staff explained why they did not put up the bed rails, as it made them unable to access the consumer to roll her, as the barrier got in the way. When asked why her bed could not be lowered staff said OSH requirements prevented this as there was a danger of staff hurting their backs. They agreed that no-one had taken the time to explain this to the consumer.

The advocate suggested any idea was worth exploring to find a solution that would work for all parties. Staff then engaged in a brainstorming exercise. Suggestions included:

Repositioning the resident's bed
Erecting the side rail on the side the resident was being turned to face as this would enable staff to carry out personal cares and the resident would know she could not fall.

The manager agreed she would discuss the options with the resident and would be present when they were trialled. One staff member captured the residents story "we heard her but she wasn't being listened to".

A few days later the advocate called the rest home to speak with the resident. The manager answered the phone and said they had trialled the new process, which she believed was working extremely well. She said it would be written in the resident's care plan.

The advocate then spoke with the resident who expressed gratitude that it had been sorted out. She said she was very happy.

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Negligent Rest Home Care

Right 4 ~ appropriate standards ~ incontinence ~ excoriation of genitalia

The daughter of a deceased man contacted an advocate for support to address negligence on the part of the rest home he had been in. The consumer had suffered from urinary incontinence which led to excoriation and infection of his genitalia. His daughter also reported he had a number of other skin injuries which the home appeared to have no record of. She said that it was only when the family insisted that the consumer was moved to the hospital that these became apparent.

After considering the options she decided she would like to meet with the rest home manager to ask about the excoriation and any actions taken to prevent it. She also wanted to discuss why her father had not been hospitalised earlier. She was seeking an assurance that no one else would find themselves in a similar situation to that of her father.

Initially the complainant wrote to the manager outlining her concerns and requesting a meeting. She received a response saying the matter was being investigated with an offer to meet at the conclusion of the investigation to discuss the results.

As agreed the daughter was contacted following the investigation. The daughter requested an advocate be present at the meeting. The manager provided both a verbal and written report on the investigation as well as the actions that had been taken as a result of the investigation which included annual competency assessment of all staff.

The complainant was delighted with the response to her concerns and conveyed this to the manager.

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Advocate promises rest home resident to help family complain after he dies

Rest Home ~ Right 4 ~ appropriate Standards ~ Right 7 ~ choice & consent ~ alternative therapies

An advocate was approached by a family member concerning the level of care being provided to a parent in a rest home.

The advocate met with the consumer and the family member wanting to make the complaint. The consumer did not want to make a fuss about care issues but did authorise the complainant to pursue the issues after he had died.

A few months later the advocate was contacted again when the resident had passed away. The advocate was able to assist the complainant and other family members to raise concerns about the level of care, record-keeping, staff training in clinical procedures and the use of alternative therapies without consent.

The complaint was taken very seriously with the rest home syndicate's national manager making a special trip to meet with the complainant. The complainant and family felt that the responses were detailed and investigations thorough. The follow up was appropriate and changes had occurred.

The family was grateful the advocate had met the consumer and had followed his instructions to support the family to raise their concerns after his death. The family felt heard and responded to positively by the rest home manager and ffelt the matter was resolved.

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Promoting Independence

Right 1 ~ respect ~ Right 3 ~ dignity & independence ~ administering medication

A consumer contacted an advocate after her Minister suggested the advocacy service may be able to assist her.

The consumer and her husband had lived in an independent unit of a retirement complex. Following the death of her husband the consumer had moved into an independent unit within the rest home. Prior to her move she had been responsible for her own medication but now it was being administered by the home's registered staff. The consumer felt her independence was being taken away as staff not only administered her medication but watched her take it. She talked about having turned down an opportunity to stay with her family for a few days because she did not have her own medication to take with her.

The consumer's goal in raising her concern was to be able to administer her own medication. She really wanted to resolve this issue as she generally liked the rest home, especially her big room, most of the staff and the relative freedom she did have. After providing her with options on how she might address her concern the consumer decided she would like advocacy support to meet with the Clinical Manager of the complex.

The consumer spoke at the meeting about when she and her husband first came to the complex and the independence they had, including administering their own medication. She said she felt she was safe and had been using the same practice for twenty years without incident. She talked about how the policy of administering her medication meant she felt unable to accept any offers of staying overnight with family and friends, and how she felt belittled when staff 'stood over her' when she was given her medication.

The Clinical Manager responded by reminding the consumer that they had only taken over the administration of her medication when she had expressed depressive thoughts and feelings of not being able to manage. The Manager confirmed that it was the policy that once people moved in to the rest home that their medication was administered by staff but that this was not intended to prevent people from spending time away from their family. She then asked the consumer to describe those times when staff gave her medication in a manner that she considered appropriate.

Although the consumer would have liked to take back the responsibility for her own medication she accepted the rest home's policy. She was happy that should she need Panadol that she would be able to self administer it. She was also happy to hear that if she wanted to go away that she would receive the necessary medication to take with her.

The consumer was pleased that staff would be provided with further training about how to administer medication in a respectful way and that if she had any further issues with her medication that she should speak directly to the Clinical Manager. The consumer was satisfied that her concerns had been addressed.

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The right to refuse medication

Rest home ~ Right 5 ~ Effective communication ~ Right 6 ~ Fully informed ~ Right 7 ~ Choice and Consent

A consumer called the advocacy service from her residential facility to ask about her right to refuse a tablet in her medico pack and if it could be removed altogether.

She told the advocate that she was already refusing to swallow it each morning and was leaving it in the pack and informing the staff each time. The consumer had been doing this for about three months as she felt unwell when she took the tablet both morning and night.

