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Iona Home and Hospital in Oamaru and two caregivers have been found to have acted abusively towards a man in his eighties with dementia while he was attempting to use the toilet.
A new report from Aged Care Commissioner Carolyn Cooper found a man's rights under the Code of Health and Disability Services Consumers' Rights (the Code) were breached.
The man had moved into the dementia unit at the home operated by Presbyterian Support Otago (PSO) in 2019, as his wife was no longer able to care for him at home.
In addition to his progressing dementia, the man had several other medical conditions, including peripheral vascular disease, resulting in a left leg above knee amputation in 2017, and suspected cancer of the colon or prostate.
He used a wheelchair or a prosthetic leg with a walking frame to mobilise, and his care plan indicated that he needed significant assistance with activities of daily living, such as mobility and personal care.
Incidents of aggression by the man were reported and his family were concerned that staff could be contributing to the behaviour, and installed a camera in his room.
Video footage showed caregivers acting abusively, including shouting and failing to provide adequate assistance.
The incident took place when a commode was taken to the man's bedside and the caregiver asked him to sit on it while she changed his wet bedsheets but not offer or give him any help.
"Mr A's response to these requests was inaudible, but the footage shows him leaning towards the side of the bed against the wall and fiddling with the sheets. Mr A appeared to be uncomfortable and to be struggling to understand Ms D's request."
Another caregiver entered the room and started vacuuming and both caregivers instructed the man, who was now leaning over the bed and looking around his feet and under the bed, to move to the commode.
He did and asked the caregivers something before one of the caregivers rasied her voice and said "Now sit there and just behave".
The report notes a few minutes later "Ms D stood behind Mr A and said: 'Stand up [Mr A] so I can pull your pants up please.' She then loudly repeated 'pull your pants up'. Mr A appeared confused and said something inaudible. Ms D then moved in front of Mr A, pointing her finger at his face, and Mr A raised his hand. Ms D said: 'Don't raise your fist. Cut it out. Pull your pants up. That's all I wanted.' Mr A then attempted to speak while Ms D was speaking; however, the exchange was inaudible."
Cooper found two caregivers breached the Code for failing to treat the man with respect and provide services of an appropriate standard.
"The conduct displayed by the caregivers towards the resident, as seen in the video footage, is never acceptable," Cooper said. Of the second caregiver she said, "under no circumstances is it acceptable to act as she did.
The third caregiver was found in breach of the Code for failing to intervene or report the abusive behaviour. "It's disappointing that she did not speak up or intervene during the inappropriate behaviour towards the man," Cooper said.
Cooper also found PSO breached the Code for failing to ensure the man received services that complied with legal, professional and ethical standards.
The report highlighted issues with workplace culture at Iona Home and Hospital, which contributed to the breaches of the Code, including staff not feeling empowered to report inappropriate behaviour and a lack of proper oversight and support.
"In my view, the widespread and repeated nature of these actions by caregivers at PSO reflects a pattern of poor care and a failure to comply with policy and legal standards, for which ultimately PSO is responsible," Cooper said.
"PSO had a responsibility to prevent issues of abuse through appropriate selection of staff, training, rostering, oversight, and performance monitoring."
The report also highlighted issues with care planning, resourcing limitations and delay in investigating the incidents relating to behaviour of the man.
Since these events, PSO has instituted changes to improve staff training, culture and care practices.
Cooper also made a number of other recommendations, including a formal written apology to the man's family.
