More people in nursing homes are dying prematurely – and the true numbers could be much higher, researchers say.
The number of premature deaths in nursing homes from preventable causes increased by 400 per cent in the 13 years between 2000 and 2013, Monash University researchers have found.
Deaths by “external” and preventable causes quadrupled from 101 to 417, while the rate of such deaths rose from 1.2 per 1,000 admissions to 5.3.
Lead researcher Professor Joseph Ibrahim said the increase was partly due to changed reporting requirements.
He added the true figures could be much higher because some deaths may have been misclassified as natural cause deaths.
The Monash study found the most frequent causes of premature death were falls (81.5%), choking (7.9%) and suicide (4.4%).
By law, all nursing home deaths resulting from non-natural causes must be reported to a coroner. The study only examined deaths in this category.
In an article in the Medical Journal of Australia the researchers say a national policy framework is needed to tackle the problem and should involve governments, nursing home staff and owners.
They recommend the establishment of a lead authority responsible for reducing harm by improving practice in nursing homes.
“Although aged care in Australia is actively monitored by a range of mechanisms, no one entity is responsible for reducing harm by improving practice,” they write.
Aged care governance and standards questioned
The findings “raise an important question about governance structures for the care and safety of nursing home residents”.
“Our data challenge the misperception that all deaths of frail, older persons with multiple comorbidities living in residential care are natural.
“Effective planning for high quality aged care requires accurate data about preventable harm, as well as acknowledging that negatively value-laden judgements about the worth of an older person’s life do not justify inaction.”
“The concept of dying well encompasses a death free of avoidable suffering” and “a person’s life should not be prematurely shortened.”
In an interview with ABC television Professor Ibrahim said the increase shows nursing homes have not improved their care standards.
“Most people tend to take the view that older people are going to die and if you’re in a nursing home, then you’re simply waiting to die.
“There is not an emphasis on looking at why these injuries occur and there is certainly not a lot of effort put into preventing them.
“These are not the natural biological processes. Someone has either done or not done something that has shortened your life.”
Research backs union findings
The Australian Nursing and Midwifery Federation (ANMF) says the Monash University study highlights the urgent need for mandated staff-to-patient ratios for both nurses and carers.
ANMF acting federal secretary Annie Butler said the research confirmed the findings of the union’s own National Aged Care Staffing and Skills Mix Project, which showed the devastating effects of chronic understaffing and produced Australia’s first aged care staffing model.
The model is based on each patient or resident receiving an average four hours and eighteen minutes of care every day with a skill mix of AiNs 50 per cent, RNs 30 per cent and ENs 20 per cent.
Annie Butler said the ANMF study found “gaping holes across the system with frequent episodes of missed care”.
“The staffing shortfall means that aged care residents are frequently missing out on essential care and treatment. Only 8.2% of the study’s 3000-plus respondents said that staffing was always adequate.
“This is a situation that is increasingly distressing for our members as well as for residents and their families and it’s one we are battling to change.
“The more evidence, such as this research, we have, the more politicians will have to listen.
Poor staffing is mainly to blame
“Inadequate staffing is definitely the main factor in premature deaths,” says retired nurse Annette Peters, president of the Quality Aged Care Action group.
“It all comes back to staffing. People don’t seem to want to acknowledge that but it’s true.”
Annette recently completed a 50-year career as a registered nurse including 25 years in aged care.
She says nursing home falls are inevitable but far more likely to happen when insufficient staff are on duty.
She describes the lack of registered nurses in aged care as “a huge problem”.
“When I worked in aged care I could have been responsible for 30 to 100 residents at any one time.
“I know nurses now who are responsible for 150 residents. That’s an impossible task. It’s unsafe for patients, other residents and the nurses themselves.”
RNs are vital in aged care
Annette calls the NSW government’s refusal to support legislation to reinstate the mandatory rostering of nurses 24/7 in aged care “the worst thing that could happen to aged care”.
“They have put some of the most vulnerable people in our community at huge risk.