The consumer said she thought she was told by a Doctor at A&E that the morning dose was to be removed and she was under the impression this information had been relayed to the facility manager.

After considering the options available, the consumer decided to have a meeting with the provider with advocacy support. With the consumer's permission, the advocate rang and spoke with the facility manager about a meeting. She also asked if the GP could attend as the consumer had requested this.

The advocate met with the consumer before the meeting so she would be confident with what she was requesting regarding her medication. The advocate encouraged her to make some notes.

At the meeting, the consumer spoke to the staff about her feelings and concerns and how she would like to proceed from here.

The GP provided the consumer with the full information about what the tablet does and what the consequences may be if she continued to refuse it. The advocate checked with the consumer if there was any further information needed and what her thoughts were. The consumer said it was still her wish to have the tablet removed from her pack.

The GP asked the consumer to reconsider starting it again if she began to have seizures. She agreed to this.

The facility manager documented the meeting and the medication change. The advocate explained the resolution agreement pad and all involved were happy to use it. The advocate wrote on the agreement what the provider and the consumer had agreed to do as ongoing actions and this was signed. This included the GP looking online at the discharge summary from A&E to see if the reduced dose had in fact been recommended.

The consumer called the advocate a few days later saying she was much happier now the tablet had been removed from her pack. The consumer was yet to hear about the outcome of the discharge medication summary and agreed to call the advocate if this needed to be followed up.

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Rest home care and management of complaint

Rest home ~ Dementia Unit ~ Right 2 ~ Assault ~ Right 4 ~ Appropriate standards ~ Right 6 ~ Fully informed

An advocate was contacted by the family of a consumer following an incident at the dementia unit in his rest home. The consumer had been assaulted by another resident and required emergency treatment at the local hospital.

The family were unhappy that they had not been kept informed about their father's condition following his return to the rest home and that there was no plan to prevent further incidents. The family had met with the management at the rest home and were not satisfied with the responses they received

The family had sent a letter to the rest home outlining their unresolved issues and expected outcomes. They wanted an assurance that that their father was safe from further assaults. They requested advocacy support to meet with the Regional Manager of the facility.

The advocate supported the family at a meeting where they received an apology from the rest home management for not addressing their concerns in a timely manner, and for a lack of communication in regard to the incident.

They were advised that the facility had taken a number of steps to address their concerns including: increased hours for an extra staff member from 3.00pm - 9.00pm; activities staff were to be employed for seven days a week in the dementia unit; further training around de-escalation for dementia unit staff; activities for consumers in the afternoons e.g. golf/putting green - plus improved training around incident reporting and the management of complaints.

The family were happy with the outcome of the complaint and the support from the advocate. They arranged to meet with the Regional Manager again in two months to review the changes that were being made.

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Sorting out the care plan

Rest home ~ Right 4 ~ Appropriate standards ~ Dementia ~ Weight loss ~ Dental hygiene

A complainant stated she was concerned about the level of care her father was receiving in a rest home. The consumer had dementia, was not moved often and was spending most of his time restrained in an arm chair.

He also did not appear to have dental hygiene care and was losing weight rapidly. The complainant had attempted to raise these issues with her father's caregivers but felt she was being fobbed off and that staff were annoyed with her for raising her concerns.

Having established the complainant had an active EPoA, the advocate discovered the daughter had never had a meeting to discuss her father's care plan with the nurse manager. The advocate explained that others had found this a useful way to address concerns about care and advised she could support the complainant at a meeting. The complainant decided she liked that option and asked the advocate to organise a meeting.

At the meeting the care plan was discussed in detail and it was agreed modifications needed to be made. The changes included two-hourly assisted walks to ensure the consumer maintained mobility, and that he would be weighed weekly rather than monthly. In response to her concerns about dental hygiene, she was advised that staff attempted to maintain this. However, at times, the consumer would not allow them to perform these cares but they would continue to attempt to.

The complainant felt reassured by the discussions at the meeting, and advised the advocate that she felt she would be able to speak freely with the nurse manager if she had concerns in the future. She was pleased with the support the advocate provided.

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Complicated problems in a rest home

Rest home ~ Right 4 ~ Appropriate standards ~Fractured hip ~ Dementia ~ Parkinson's disease

Following a fractured hip the consumer was moved from dementia care to hospital care within a rest home. His wife contacted the advocate for support following the consumer being misdiagnosed as having a urinary tract infection when in fact he had an impacted bowel which was causing bleeding.

The diagnosis of impacted bowel had been made when she had taken the consumer to a private urology appointment after being advised of the waiting time for him to be seen in the public hospital system. The consumer's wife was also concerned that she had recently been advised that he no longer required hospital level care and as there were no vacancies for dementia care at the home she would have to move him.

Having considered the information provided by the advocate, the complainant decided she needed the advocate to assist her with writing to the home outlining her concerns and requesting a meeting. In her letter she stated what the issues were she wanted to address and the outcome sought, which included staff receiving training about caring for consumers with Parkinson 's disease and reimbursement of a specialist fee that she had been charged.

Once the home had agreed to meet, the advocate prepared the complainant for the meeting so she was able to articulate her concerns and the outcome she was wanting. Staff from the home advised that to respond fully they needed to further investigate her concerns and following that she would receive a written response.

The complainant received the written response and took up the offer of another meeting with the advocate present for support. This time she received a full explanation about why the staff had not been able to correctly diagnose her husband. The complainant received reimbursement of the specialist fee as a measure of good faith.

