The Royal Commission into Aged Care Quality and Safety held its Sydney hearing this week. Its focus was on residential aged care, with a particular emphasis on care for people with dementia.

Here, we summarise the activities of each day. The hearing will continue in Sydney next week on the 13-17 May.

Day 1 – Monday 6 May

The Royal Commission held its first day of the Sydney hearings on Monday, with a strong focus on residential aged care and with particular emphasis on care for people living with dementia. Counsel assisting, Peter Gray QC, opened the hearing with an address that outlined the themes that the Sydney hearing would investigate over the course of the next few days. He drew upon the recently published background papers to provide context for the focus on those living in aged care facilities suffering from dementia. The first witness called to give evidence was Darryl Melchart, a resident of an aged care facility since 2014. She had been deprived vital heart medication for periods of three to four days and felt unsafe due to the behaviour of fellow residents and staff. The second witness for the day, Merle Mitchell, recounted her experience at Waverly Valley Aged Care Facility, where poor staffing ratios result in the regular timetabling of only one nurse for 170 care recipients during night shift. The third witness, George Akl, spoke of his migrant father’s experience in three separate residential aged care facilities who, as a result of dementia, lost his English speaking skills and was unable to communicate with staff in his native Arabic. Eresha Dassanayake then gave evidence about her mother’s experience with dementia in residential aged care, which was followed by Peter Gray QC introducing a case study concerning Garden View Aged Care Pty Ltd and its use of physical restraints. The day ended with Lillian Reeves describing her husband’s experience as a resident at Garden View who was subjected to both physical and chemical restraint.

Day 2 – Tuesday 7 May

The second day of Sydney hearings focused solely on the case study involving Mr Terence Reeves, a respite care recipient at Garden View Aged Care. The first two witnesses, Michelle McCulla and Natalie Smith, gave evidence about their experiences visiting their father at Garden View. Both witnesses recounted instances where their father had been physically restrained and gave evidence regarding the use of chemical restraint. Jayanthi Kanna, a registered nurse at Garden View, then spoke about the administration of Risperidone at Garden View and the efficacy of the monitoring chart used to keep track of resident’s movements throughout the day. Dr Miles Burkitt outlined his experience at Garden View as Mr Reeves’ doctor and explained that chemical restraint was used at Garden View as a last resort after attempting to calm the patient. Dr Burkitt claimed that although he did not recall examining Mr Reeves before prescribing Risperidone, he could not imagine prescribing Risperidone without reviewing the care recipient. Dr Kenneth Wong then gave evidence regarding Mr Reeve’s condition at the time of his admission which was mobile and not a falls risk. He later prescribed Risperidone to Mr Reeves on advice from the nurses that he had been taking Risperidone prior to entering Garden View. The final witness, Kee Ling Lau, the Director of Nursing at Garden View, explained that there are instances where restraining residents day after day for six to seven hours at a time could be justified.

Day 3 – Wednesday 8 May

The third day of the Sydney hearing examined a second case study that focused on the experience of Mrs CO, an 85 year old resident at Brian King Gardens who suffers from dementia. The first and second witnesses, the daughters of Mrs CO, gave evidence together about the care provided to their mother. They disputed a statement made by the Resident Manager at Brian King Gardens that their mother was resistive when staff would attempt to remove their mother’s dentures and perform general dental care. As a result she was prescribed mirtazapine without the consent of the family, nor any explanation as to the significant side effects. The Resident Manager of Brian King Gardens conceded that they do not have a policy regarding issues of resident capacity and consent. He further stated that he was not concerned about the prescription of psychotropic drugs at Bring King Gardens despite statistics showing that 109 of the 197 residents were on a regular prescription.

Clinical speech pathologist, Cheryl Lee, was the fourth witness for the day, and was questioned on her decision to place Mrs CO on a soft food diet when mere assistance with her eating would have been sufficient to keep Mrs CO on a regular diet. The next witness for the day, Dr Margaret Ginger, gave evidence about her treatment of Mrs CO as her GP. When questioned about her decision to administer mirtazapine, she stated that “I really have no explanation for why I did that” and that pastoral care visitations would have been more appropriate. The sixth witness gave evidence unrelated to the case study, and spoke about her experience as an aged care worker at a residential care facility. Counsel assisting then introduced a third case study that examined incidents at Oberon Village, owned by Columbia Nursing Home Pty Ltd. The case study concerned CA, a respite resident at Oberon Village who was diagnosed with advanced Alzheimer’s disease. CA had been admitted to Oberon Village for little over a month before she was hospitalised following an incident with a male resident who had a reported history of aggression. CA’s daughter gave evidence explaining her mother’s condition and the failure of staff to supervise the residents, which would otherwise have prevented her mother’s injury.

The final witness for the day, the General Manager of Operations for Columbia Nursing Home, gave evidence as to the regulatory action undertaken at Oberon Village. She admitted that Oberon Village was deemed non-compliant in behaviour management between March and July 2018. She explained that following this assessment, as well as the incident with CA, staff have been re-educated and denies that the incidents relating to CA were a result of substandard care.