Rest homes: The care factor

BY ADAM DUDDING

Finding a rest home for an ailing elderly relative is often a rushed and traumatic process – and one that more of us will be forced to go through as our population ages. Adam Dudding finds out what it takes. 

A COUPLE of months ago, Paul Martin* picked up a postcard he spotted in a store during a break in the long drive from Auckland to his parents' home in Northland.

It read: "Be nice to your children. They choose your nursing home."

It seemed amusing at the time, but just weeks later Martin, a professional in his early 50s, was doing precisely that – and found the experience deeply unpleasant.

Martin's 76-year-old mother, who had survived a series of small strokes four years ago, last month suffered a far more serious stroke at home, and was found on the bathroom floor by Martin's 83-year-old father. She was unable to talk, and able to move only her hand. After some initial improvement, the stroke deepened over the following days in hospital. Doctors said she was a poor candidate for a place in a rehab unit, and her husband was in no position to give the intensive attention she now needs. This woman, the hospital said, needs to be in a rest home – now.

"It was like being hit by a sledgehammer one blow after another," says Martin. He had to compartmentalise his emotions: there was his own grief at seeing his mother, a woman of great vitality, trapped in her chair with the characteristic slumped face of the stroke victim. Meanwhile, he had to support and comfort his father, who was extremely distressed and often in tears. And hanging over it all, there was a wretched rush to find the best possible place for his mother while juggling all the usual demands of family and a fulltime job back home in Auckland.

The hospital gave them a list of possibles – one rest home had no immediate spaces; another was an hour's drive away from the family home; another was, well, grim. Martin recoiled at the sight of rows of extremely elderly people who'd "clearly been through major medical trauma", lined up in their chairs and staring into space. The idea that his mother was about to join their ranks was "quite shocking".

One place seemed promising but before Martin had booked his mother in, he received a discreet call from a friendly health professional suggesting, strictly off the record, that he should look elsewhere.

Eventually, a place was found (though Martin hopes it is only a temporary solution as rehab options for his mother are reconsidered). But in all, says Martin, it was "a traumatic beginning to a journey that will have further trauma".

Finding a place for a relative who can no longer look after themselves is never going to be fun (though it can often be a huge relief after a period of struggling to cope). There are nearly 40,000 New Zealanders in rest-home care, generally because they need levels of assistance with eating, dressing, toileting or walking that mean they can no longer live independently or with family. As the population ages, their numbers are going to soar. The number of Kiwis aged 65 and over is expected to climb from 500,000 to more than a million by 2031.

But a number of factors make that process of finding a rest home even more traumatic than it needs to be.

At the heart of the problem is widespread concern at the overall quality of rest-home care in New Zealand.

Green MP Sue Kedgley, who with Labour's Winnie Laban has been compiling a report into the aged-care sector to be tabled in parliament in September, says the problems are a legacy of the 1990s deregulation of the health sector, coupled with persistent government under-funding, and the steady takeover of the rest-home industry by private, profit-driven investment groups.

The result, says Kedgley, is an acute shortage of nurses in aged care. As a consequence, 90% of rest home work is provided by caregivers earning an average of $14.40 an hour. Staff turnover is high. Many have no training or qualifications, and there is little financial incentive to earn them.

Critics say this staffing and funding crisis explains many of the rest-home horror stories that periodically make headlines: patients strapped into their beds, the rationing of incontinence pads, or, as featured on the front page of the Sunday Star-Times last week, the misdiagnosis of serious injuries after a fall.

But, while the horror stories suggest choosing the right rest home might be a matter of life and death, it can be surprisingly difficult to find information that allows you to compare one rest home with another.

"There is a lack of accountability and transparency," says Kedgley. The Ministry of Health does certify and audit rest homes, but the audits posted on the ministry website are largely "incomprehensible".

When Kedgley had to find a rest home for her father after he broke his leg, she had "no idea" where to send him, "and sometimes you've got to decide in half an hour.

"We need a simple web-based consumer guide – as in the UK – where you have a list of criteria and they're accounted for."

When comparing rest homes, says Kedgley, a relative should be able to quickly and easily find out things like the number of falls and adverse events at a rest home; the staff-to-patient ratios; the number of showers given per week; details of meals. "At the moment you just take a punt." Worse still, says Kedgley, if a relative is very frail, you want to get the decision right first time, as each move is difficult and traumatic.

IN THE absence of the kind of system Kedgley is calling for, consumers are left to make a choice with a mix of luck, gut instinct and rumour. Wellingtonian Tony Hampton* has been pretty happy with the two rest homes he has found for his father, but it took a bit of work and – as for Martin – some discreet advice from a medical professional.

"I went to quite a few [homes]," says Hampton, "and asked plenty of questions." When the answers given were cagey, he got "really turned off" and kept on looking. One home looked OK, but then a relative who is a doctor warned Hampton "don't go there – there aren't many nurses".

Hampton accepts the argument that corporate-owned rest homes, driven to make a return for shareholders, might be tempted to keep staff levels lower to save costs, but in his experience it's the individuals running the place that matter more than the ownership structure. Rest-home staff at a for-profit Summerset retirement village in Hawke's Bay were "genuinely loving and caring", and the same has been true at the Catholic-run Vincentian Rest Home in Wellington.