The rest home staff advised they had contacted the DHB and arranged training for staff at their facility the following week. The complainant was also assured that her husband would be able to transfer back to their care when a further bed in the dementia unit became available.

With the exception of her husband not being able to be accommodated in the dementia unit at that time, the complainant was happy with the outcome of her complaint.

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Being able to use gel of choice

Rest home ~ Right 1 ~ Respect ~ Right 5 ~ Effective communication ~ Pain relief ~ Lavender gel

A consumer had recently moved from living with her family into a rest home.

She had a medical condition which resulted in her experiencing leg pain which Panadol did not relieve. However, she found that rubbing natural lavender gel on her legs helped. Her concern was that she and her family had been told by rest home staff that she must use Panadol as she had other creams she used on her body.

The concern for the consumer and her daughter was that when they had attempted to raise their concerns they were not listened to. After considering their options including processes that other people had found effective in a similar situation, the consumer requested the advocate contact the rest home manager and raise their concerns.

The situation was discussed with the GP and as a result the consumer was advised there was nothing to prevent her using the lavender gel for pain relief. The consumer and her daughter were very happy with this outcome and the assistance provided by the advocate.

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Getting women to provide personal care

Rest home ~ Dementia care ~ Right 1 ~ Respect and cultural values ~ Right 3 ~ Dignity ~ Personal cares ~ Fish oil

The daughter of a consumer who has dementia wanted advocacy support to make a complaint. The complainant said she had been contacted by a male staff member requesting she send more medication for her mother. This call raised two concerns, the first being that her mother was not on medication apart from fish oil, and the second was that she did not feel it was appropriate due to culture and past history that a male provide care for her mother.

She had raised her concerns with the home and been told if she was not happy with her mother's care then she could move her to another home. The complainant said the discussion had become heated and the rest home staff member had hung up on her.

The complainant was very upset as she did not want to move her mum but neither did she want a male carrying out her personal cares. She was also concerned at the nurse referring to fish oil as medicine, which she felt was unprofessional. After considering the options along with the breakdown in the relationship, the complainant requested the advocate contact the rest home on her behalf.

The advocate put in writing the complainant's concerns and it was emailed to the Quality Manager. The response received stated that female staff did carry out the cares and an assurance was given that at no stage would a male staff member do them. Further, the Quality Manager also advised that all communication with the family would be done by female staff, and that the staff member the complainant had spoken to about her concerns was to receive cultural and communication training. The complainant also received a written apology.

The complainant felt reassured that her mum would be getting care that respected her cultural values, and was happy that any future communication with the family would be made by female staff members.

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Concerns about choking

Rest Home ~ Right 4 ~ Appropriate standards ~ Right 6 ~ Fully informed ~ Choking ~ Asphyxia

A woman contacted the advocacy service with concerns about the events surrounding the death of her mother in a rest home. Her mother was in her late eighties and had died of asphyxiation, caused by a food choking incident earlier in the day.

The complainant said she had had an excellent relationship with rest home staff up until that event. Her main concerns were the lack of information around her mother's death, and the timeline of events. She was concerned the rest home did not contact her immediately as there was a lapse of several hours between the incident and her mother's death.

Following discussions between the daughter and the advocate, the complainant felt a meeting with the rest home management would provide the best opportunity to have her questions answered.

The advocate supported the complainant at a meeting where she was able to put forward her questions. Using the consumer's notes as a reference, the rest home manager advised that nursing staff and the attending doctor had assessed her recovery from the choking incident. At that time she showed no outward symptoms. The manager acknowledged the consumer's death from asphyxiation later in the day was quite unexpected.

The complainant was satisfied with the explanations provided and thanked the staff for their care.

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Rest home self advocacy

Rest home ~ Self advocacy ~ Right 1 ~ Respect ~ Right 3 ~ Dignity

A consumer, who had recently moved into a rest home, contacted an advocate to discuss concerns relating to two staff members who were disrespectful and compromising the consumer's dignity. The consumer said the two staff members refused to address them by a preferred name and told the consumer what to do rather than asking them to do things.

The advocate provided information about the Code of Rights and the role of the advocate in supporting the consumer to address the concerns. Having listened to the advocate, the consumer requested time to consider the options the advocate had presented and said they would be in touch with the advocate once a decision had been made about how to proceed.

The consumer later contacted the advocate to advise that following their discussion they had decided to self advocate and had had a chat with the staff involved and that things were now going well.

The consumer was pleased to have managed the process themself using the information provided by the advocate.

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A worried resident seeks tests

Rest home ~ Right 6 ~ Fully informed

A rest home resident was unhappy about the management of her health condition and prior to contacting an advocate had attempted to address her concerns with senior staff at the home. The view of the staff was that everything had been done to deal with her situation. They had discussed their reasons for these conclusions with her. However the consumer felt that a proper review was called for.

Although there had been medical investigations done some time previously, the consumer was questioning whether her health situation could be managed differently if there were further tests.

With advocacy support she requested that specialist referrals be initiated in case there were other factors identified which could be treated. When this was discussed with the clinical manager and visiting doctor it was decided to refer her to the hospital for further tests. This was done.

She said she would be accepting of the outcome of these tests if it confirmed she had tried all possible options to manage her health condition better.

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Adjusting to a new way of life

Rest Home ~ Right 5 ~ Effective communication

An advocate was visiting a rest home on advocacy business and by chance, got to talking with a resident. She had only recently moved into the rest home and was satisfied with the standard of care provided. However, she felt a general sense of distress and loneliness, finding it hard to mingle with other residents. She spent most of her time in her room and was in tears as she explained how hard it was to accept her new living circumstances.

