A man who had suffered a serious brain injury was left living in squalor after disability service providers and ACC failed to address issues including a toilet that was left blocked and overflowing for months.
Deputy Health and Disability and Commissioner Rose Wall this week released a report criticising the lack of continuity and communication between two disability support providers contracted to care for the man by ACC and also criticising the response by ACC once alerted to concerns about the man’s squalid living conditions.
Home help was arranged for the man once he was discharged from hospital after suffering a severe traumatic brain injury in 2008. His clinical history included congenital hydrocephalus and a mild form of cerebral palsy. Support workers noted he was at times difficult to engage, did not like visits from new people, showed tendencies to hoarding and often refused help.
In 2012 a disability support provider was contracted by ACC to provide the man with supported living assistance. The provider had arranged for bathroom repairs where he could but the man still had to use a bucket of water from the bath to flush the broken toilet.
In April 2014 a second disability provider, Geneva Health, was contracted by ACC to provide further assistance to the man including increasing his personal hygiene and persuading him to remove some of the clutter from his home. A nurse, the clinical co-ordinator developing a service plan for the man, visited him in April 2014 and noted the ‘horrific’ living conditions and asked that ACC do a further assessment so that her concerns were dealt with.
“The windows were all shut and the curtains were thick with dust. The smell was rather potent. It was a three-bedroom home and all rooms were full to the brim with hoarded items,” the nurse said.
“The kitchen had rotting benches and the cupboard doors were either missing or broken. There were the usual items in the kitchen (oven, fridge etc) but none of them were in working order. The only working thing in the kitchen was the microwave.
“I went down to the bathroom which was also very dirty and unkempt. The bathroom had a bath which Mr A had clearly been using as a toilet and also to wash his clothes in. The toilet itself was non-functioning. The floor boards were clearly rotten/wet and some had been replaced.
“I sat on his bed to talk with him and noted how old and very hard his bed was. I wondered if there was even a mattress under there. The sheets, blankets and pillows were all extremely old, dirty and mouldy. The room was very cluttered and had no ventilation at all.”
No improvements were made and eventually the toilet blocked completely. Support workers struggled to get their client to pay for or allow a plumber to fix it and ACC said it was the client’s responsibility to arrange and pay for repairs.
A support worker described the worsening condition of the client and his house in July 2014. “The toilet is now completely overflowing with body waste. When [Mr G] arrived yesterday, the man had soiled himself and Mr G suggested he takes a shower. [Mr G] observed that there was a lot of faeces at the bottom of the shower that did not wash away. After the shower, the man said that he had no underwear and they were all soiled. [Mr G] managed to find a pair, not clean, but at least not soiled.”
One support worker refused to see the client anymore after requesting his toilet be fixed for two weeks and the person hired to replace the worker refused to return after the first visit.
Eventually an arrangement was made in late July for the man’s GP to visit at home and he referred the man to the District Health Board’s Mental Health Service for Older People (MHSOP).
The Mental Health Service visited in early August 2014 and managed to convince the man to go to hospital. When he was discharged from hospital he was finally put into fulltime residential care.
Deputy Health and Disability Commissioner Rose Wall was critical of the care provided by support providers and ACC’s response to concerns raised.
She felt the disability support provider should have considered whether the man’s capacity to make decisions had reduced and contact his doctor and alert ACC.
Wall found the care that Geneva, which was contracted to provide disability support services, provided failed to ensure quality and continuity of services because it did not escalate concerns correctly and there was no effective system for monitoring staff attendance. This resulted in no support being provided to the man for about a month.
Wall also found ACC had an obligation to ensure that the man’s needs were assessed appropriately, and that appropriate services were put in place in accordance with his needs.
“Those services were not in place, and, despite receiving reports that the man was living in circumstances that raised serious health and safety concerns, it failed to take appropriate action to ensure that his needs and competence were reviewed.”
She accepted ACC was not responsible for repairs to the man’s house but said the squalid conditions were indicative his competence was reducing and more care was needed.
She recommended Geneva provide the man with a formal apology and that both Geneva and the disability support provider improve processes and procedures.
ACC admitted they did not respond appropriately to concerns raised by support workers about the conditions the man was living in.
“Both [the disability support provider] and ACC’s response to them lacked the urgency and clarity of purpose required in the circumstances,” ACC told the Health and Disability Commissioner.
In a statement released this week ACC chief customer officer Mike Tully said it accepted the findings and had apologised unreservedly to the client and his family for the poor standard of care he received.
“ACC conducted an investigation into how this situation occurred and, as a result, a significant programme of work was completed to improve the care given to our most high-needs clients.”
He said more training was given to staff who dealt with high-needs clients and work had been done with providers to improve communication and processes.
Tully said ACC was confident the changes would prevent this happening again.