Health board defends closing rest home

Midcentral Health says the rapid close-down of Rose A Lea rest home was justified because there was compelling evidence it couldn't be made safe quickly enough.

The DHB's funding manager Mike Grant has responded to criticism from Aged Care Providers chief executive Martin Taylor that the board acted too hastily and not in the best interests of residents. All 13 residents were moved out of the rest home within four days of a complaint being received about standards of care, including the way elderly resident Myra Letts had her legs tied down in her bed before she died.

Mr Taylor said the owners, Joyce and Bryan Wenmoth, hadn't been given a fair chance to respond to the emergency audit team's criticisms or time to fix the problems.

He said residents and their families didn't want the home to close, and rushing elderly people out of their home with about 24 hours warning was not appropriate.

But Mr Grant said the breaches the auditors found were so "material" it was not in residents' interests to leave them there.

Restraining patients 'ought to be last resort'

Paitents in hospital or rest home care should only ever be restrained as a last resort to stop them hurting themselves or someone else, says MidCentral Health Restraint Approval Group chairwoman Susan Murphy.

"It would absolutely not be used to hold someone in a particular position." Mrs Murphy said she found it hard to imagine a situation where restraining a terminally ill patient would be the best option."We would not consider that even if a family member asked for it."

The hospital's restraint minimisation and safe practice policy was singled out for praise when it went through a certification process in May. There is a restraint co-ordinator who checks on every case where a person might need to be restrained and looks at what else could be done to avoid it.

"We look at how to act in the best possible way while managing their dignity and keeping them safe."

The restraints the hospital used were sheepskin-lined leather wrist and ankle straps that could be attached to railings with velcro fasteners.

The "blue bags" were rarely called for, Mrs Murphy said.

Their most common use was with "incredibly unwell" patients, usually in mental health care, but sometimes where elderly or brain injured people were delirious. Patients who kept trying to pull out tubes were an example.

Options such as medication or "specialling" – having someone sit with the patient around the clock – were tried first, and staff were also trained in calming patients.

* The Manawatu Standard put some of Aged Care Providers chief executive Martin Taylor's questions to MidCentral District Health Board funding manager Mike Grant.

Was due process followed? The board followed the processes provided for in the Aged Related Residential Care Contract. If we believe that delay will prejudice the interests of any person we may carry out a quality audit without prior warning. The agreement can be terminated if the home has failed to carry out any obligations under the agreement, and the failure is material.

Was it in the interests of residents to break up this community? Residents who wanted to stay together were placed in alternative facilities as a group, in all but one case.

Were the residents in danger? At least one resident's clinical condition was fragile and required immediate intervention. Management were also finding it difficult to meet the clinical needs of other residents.

The home passed certification in March. Has its restraint policy somehow disappeared since then? Or is it that the auditors didn't ask for it? The audit report will discuss this matter further as indeed it will discuss other matters of clinical management, however the practice of restraint did not follow conventional restraint practice and by definition a generic restraint policy.

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