The advocate discussed the options, acknowledging the resident wasn't comfortable with the word "complaint", focussing instead on the importance of open communication between residents and staff.

After this discussion the resident asked the advocate for support to talk frankly with the rest home manager and the activities coordinator.

The resident led the meeting and talked about her wariness around other residents, her fears about communal living and her sense of having somehow failed in life. The manager and the activities coordinator listened, confirming it is normal for people to feel uncertain as they adjust to a different living environment. It was a great relief to the resident to know that other people feel the same way as her. She was also gently reminded that since moving in, she had spent more and more time in the lounge with other residents and was engaging in various activities. There was discussion about what other activities she might enjoy as well as an upcoming craft class she seemed keen to join.

The resident talked about a burgeoning friendship with another resident, whom the activities coordinator had noticed regularly sitting outside in the sun to have afternoon tea. She suggested the resident could sit with her. The resident said she would love to do this.

The meeting ended with the resident thanking the manager and the activities coordinator for listening to her, understanding her concerns and encouraging her to communicate openly with them. The resident and advocate walked outside to join the other resident in the sunshine.

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Speaking up results in positive changes to a care plan

Rest Home ~ Right 4 ~ Needs met ~ Dementia ~ Weight loss ~ Care plan

A consumer had recently entered a rest home. His wife said he had dementia and as a result staff were restraining him in a chair for most of the day. The complainant was concerned that the consumer was not being stood up and moved around often enough, and also expressed concern about his weight loss. She said she had tried to talk to staff but felt that she was not being listened too, and staff found her annoying.

The advocate went through the options and the complainant decided the most effective way to progress the matter was to request a meeting with the Nurse in Charge. The advocate advised she was able to support the complainant at the meeting and the complainant agreed she would like this.

At the meeting, the complainant raised her concerns and the care plan was discussed. As a result of the complainant voicing her concerns the care plan was changed to include getting the consumer up and walking him around every two hours, rather than four hourly as was on the existing plan.

The nurse agreed to speak to the doctor about ordering a supplementary drink to try and stop the weight loss and said his weight would be measured weekly instead of monthly as had been on the old plan. The provider apologised for the poor communication and the complainant and provider agreed on a plan for communicating any future concerns.

A few days after the meeting the advocate called the complainant to see if she felt that the level of care and communication had improved. She advised that it had and she was now confident to speak of any issues directly to the nurse.

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Seeking resolution after a death in a rest home

Rest Home ~ Right 4 ~ Appropriate Standards ~ executor of will

A daughter who was the executor of her mother's will phoned the advocacy service as she was unhappy with the treatment of her mother who had passed away in a rest home. The advocate spoke to her about her options including writing to the manager, or having a meeting

The daughter said she would like to meet with the manager to have questions answered in person and to express her concerns about her mother's care. She said that she would like to know that what happened to her mother will not happen again to another person. The daughter felt she would not be ready to have a meeting right away because she was still grieving and the pain was too raw.

Three weeks later she contacted the advocate saying she was ready to meet with the rest home manager. The advocate suggested writing down a list of questions and items that she would like to talk about in the meeting. She thought this was a good idea as she would possibly get emotional during the meeting and could overlook questions she wanted to ask.

With advocacy assistance, a time and venue was arranged for a meeting between the rest home manager and the daughter. The daughter sent her agenda to the rest home manager before the meeting to make sure they could prepare their answers properly. The daughter brought along her own daughter as a support person but also asked if the advocate could attend, as the advocate was not emotionally involved.

A meeting was held and at the end the complainant said she was very happy with the outcome. She said she felt that she was heard, taken seriously and that the rest home would do all they could to improve their service. She felt the process had helped her to move on from her mother's death and she had some closure. The advocate was thanked for their help in organising the meeting which the complainant had been unable to do due to her grieving.

Dealing effectively with difficult behaviour in a rest home

Rest home ~ Right 4 ~ Appropriate standards ~ Right 7 ~ Give informed consent ~ EPoA

A complainant had an enacted Power of Attorney for her sister, a resident in a rest home. She contacted the advocacy service after receiving a letter from rest home management. The letter advised her sister had to be moved as they were unable to manage her behaviour. The previous week she had received a phone call from the second-in-charge at the home, stating that her sister's behaviour was so unacceptable and they were calling in the Mental Health Service for an assessment.

The complainant attempted to get information about what had changed but despite having EPoA, the staff member was not prepared to discuss the matter.

She told the advocate she was in a fragile, vulnerable state due to the recent death of her husband six weeks previous. She wanted to meet with the rest home management but did not have the strength to do it alone, and requested advocacy support at the meeting. The advocate contacted the manager at the complainant's request and a meeting was arranged.

At the meeting the complainant was able to tell how the recent conversations and letters had affected her. She also asked what had changed as her sister had been a resident for two years and previous managers had never discussed any concerns with her. She was aware her sister yelled out in pain from time to time, and that her sister's behaviour was difficult to manage at times, but they were professionals and should be able to manage this behaviour. She was advised that her other sister from Australia had visited and had complained about a few things.

The provider produced documentation showing the family had requested no medication to be given. They felt it was in her sister's best interests that they get her assessed for another placement. The complainant became visibly upset and said all she had asked for was that the medication that made her sister a zombie be stopped, not all the medications. The provider stated they had not informed the family of their intention to have the consumer assessed as they didn't understand how the EPoA worked.

