Case study of Bupa's Tasmanian facility begins before Royal Commission into Aged Care

Diane Daniels told a hearing of the Royal Commission into Aged Care Quality and Safety in Hobart on Wednesday about the ongoing issues she's faced with her mother's care including missed meals, faulty equipment and her mother suffering from marks and bruises due to rough handling by inexperienced staff.

Her mother Emily Flanagan, 95, has been a permanent resident at Bupa South Hobart since 2015 after being diagnosed with dementia in 2014.

An audit of the facility in October 2018 revealed it did not meet 32 of the 44 expected quality outcomes in the applicable aged care accreditation standards and the facility was sanctioned from October 2018 until July 2019.

It was one of ten Bupa-operated homes across Australia sanctioned between July 2018 and March 2019.

A delegate visiting on October 25 reported residents were at an "immediate and severe risk."

The facility is being scrutinised at a hearing of the royal commission in Hobart this week.

Full-time GP at Bupa South Hobart Dr Elizabeth Monks first raised concerns about clinical care deficiencies in September 2016 but said this fell on deaf ears.

In an email to the then-regional director Dr Monks wrote she believed the home was having "premature deaths and hugely increased morbidity of our residents, secondary to lack of nursing staff and paralysed ability to deal with those staff who I believe need to be performance-managed and educated properly".

Her concerns included medication mishaps, inadequate wound care and preventable life-threatening falls.

Dr Monks told the commission after staff cuts were introduced resident care deteriorated significantly.

"The home was in chaos. No one knew their roles," she said.

In an email she wrote "I'm 100 per cent there is a culture among general managers not to report problems so that they look good to the powers that be. They don't want to be red-flagged."

"I don't think he [general manager David Neal] felt there was anything wrong with what was going on," Dr Monks told the commission.

Dr Monks said the response to her concerns portrayed her as histrionic.

When opening the Bupa South Hobart case study, senior counsel assisting Peter Rozen told the commission they would hear evidence, despite extensive deficiencies in the clinical care provided to Bupa's frail elderly residents being identified by Bupa's internal audits and by Dr Monks, Bupa implemented a policy of significant staff cuts.

Mr Rozen said this was a Bupa-wide policy implemented to save money because the business was facing financial difficulties.

He outlined four strategies which were implemented by Bupa South Hobart between 2016 and 2018 to reduce costs, which directed:

"Despite the clear pattern of substandard care at South Hobart ... no clinical governance audit was instigated by Bupa at South Hobart," Mr Rozen said.

"At the heart of this case study are two questions. [One] were audits and concerns taken into account by those who decided to cut nursing staff at Bupa South Hobart? And two, if not, why not?"

Ms Daniels said her mother Emily spends her life in her bed or a chair.

"I believe this neglect and makes a sham of [Bupa's] publicised view," she said.

In her first month at Bupa South Hobart, Emily had two unwitnessed falls with the second resulting in a fractured hip.

Ms Daniels said a lack of suitable physiotherapy services resulted in her mother losing her ability to walk.

"I believe Bupa South Hobart was neglectful in not providing timely and effective physiotherapy and rehabilitation," she said.

"I knew that mum wanted to get up. She wanted to walk. The physiotherapist gave up too easily and didn't adopt a positive, proactive approach.

"Mum became a two person assist and lost her independence."

Ms Daniels became emotional when she spoke of an incident when her mother had accidentally hit the redial button on her phone and called her.

"I could hear that mum was calling out for a nurse and getting more agitated," she said.

"I waited but mum began sobbing and said 'I wish I was out of it', and this broke my heart."

She said she learned later a nurse or carer had gone into Emily's room and told her mother off for calling out, shut the door and left.

Ms Daniels said the constant monitoring of her mother's care was exhausting and no matter how she tried she was not able to access the right kind of care.

"I felt like I was failing her," Ms Daniels said.

Ms Daniels said as recently as August this year she found feaces on the carpet of her mother's room which took a week to be cleaned.

"I believe that Bupa South Hobart needs to be held accountable for its failure to put people before profits," she said.

The hearing continues on Thursday.