Changes to dementia care follow death of man in his 90s

Thursday 12 May 2016

The death of an elderly man with dementia has led to significant changes in the way that old people are looked after, following a review.

While a post-mortem ultimately concluded that the man's death was caused by underlying health issues and not institutional neglect, the man's increasingly alarming condition in the months leading up to his death raised the need for a review, Glenys Johnston, the Independent Chair of the Safeguarding Partnership Board told a press conference yesterday.

Concerns about the man’s care arose as early as July 2014, and when he was admitted to hospital one month before his death in March 2015, he was malnourished and suffering from hypothermia. The attending doctor also noted lacerations to his arms, unexplained bruising and multiple leg ulcers.

Over this time period, “Mr Benjamin” (not his real name) had been cared for initially at home by his similarly-aged wife, later in hospital and then at a residential care home. He spent his final day in hospice care.

“The family felt that they were having to shout to get the support they needed,” Mrs Johnston said yesterday.

According to the report: “Mrs B as a carer, was not effectively heard and it often required the intervention of her son or daughter-in-law before her requests for help in a rapidly deteriorating situation were expedited.”

The SCR made public details the family's frustrating attempts to raise the issues of Mr. Benjamin's care with multiple agencies including the GP's office, district nurses, the residential home, the Memory Clinic and the hospital.

Failures of interagency communication were highlighted in the report as well as many instances where care plans were not followed or simply dropped off.

One social worker is noted as having visited Mr Benjamin and then immediately leaving for seven weeks’ holiday. While another seemed to establish a rapport with the family on a first visit and intended to return, only to then leave employment with CSS. His January 2015 visit was the last from CSS before Mr Benjamin's death.

"During February in particular the family, who were frequent visitors to the (residential) home, expressed concern about Mr Benjamin's physical appearance," the report said.

"A previously proud and well-dressed man was too often looking dishevelled and unkempt."

Problems which arise in dealing with patients with dementia or diminished capacity in care – chiefly that often the person in question does not recognize the extent of their illness – were also discussed at yesterday’s press conference.

Mr Benjamin had rejected residential day care, which would have offered respite to his wife, and his wife also rejected early interventions which were made on the behest of their son.

“If you are an adult and have the capacity to make decisions and remember those decisions, you can make a decision not to be protected,” Mrs Johnston said. This is problematic for professionals who must be constantly assessing capacity.

New laws are being introduced to outline how health and helping agencies should deal with dementia patients and others with diminished capacity. The Capacity and Self Determination Law for Jersey is expected to go before the States by the end of the year.

The SCR concluded with five recommendations recommendations to immediately improve care including the development of a care coordinator role and a new cross-agency integrated IT structure, called Care Partner.

"Several of the recommendations from the two SCRs have been implemented but will take time to be embedded and make a difference, the SAPB will continue to scrutinise and hold agencies to account for this," Mrs Johnston told Bailiwick Express.

"The development of the care co-ordinator role and the carer’s assessment are two examples of areas that would have made a difference to the experience of this family."