The provider suggested they commence a behavioural chart which would be overseen by a registered nurse. The complainant agreed and said it would be a good start. They discussed positive behaviour reinforcement by placing the consumer in a place that she enjoys, like being outside in the garden, rather than punishing her by putting her in her room with the door shut. The complainant spoke of the things her sister used to enjoy and what she appeared to like now and how participating in these types of activities might help with her behaviour.

The meeting ended on a very positive note with both parties feeling they had established a rapport which would enable them to communicate more freely.

The consumer remained in the home and staff would communicate with the EPoA if her behaviour became unmanageable and a new plan developed.

The complainant was extremely pleased with the outcome.

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Seeking resolution after a death in a rest home

Rest home ~ Right 4 ~ Appropriate standards ~ Executor of will

The daughter said she would like to meet with the manager to have questions answered in person and to express her concerns about her mother's care. She said that she wanted to know that what happened to her mother would not happen again to another person.

The daughter felt she would not be ready to have a meeting right away because she was still grieving and the pain was too raw.

The advocate was thanked for their help in organising the meeting which the complainant had been unable to do due to her grieving.

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An EPoA highlights the importance of routine

Rest home - Right 1~ Respect ~ Right 3 ~ Dignity and independence

The daughter of aging parents contacted the advocacy service with concerns about the care provided by a local rest home her parents had recently moved into.

The daughter had an enacted Enduring Power of Attorney (EPoA) which meant she could act on behalf of the consumer.

After considering the options she requested the advocate support her to organise a family meeting with the rest home manager.

At the meeting, one of the issues raised by the daughter was the importance of routine for her father who was experiencing the onset of dementia. Prior to moving to the rest home her father would remain in his dressing gown until he had had breakfast and read the daily newspaper before having his shower. While this may seem small to the rest home staff it was important to her father. The rest home manager agreed to adopt a system where the staff member allocated to assist her father with his daily care would be responsible for making sure he received the paper with his breakfast.

The daughter was very pleased to have had the opportunity to discuss her concerns directly with the manager and to have her concerns responded to in a very appropriate manner.

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Happy to go home to die

Rest Home ~ Palliative care ~ Right 1 ~ Respect ~ Right 5 ~ Effective Communication ~ Right 6 ~ Full Information

The consumer was receiving palliative care at a rest home. The family felt their wish to have the consumer home to die was not being respected by rest home staff. Following initial discussions with the family the advocate met with the consumer, who while very frail, was clear that she wanted to go home, and requested the advocate speak on her behalf at a meeting with the provider and her family.

At the meeting with family members the advocate was able to tell the staff that it was indeed the consumer's wish to go home. The family expressed concern that the provider was putting obstacles in the way to prevent this happening. The meeting provided a forum for the consumer's voice to be heard, the family's concerns to be addressed and for the provider to advise what equipment would be needed and the timeframe for delivery so that the consumer would be as comfortable as possible at home.

The consumer was transferred home by ambulance later that day and spent two days at home, before peacefully dying with her family around.

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Challenging unsafe rest home care

Rest home ~ Right 4 ~ Appropriate standards ~ Diabetes

The daughter of a rest home resident contacted an advocate with her mother's permission. The daughter was concerned that her mother had been hospitalised four times in eight weeks due to her diabetes not being well managed. The daughter questioned what was happening in the facility as each time her mother was readmitted to hospital she was in the same condition.

After considering the options the complainant requested advocacy support at a meeting with the rest home manager.

By the time they attended the meeting the manager had already put in place a number of changes. These included monitoring measures, further training for a caregiver, as well as organising a diabetes educator to speak to all the staff. The manager provided documentation detailing what had been done and arranged with the complainant to have a follow-up meeting.

The complainant advised that she attended the follow-up meeting, was satisfied all changes have been made and that her mother was now in a safe environment.

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Empowering other rest home residents through speaking up and self-advocacy

Rest home ~ Right 5 ~ Effective communication ~ Right 6 ~ Fully informed ~ Self advocacy ~ Speaking up

A consumer and his daughter contacted an advocate to discuss concerns about the rest home where the consumer lived. They were happy to take their own action but wanted to discuss the best way to proceed. Both considered the staff to be rude and that they made no effort to communicate changes being made. As well as the poor communication, the residents never had any input into things that affected them. Recent changes had been made to the lounge area so that residents now shared the area with staff, and alterations being done to the showers were taking a very long time.

After discussing with the advocate the options they could take, they both decided to speak with the manager to discuss their concerns. As the issues affected all of the residents it was agreed a meeting would be held the following week to provide an opportunity for all residents and families to raise their concerns. At the meeting the management made a commitment to respond to the following issues:

1. A manager living on site and the conditions
2. The staff using the residents' lounge area for breaks
3. The length of time for the repair and alterations to the showers

As a result of the consumer and his daughter raising their concerns other residents and their families felt empowered to speak up. They are now more aware of their right to address any issues that arise. In addition, everyone agreed that good communication is really important.

A month after the initial discussion with the advocate, the consumer reported back that the management had followed up on all agreed actions and that communication had improved.

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Home trial helps transition to rest home care

DHB ~ Rest home care assessed ~ Home trial ~ Right 3 ~ Dignity & independence

An elderly lady who was ready to be discharged from hospital wanted to return home, despite the concerns of her family and hospital staff. She had already been assessed as qualifying for rest home care. She contacted an advocate for help as she felt her independence was being taken away by the suggestion she should go to a rest home. She also told the advocate that no one was listening to her request to go home - even if it was just for a trial.

