"Important aspects of the care of my elderly mother"

About: Aaron House Care Home Midlothian Community Hospital Royal Infirmary of Edinburgh at Little France / Accident & Emergency

(as a relative),

My mother was a resident of Aaron House Care Home, Penicuik, Midlothian. She was there for two years. She was in the nursing wing because her main health problems involved a degree of heart failure and a degree of kidney failure. With adequate care these conditions were stable, and she enjoyed interaction with friends and relatives, discussing a range of subjects and exchanging stories and memories with ease. I had full Power of Attorney during those two years.

My mother died in the Midlothian Community Hospital in June 2014, where she had been transferred after emergency treatment at ERI for dehydration and infection. Please note that this emergency admission had been initiated by me.

During my mother’s 2-year stay in Aaron House, basic failures in care led to her having to receive hospital treatment for dehydration. This happened three times. I complained to the Care Inspectorate on two of those occasions (January 2013 and April 2014) and both times the Inspectorate upheld that adequate fluid and nutrition had not been provided. During my regular visits (a minimum of four visits per week) to see my mother in Aaron House I often noticed examples of substandard care.

I am placing certain key aspects of this story on the Patient Opinion website because the whole experience of monitoring my mother’s care has demonstrated to me several very serious failings in a system which purports to provide adequate care to elderly vulnerable people.

Care Inspectorate

Having determined in January 2013 that my mother had indeed been deprived of adequate fluids and nutrition, the Inspectorate placed certain requirements on the functioning of the care home. However, I believe the Care Inspectorate failed to ensure that these requirements were being carried out, and the care home continued with its faulty practices, leaving my mother seriously dehydrated on two further occasions.

Social Work Department

Aaron House is one of a number of care homes used by Midlothian Council, and my mother’s care there was funded largely by the Council. However, as far as I was aware, the Council’s Social Work Department did not involve itself in checking the competence of the day-to-day care provided by Aaron House. Certainly my mother did not have the required reviews of her care.

GP practice

It is my understanding that the local GP practice made regular visits to Aaron House as well as at times being called out to patients, and that this had been the case for a number of years. I am alarmed and horrified that the GP practice apparently did not notice the deficits in care such as inadequate provision of fluids and nutrition, and did not implement vigilance even when complaints were upheld by the Care Inspectorate.

At the end of March 2014, I believe my mother would have died of lack of care in Aaron House had I not insisted that she was moved to the ERI by ambulance. At first Care Home staff had told me that my mother ‘did not meet the criteria’ for triggering GP attendance, and when a GP did eventually attend, she seemed unwilling to move my mother to hospital and I had to press her to do so. Soon after my mother arrived at the ERI, I took photographs of her in her dehydrated collapsed state. What these photographs have recorded is very shocking indeed. Not only was my mother barely conscious, but also the contents of her urine bag appeared to be largely pus.

ERI triage immediately began to rehydrate my mother, and her condition quickly improved.

ERI triage

In this busy department, my mother received appropriate medical care, delivered with compassion. During my discussions with staff, I was shocked to learn that it was not uncommon for a resident of a care home to be brought in by ambulance for emergency rehydration. I wonder how that could be. Surely it is a central function of each care home to ensure that its residents receive adequate fluid and I wonder why should failings in care homes be allowed to continue – resulting in extra work being piled on to a busy hospital department. I asked if figures were kept of how many dehydrated residents of care homes were brought in, and was told that no one kept such records.

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I think there is a massive and entirely unacceptable difference between dying of lack of care and dying while being cared for.

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I believe that that vulnerable people – even those of full cognitive capacity – can find it impossible to insist on receiving adequate care, and that ‘surveys’ of ‘patient or resident satisfaction’ can give ‘results’ that are skewed by the fact that patients do not feel safe to express their actual views and experiences.

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Response from Aaron House Care Home We have made a change

Our priority is to ensure the health and welfare of the people we support. We take all feedback from the Care Inspectorate and from the relatives of the people we support extremely seriously. The Care Inspectorate’s outcomes in relation to this matter were published in July 2014, and we acted on their feedback immediately.

In the intervening year the home has continued to improve in all areas. We were pleased to receive positive feedback from the Care Inspectorate in our March 2015 inspection and we continue to work hard to ensure we provide good quality care and support.

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