The threat of Omicron was just the final nail in the coffin of a mismanaged DHB-owned and run aged-care facility
A report into the controversial closure of Reefton’s only rest home shows its owner, the West Coast District Health Board, was breaching its government funding contract and national health standards for months before it shut the doors.
Ziman House was closed abruptly in March 2022 and its 10 elderly residents packed off to care homes in Greymouth and Christchurch, many of them in distress.
Most have since died.
DHB managers told an angry public meeting in Reefton at the time that a shortage of registered nurses and the growing threat of the Covid Omicron variant posed an unacceptable clinical risk to the Ziman residents and “temporary” closure was the only option.
But a report by aged-care expert Rhonda Sherriff commissioned by the board reveals the residents had been at risk for some time and senior managers didn’t know.
Sherriff’s June 2022 report, released recently to Newsroom, found Ziman House had been short-staffed for months, administration was sub-standard and the residents were at serious clinical risk.
The home needed six registered nurses to comply with its aged residential care contract for round-the-clock hospital-level care.
But it was well short of that number.
“(There was) one RN taking on a vaccinator’s role during the pandemic, another doing contract work in Australia was frequently unavailable and other RNs had left to pursue work in other regions or were on protracted leave,” the report says.
Some DHB members had alleged a serious bullying culture on the site was behind the loss of staff.
“One board member stated she had raised the bullying concern with the DHB’s human resources personnel but was disappointed the information was not dealt with,” Sherriff reported.
The first alarm signals sounded publicly in November 2021, her report shows.
“The nurse director operations has started working with Reefton staff to improve culture and work on sustainable ways to provide services,” DHB general manager Phil Wheble reported to the board.
A month later the clinical nurse manager of Ziman quit for a new role in community nursing.
In her wake the full extent of the DHB’s systems-failure was revealed.
A temporary manager from Ryman Healthcare was installed for two weeks at Ziman and immediately raised the alarm.
“She confirms the residents are considered at high clinical risk. There are significant gaps in resident assessments, care-plan documentation, compliance with health and disability standards and clinical-care delivery,” Sherriff says.
It was not just the residents who were at risk, the report shows: the DHB was also failing in its obligation to provide training.
The staff were supposed to receive up to 12 hours’ education a year but the Ziman caregivers weren’t getting it.
“Age-related-care-specific education was not being provided at Ziman, in accordance with the requirements of the ARC contract and the health and disability service standards,” Sherriff says.
Under the radar
Somehow the DHB’s reporting systems had failed to detect the myriad problems at its Reefton facility, including the staff shortage.
“The outgoing clinical manager had been covering vacant shifts herself, which while commendable was obscuring the … roster gaps,” Sherriff says.
Senior DHB managers had been caught up in other crises at the time, including Omicron and the effect of floods in Westport.
But by February Sherriff’s report shows they were scrambling to deal with the risk – and not just to the Ziman staff and residents.
The managers called for an urgent meeting to tell the board what was going on and “identify the risk to board members”.
At the urging of senior managers, stunned board members who had no idea there were serious problems at the Reefton rest home voted 6-4 to close it temporarily on clinical grounds and move the residents.
Sherriff, a nursing veteran and part-owner of a Christchurch retirement village, says the decision was the right one given the staffing gaps and impending Omicron outbreak on the West Coast.
But she advises the DHB’s systems failure revealed by the Ziman House crisis must be addressed, in particular its monitoring and reporting systems.
“Larger aged-care corporates favour weekly written reporting as it highlights immediately any concerns to the operations managers.”
DHB ownership of an aged-care facility is uncommon these days and that poses another potential problem, the report suggests.
“The facility being owned, funded, managed and audited by the DHB raises issues of impartiality.”
To meet the requirements of the aged-care residential care contract the DHB should have commissioned an (independent) HealthCERT audit as soon as the problems surfaced, she says.
But it did not.
Way ahead
As for the future of the sorely missed Reefton facility, Sherriff suggests local ownership could be an option.
The small rest home, renovated by the DHB in the absence of its residents last year, would be less economic to run than a larger one, she warns.
“But there may be an opportunity for the local community to establish a trust and work with Te Whatu Ora to provide at least rest-home level care, which requires less RN input than an aged-care hospital.”
A spokesperson for the Reefton Health Action Group, Helen Bollinger, says it’s unfortunate the Sherriff report was not made public earlier.
“It might have saved a lot of confusion and distrust in the community and shown us a way forward.”
It was clear the DHB’s neglect over time coupled with Covid had forced it to take drastic action but the closure might have been avoided if it had acted earlier, Bollinger says.
“Sherriff’s report does give us some hope that we might see Ziman re-opened; there are so many people in the Inangahua district who would use it.”
The empty building is still being heated and cleaned and Te Whatu Ora plans to run a daycare and activities programme in it starting next month.
A number of locals with mobility problems would welcome being able to use the upgraded bathrooms, Bollinger says.
Te Whatu Ora West Coast general manager Phil Wheble was invited to comment on the report but could not respond by deadline.
Made with the support of the Public Interest Journalism Fund