With the consumer's consent, the advocate spoke to hospital staff about the possibility of a home trial, which was agreed to. Staff discussed the home trial plan with the consumer. She would be taken home by a staff member for a few hours over three consecutive days. The staff member would assess how she managed and if things went well she would progress to being left for a few hours with services in place to support her. The consumer was happy with the proposed plan.

However, within the first hour of being home the consumer turned to the staff member, and said "I don't want to stay here - take me back". After a discussion with her family, she went to a rest home the following day happy to have had a trial at home. She is now settled happily in the rest home.

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Concerns regarding rest home standards

Rest home ~ Right 4 ~ Appropriate standards ~ Right 5 ~Effective communication ~ Right 10 ~ Timely response ~ Self advocacy

A consumer who received respite care became concerned with declining standards in the rest home. She contacted the advocacy service three months after sending a letter of complaint to the rest home manager, as she had not received any response.She was upset to have had no acknowledgement of her letter or a timely response to her concerns.

After discussing her options with an advocate, her original complaint letter along with a covering letter from the advocate was sent to the rest home manager. Within a week the rest home manager arranged to visit her at home to discuss her concerns.

Although the consumer felt able to advocate on her own behalf at the meeting with the manager, she kept in touch with the advocate.

At the meeting, the rest home manager provided an apology, an explanation for the delay in responding to her letter and a full refund of her respite care fees as a token of good will. She also told the consumer that her feedback had been pivotal in helping rest home staff identify opportunities to improve the services they provide. The consumer was very pleased to hear about the positive changes she would see next time she needed respite care.

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Timing of a complaint can be important

Rest home ~ Right 4 ~ Appropriate standards ~ Third party complaint

An advocate was approached by a family member with concerns about a parent in rest home care. However when the advocate met with the resident and the complainant it was clear the resident 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, 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 system changes had occurred as a result of the complaint. They were grateful the advocate had met the resident before his death and for the ongoing support including during the resolution meeting. The family felt heard and able to move on.

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Confusion in a rest home

Rest Home ~ Right 5 ~ Effective communication

An initial approach to an advocate was made by a friend of a rest home resident. The advocate supplied the friend with verbal and written information to pass on to the resident wo subsequently contacted the advocate.

She said she had requested to be moved to a sunnier part of the rest home's hospital wing and had been told she was at the top of the list. However she had noticed newer residents being given the better positioned rooms. She felt bypassed and wanted an explanation. The advocate assisted the resident to write a letter seeking an explanation and asking to meet to discuss the situation. She felt she was not being adequately communicated with.

The Facility Manager apologised for any confusion. She confirmed the consumer was first on the waiting list for the next available standard room on the sunnier side. As the only standard room was occupied the Manager arranged for the resident to be taken to a warmer, sunnier location in an alcove by her office each day. She would be provided with a hand bell to summon assistance if she needed it while there.

The resident was happy with the explanation about how rooms are allocated as well as the temporary arrangements until a suitable room becomes available.

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Achieving a solution for independence

Rest Home ~ Self advocacy ~ Right 3 ~ Independence and dignity

A rest home resident spoke to an advocate who had just completed an education session for the residents on their rights.

She was unhappy about aspects of her care. Rather than patting them dry, the staff rubbed the lesions on her hands and body. She also felt the staff failed to follow up on things they had agreed to. However, the thing that most upset her was being made to swallow her medication in front of staff as she felt it took away her dignity and independence.

After considering her options the resident opted to address her complaint in writing. by letter, As she was unable to write due to the lesions on her hands the advocate assisted by typing up her letter and returning it to the consumer the following day. Her letter made it clear that she wanted to take her medication in her own time, unsupervised. Once satisfied with the content she decided to hand deliver it to the rest home manager herself.

When the advocate followed up with the resident to see if things had improved she said it had all been sorted and she was now self-medicating.

She was very happy she had been able to address the matter and get the outcome that was most important to her.

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A communication problem in a rest home provides the best staff education

Rest home ~ Right 5 ~ Effective communication ~ Interpreters ~ Education session

A few days before a booked education session on effective communication for rest home staff, the manager emailed the advocate about a request from a resident. This resident had difficulty communicating and wanted to meet with the advocate at the end of the session.

Following the session the advocate and interpreter met with the resident to discuss the resident's needs. They then met with the manager where the resident was able to convey these needs with the help of the advocate and interpreter working together to make sure they were clear about what was being said. The outcome of the meeting was very positive. Both parties had learnt more about each other.

Some time later the manager contacted the advocate to say the resident wanted to see the advocate again for help with another situation that had arisen.

At this next meeting the manager requested information about how to contact interpreters. The advocate and the interpreter then worked with the resident to communicate with staff about some of the more common words the resident used giving the staff a better understanding about what the resident was saying. The resident felt their world was changing for the better because of the advocate's assistance. In addition, having the Code of Rights Poster displayed in the resident's room was a constant reminder to speak up when things were not OK.

The resident was thrilled when the advocate suggested an electrical device that would help achieve better communication and a much easier way to communicate with others.

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A daughter advocates for her mother

Rights 4 & 5 ~ Appropriate standards ~ Effective communication ~ Residential care ~ Pacific language ~ Strength-based approach

A woman from a Pacific Island community contacted an advocate in a distressed state. She was struggling with having recently placed her mother in care; something she described as very unusual within her culture. She was finding it difficult because the rest home staff were not providing an appropriate standard of care for her mother. She was not sure how to deal with the situation as complaining was also unusual in her culture.