Aucklander Heather Sargent was happy enough with the staff at the rest home where her uncle Cyril spent the last six months of his life, but like Martin, she found the hunt for a home horrendous. And she was dismayed at the choices available to her. Aged 96, Cyril had lived independently in a retirement village in Mission Bay for a couple of years when a sudden decline in health a year ago meant he needed 24-hour care. Sargent was given just a day and a bit to find a place, after doctors said he wasn't suitable for hospital care and his bed was needed.

"You've got this lovely gentleman who fought for his country. He's had this dear little unit where he could have his finger of whiskey and watch the sun go down, and he was making what we knew was the final move. But to find something like that in 24 hours... "

Juggling the search with a fulltime job, Sargent looked at five rest homes and was appalled by most of them. They stank of urine; the bathrooms were substandard; the beds were too low for a frail man to get out of easily. She settled on the "best of a bad lot". Each week Cyril paid his $310 superannuation, plus another $834 of his own, for a room that Sargent says was too small for "anything of a significant personal nature – there was no room for knick-knacks".

The "girls" looking after Cyril were "lovely", says Sargent, but "they weren't able to be there for him all the time. They can't be everywhere at once".

Cyril died in November, six months after entering the home.

Simon Challies, marketing manager of retirement village and rest home provider Ryman, agrees that choosing the right home is tough, and is generally done under stressful circumstances. He says the presentation of rest home audits on the Ministry of Health website is "not that easy for the average person to interpret".

But while some sort of central database containing figures for staffing and adverse events might be "helpful", he believes "most people would trust friends' and family's judgement to find out; that's how consumers' decisions are made".

The Consumers Institute takes a different view. After an investigation last year in the wake of a string of high-profile rest-home complaints, Consumer magazine called for legislation to force rest homes to report on key indicators of care – "not just staffing ratios, but also negative health indicators such as presence of pressure sores, infections, weight loss, depression, and decreased mobility in residents".

Last week the Ministry of Health told the Star-Times that following feedback from consumer organisations, they were working to make audit reports more "accessible" to the public.

For Martin, though, finding his way through the rest-home maze is far from over. There will be a move if a reassessment of his mother finds she is suitable for rehab treatment, but that's not the end of of it. Martin's father is, after all, 83.

"So that's the next step," says Martin. "How long can he be on his own?"

*Most interviewees asked to remain anonymous, either out of concern for the privacy of their relative in a rest home, or for fear that speaking out might affect the quality of that care.

HOW TO FIND A DECENT REST HOME

Finding the right rest home is an involved process, and a range of online resources give detailed guidance into where to look, the criteria to consider and the questions to ask. But the following tips will help you on your way.

THE LONGLIST: Ask your health professional for a list of certified providers of rest home services, or find it on the Ministry of Health website (www.moh.govt.nz/assettesting). On the same site you can download the PDF "Long-term Residential Care for Older People – what you need to know", which explains what state funding you are entitled to, depending on your assets.

THE SHORTLIST: Once you've found options in your area, arrange a visit or phone them up to narrow down the options. Ask lots of questions about matters such as staff levels, turnover and training, whether there is a registered nurse on site at all times, the food on offer, the activities available, the availability of newspapers, TVs, phones and internet-connected computers and additional costs that might crop up. (See Age Concern and Consumer links below for comprehensive checklists.)

ASK THE TOUGH QUESTIONS: Go to the Ministry of Health website (full address below) and look at the audit report summary if it is available for a home.

GOOGLE: It's a bit unscientific, but if a rest home has had bad press, you'll probably find the articles online. ASK AROUND: Talk to friends and relatives about their experiences. Ask your doctor too – they're not really allowed to recommend a particular institution, but they may give you a nod and a wink.

PAY A VISIT: Get a tour, talk to the manager, and get copies of any written information. If there was anything of concern in the Ministry of Health audit report summary, ask what has been done to fix it. Ask if you can stay for a while when the tour is over – talk to the residents and find out what they think of the home.

PAY ANOTHER VISIT: Turn up, without an appointment, perhaps choosing a meal time, and see if your first impressions still hold true. Sources include: Age Concern, Ministry of Health, Consumer.

ONLINE RESOURCES

Ministry of Health guide: www.moh.govt.nz/assettesting

Ministry of Health rest-home audits: www.moh.govt.nz/moh.nsf/indexmh/certification-certifiedproviders-audits

Health and Disability Commissioner: www.hdc.org.nz

Age Concern: www.ageconcern.org.nz

Eldernet: www.eldernet.co.nz

Consumer's rest homes checklist: www.consumer.org.nz/reports/rest-homes/checklist

HAVING PROBLEMS WITH A REST HOME?

If you have an issue with a relative's care that is not getting resolved by talking to the rest home managers, contact the Health and Disability Advocacy service on 0800 555 050 – they're independent and they're free. They have consumer advocates who will investigate your concerns, even if it's a minor matter. If the matter is serious they will pass the case on to the health and disability commissioner, who has the power to thoroughly investigate. www.advocacy.hdc.org.nz

- © Fairfax NZ News