She was happy to advocate on behalf of her mother so the advocate provided her with information about taking a strength-based approach to the situation so she felt confident to discuss her concerns with the rest home manager. The advocate was also able to provide written information about consumer rights in a language the consumer could understand.

A few days later the consumer's daughter contacted the advocate to say she had met with the rest home manager to discuss her mother's care. The manager had gone through the staff rosters to see when Pasifika staff, who spoke the same language as her mother, would be on duty so they could be assigned to her. She was very pleased with this outcome and that she had been able to advocate on her mothers behalf without having to make a complaint.

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Getting safety features into a rest home care plan

Rights 4, 5, 6 & 10 ~ Appropriate standards ~ Effective communication ~ Fully informed ~ Complaint taken seriously ~ Rest home ~ Care plan

A woman with legal responsibility for both her parents was concerned that the staff of the rest home where they lived were unable to explain her mother's bruising on several occasions. Having attempted to address her concerns, without success, she contacted the local advocate for support.

Although she was keen to maintain a good relationship with the staff, she wanted to know her concerns about her mother's safety were being taken seriously. The advocate met with the consumer and her daughter, the complainant, to discuss their concerns and the options available to them. The daughter (with agreement from her mother) opted to write to the provider.

Following receipt of the response the complainant remained unhappy and after considering further options decided that an advocacy-supported meeting away from the provider's premises was the best way forward. At the meeting, the manager agreed to a number of actions that included a revision of the consumer's care plan, developing a communication flowchart, and a meeting with the registered nurse. The complainant would also receive written acknowledgement of her concerns and an apology. These ongoing actions were all recorded on the advocacy resolution agreement form.

The complainant was invited to meet with the registered nurse to help develop the consumer's care plan. As a result of her previous experiences the complainant requested the advocate support her at the meeting. The care plan included a number of new features, including safety measures which the complainant was very happy with. As they left the meeting the complainant advised the advocate she was very happy with the results that had been achieved.

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Bullying in a rest home

The daughter of a rest home resident with significant sight impairment contacted the advocacy service. She had a number of concerns about the care and treatment her father was receiving and from one staff member in particular.

The concerns included a lack of respect and intimidation. Staff would threaten to make him leave the rest home if he made a fuss and were reluctant to provide assistance for him to get to the toilet.

He was subjected to rough handling by staff who would rush through preparations for bed, putting him to bed without pyjama pants.

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.

The daughter said that all they wanted was to have their concerns acknowledged and dealt with, and for her father to feel safe and happy in his home.

Once the family were made aware of the protection afforded by the Code of Rights and the role of the advocacy service they felt happy to pursue the matter themselves.

They have since reported back that the matter has been resolved to their satisfaction.

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Activated alarm left unanswered following fall

Residential home - Supported living ~ Right 4(4 ) ~ Appropriate services ~ Minimising harm

A consumer living in a unit on the grounds of a rest home activated her alarm after falling over. However, none of the night staff responded to the alarm and she remained on the floor for several hours until the day support service arrived.

The consumer wanted to discuss this with the rest home manager and contacted an advocate to help arrange the meeting. The manager offered her sincerest apologies and confirmed the incident had since been documented as the consumer requested. She had also carried out an investigation which included checking whether personal alarm pendant devices and villa alarm wiring were all functioning as they should be. The investigation identified that an upgrade was required for the system to ensure staff were fully aware of when alarms are activated. Staff were also to receive further training on what they should do when an alarm went off.

Following the meeting the manager advised the consumer in writing that a contractor was assessing the alarm system and had provided the timeframe for the upgrade to be completed. She also requested the advocate provide an education session on the Code of Rights for all staff.

The consumer was very happy with the outcome and informed the advocate when the upgrade of the alarm system had been completed.

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Dealing with loss of speech following multiple strokes

Rest Home ~ Right 5 ~ Effective communication ~ Stroke

The son of a resident who is unable to speak or write following multiple strokes contacted an advocate, as she appeared to be unhappy at the rest home. The advocate agreed to visit the resident. Through a combination of signs, writing and yes/no questions, she told the advocate that she was very unhappy that she could not live at home but knew that it was not practical for her to go back there. Although she was generally happy with the way the staff at the rest home treated her she did find it distressing when they spoke to each other over her head as if she couldn't understand them. She asked the advocate if it would be possible to organise a meeting with the Manager while the advocate was present.

The Manager was happy to meet and the advocate assisted the resident to relay her concerns about how staff spoke about her rather than to her. The Manager agreed to address these communication issues with the staff. The contact details for the advocate were placed on her notice board with a copy on her file in case she needed advocacy assistance in the future. The resident was very pleased with this outcome.

Rest home staff contacted the advocate on two occasions after the consumer presented them with the card left by the advocate. At the second visit the resident introduced the advocate to a staff member who she could communicate well with. Her subsequent complaints have not related to communication which she describes as working well since the meeting.

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The challenge of dementia

Dementia care ~ Enduring power of attorney( EPoA) ~ Residential facility ~ Staff training

A woman with an enduring power of attorney (EPoA) for her father contacted an advocate for assistance. Her father had dementia and was deteriorating mentally. Due to his attempts to leave the facility where he was a resident, the family received calls from the provider with threats to expel him from the home. The family felt stressed by these calls and wished to raise a number of concerns relating to his care.

The daughter told the advocate the unit had exposed wiring and that her father had managed to start a fire due to this. He had also managed to exit the building on more than one occasion. She believed the staff did not have the experience to manage people with dementia. Then she received a letter advising her to remove her father within two weeks. This eviction notice was later revoked with the explanation that it was a ploy to get an urgent assessment by the mental health team. The family had also been asked to provide a deposit to hold a room for their father, but since received advice that this is not standard practice.

After discussion of the options available through advocacy the daughter opted to have advocacy support to meet with the provider. At the meeting she said she found the staff to be very thoughtful and caring but felt some lacked training in dementia care. She asked for the details of the training received by those caring for her father. She also told the provider that her father's rights had been violated by using his situation in a letter which was later said to be just a "ploy" to get him assessed. Finally she spoke of her concerns that other consumers were able to freely come and go in and out of her father's room.

The provider undertook to improve their communication with her and to provide further training for the staff working in the dementia unit. The advocate was invited back to provide education for the staff. The daughter felt the meeting had gone well and said she was satisfied with the outcome.

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You are able to speak up for yourself

A resident of an independent unit at a retirement village contacted an advocate. She had discovered that after a recent appointment at the local hospital that a copy of the letter was sent to both the retirement village manager and her GP. She thought it unnecessary for a copy to go to anyone but her GP. Her GP suggested that she ask at each consultation that the letter only go to her GP, but she did not think this was the best way to deal with the situation. She wanted to find out whether this was the practice of her consultant or a request from the retirement village.

After considering her options she asked the advocate to make a preliminary enquiry to the hospital's patient affairs and privacy officers. They responded that they would welcome a complaint, so she wrote to them. Although initially reluctant to complain to the retirement village since she had to live with them, she decided to also complain to them.

She thanked the advocate for helping her see a way forward.

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Confidence through advocacy support

The son of a 92-year-old rest home resident contacted advocacy. He said that his father had raised a number of concerns with him and that when he had attempted to address them with management and staff they appeared disinterested and evasive.

After discussing the advocacy process the son advised that he and his father wanted the advocate to arrange a meeting with the manager, with the advocate to attend for support.

At the meeting both the man and his son asked questions of the provider but did not feel that the responses addressed the issues. Although they were not happy with the outcome of the meeting, and they felt that a move to another home may be better, they were extremely happy with the support they had received from advocacy, and said that the information provided had made them feel empowered.

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Resolving issues through communication

A man contacted advocacy as he felt the manager of his rest home was attempting to bully him. He said the manager had taken away the facility mobility scooter, and had informed him by letter that he could no longer smoke in the designated area. He also said that the manager was speaking to others about him without his permission. He had attempted, over a three-month period, to resolve his concerns.

The man did not want a meeting as the relationship with the manager had become strained, and asked that the advocate speak on his behalf. In speaking with the manager it became apparent that there were different perspectives on the situation and that the best way forward would be to have a meeting. The man agreed, and asked the advocate to support him at the meeting.

The manager apologised and explained that she had inherited the facility and its many issues, and that she was determined to make changes. She had forgotten the most important thing which was to communicate effectively with the residents. It was agreed that they would meet in a week to ascertain if communication had improved and that they would discuss the smoking areas and use of the mobility scooter.

At the next meeting, both stated that communication was vastly improved. A new, safe smoking area was designated, and the man was seen by an occupational therapist regarding a new mobility scooter. He was also provided with the company policy on privacy.

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Providing assistance in a rest home

A woman, resident in a rest home, contacted an advocate to discuss her concern about a a carer she described as being cheeky to her when she required assistance, insisting she could do the task herself. The woman liked to stay up late and would call for assistance when she needed help with her bedding. After discussing the options the woman decided she would like to have the advocate support her at a meeting with the manager and a letter was sent outlining her concerns and requesting a meeting.

The meeting was attended by rest home management, the woman and her closest relative, and the advocate. The manager explained she had spoken to the carer about his actions. It was agreed that while the carer had good intentions, it would be in the resident's best interests if she was attended by a different carer. Discussions also took place about how things could be better organised to minimise the frequency of requests for assistance.

The woman left the meeting feeling her concerns had been addressed.

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Anxiety about uncontrolled diabetes

The daughter of an elderly woman resident in a rest home contacted advocacy. The daughter said she had tried to address her mother's concerns but felt she was not being listened to. Having established with the daughter that her mother was competent the advocate arranged to meet her to discuss whether she had the same concerns as her daughter.

The elderly woman was worried as her uncontrolled diabetes was out of control and she had a bad reaction if her blood sugar dropped below a certain point. She was also concerned that some of the staff at the rest home understood diabetes and diet, but most did not.

The advocate organised a meeting for the woman and her daughter with the rest home manager, the diabetes nurse, dietitian and registered nurse responsible for her care. The aim of the meeting was to sort out her medication and to relieve her anxiety about her diabetes. A new medication regime was organised and an education session with carers was to be held by the dietitian and diabetes nurse to educate the staff regarding how food affected diabetics.

Following the meeting, the woman reported that the new medication was working well and she was no longer anxious.

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Independence with regard to medication

A woman resident in a rest home approached an advocate following an education session. She had a number of issues to discuss, but had particular concerns that she was made to swallow her medication in front of staff, which made her feel a loss of independence. She also felt that she had to take medication quickly despite the fact some tablets were large, and due to swallowing difficulties she needed time to get them down.

The woman asked for help writing a letter, which she hand delivered to the manager.

The woman later advised she had met with the manager to discuss her issues. The manager had arranged for a self-medicating competency assessment and a form to be completed that allowed her to continue with some degree of independence with taking/keeping medication. She was very happy with this outcome.

She thanked the advocate and said it was a very positive process for her.

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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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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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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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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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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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