Personal stories highlight concerns around care of elderly

Liz Farsaci looks at cases of complaints that have come before the Nursing and Midwifery Board of Ireland in the past year, in which inadequate care and financial abuse of elderly people by nurses were two prominent emerging themes

WHEN examining the complaints made against nurses, which have come to public inquiry over the past year, two themes immediately emerged: a lack of care afforded to elderly people living in residential care settings, and financial abuse of elderly people.

The Nursing and Midwifery Board of Ireland is the regulatory body for all nurses and midwives in the country. Part of its remit is to handle complaints made against all nurses and midwives and so, theoretically, anyone within the sector could come before the attention of the inquiry.

However, a large number of those who have been the subject of public disciplinary hearings within the past year have been nurses working in residential homes or rehabilitation centres, caring for old and vulnerable patients. Amongst these, several complaints were in relation to nurses stealing money from elderly patients, some of whom had terminal cancer or dementia.

Although nurse John de Lara did not face any allegations in relation to harming patients, the fact that he was ordering Sudafed using the names of colleagues — and then failed to inform his employer, the Royal Hospital Donnybrook, that he was under investigation for the possession of crystal meth — shocked many of his colleagues and others.

John Benedict Butalid de Lara, 46, cared for elderly patients as a staff nurse at the Royal Hospital Donnybrook, for 11 years, from December 2003 until 2014. He was part of a team providing rehabilitation services primarily for elderly people, and served both long- and short-term patients.

But on March 31, 2014, Mr de Lara was arrested following a search of a flat on Marlborough Road in Donnybrook. During the search, Mr de Lara arrived at the flat and put a bag of something into his mouth, which he later spat out at a garda’s request. The substance in the bag was later identified as just over 2.4 grams of crystal meth.

The following day, Mr de Lara was charged with possession of a controlled drug, namely methamphetamine.

The case was heard before the district court in July 2014, where the charges against Mr de Lara were dismissed, after he paid €1,000 to a charity. He was then fired from his job at the Royal Hospital Donnybrook, after his employer found out about his court appearance from a newspaper article.

At the disciplinary inquiry in February of this year, Mr de Lara, from Ballyfermot, Dublin, was found guilty of six counts of professional misconduct in relation to the possession of crystal meth, of ordering Sudafed using the names of several colleagues and of failing to inform his employer that he was under Garda investigation.

The hearing, held at the Nursing and Midwifery Board of Ireland’s headquarters in Blackrock, Co Dublin, heard that an ingredient in Sudafed, pseudoephedrine, can be used in the making of crystal meth.

On foot of the inquiry’s findings, Mr de Lara was struck off the register by the NMBI. He has since taken an unfair dismissal case against his former employer, which is ongoing at the moment.

During the inquiry, Mr de Lara’s former colleagues struggled to understand how someone who appeared to be such a conscientious nurse could become involved in something so unseemly. One of Mr de Lara’s former colleagues, health care assistant Nicholas Mallari, said he was shocked and surprised to find out Mr de Lara had used his name to order Sudafed. Referring to Mr de Lara, Mr Mallari said: “He’s a nice person. He’s a good colleague. He’s a good nurse. As far as I know, he’s a good man.”

Asleep on the job

Another case involving a nurse charged with caring for elderly people was that of Eileen Mary Mulligan Kiernan, who worked at the Maple Court Nursing Home in Castlepollard, Co Westmeath, for more than a decade, from October 2002 until July 2013.

During her shifts, she would be in charge of the care for 21 elderly residents, most of whom were more than 80 years of age.

Personal stories highlight concerns around care of elderly

A disciplinary hearing at the Nursing Board’s headquarters in December 2015 heard that Ms Kiernan would routinely sleep for one to three hours during her night shifts, between 2am and 5am. During this time, she would insist that the lights in the staff room were turned off, the refrigerator unplugged and that no laundry be done.

Sometimes, she would also insist that a care assistant stay with her in the staff room during these periods, which meant that no staff were present with the residents.

In May 2013, two care assistants at the nursing home completed whistleblower forms in relation to Ms Mulligan Kiernan, and gave them to nursing home manager Caroline Day, who then made a complaint to the nursing board. During the inquiry, one care assistant said she did not raise the alarm about Ms Mulligan Kiernan’s behaviour because she was afraid of her.

Care assistant Ann Daly said she worked one or two night shifts per fortnight with Ms Mulligan Kiernan, and that the nurse went to sleep in the staff room on every night she worked with her. Ms Daly said the nurse would go into the staff room around 1 or 2am, put several chairs together, get a blanket and lay down. Ms Daly said the nurse would set an alarm for 5 or 5.30am, and would sometimes say, ‘Half a night’s work for half a night’s pay’.

While Ms Mulligan was sleeping, Ms Daly said she herself was not able to properly do her rounds — which were usually done every two hours — because she needed another person to help her complete some of the tasks, such as repositioning the residents so they wouldn’t get bed sores.

Ms Daly told the inquiry that before completing a whistleblower form in May 2013 in relation to Ms Mulligan Kiernan, she never said anything because the nurse used to say, “If I go down, you go down”.

Ms Mulligan Kiernan, who was not present at the hearing last December, denied the allegations.

Inadequate care

In May of this year, a disciplinary inquiry at the Nursing Board’s headquarters in Blackrock found that nurse Allan Lasam Sanchez failed to provide adequate care to an elderly mother after she suffered a fall.

The 86-year-old woman, referred to as Ms C, suffers from dementia, and was a resident at the Carysfort Nursing Home in Dublin when she fell on the night of July 7, 2013.

Mr Sanchez failed to adequately examine the elderly woman after she fell, and failed to adequately document care provided to her. On the morning of July 8, 2013, Patient C was taken to hospital, where it was discovered she had a fractured hip. She has suffered increased mobility issues since then.

Personal stories highlight concerns around care of elderly

Stealing from elderly

Some of the most upsetting cases that came before the inquiries at the Nursing Board include ones involving elder financial abuse — a distressing issue which many older people are not even aware of, according to Age Action Ireland.

In April this year, nurse Elizabeth Yvonne Williamson Claffey was accused of stealing money from a terminally ill cancer patient, during her time working at Bloomfield Care Centre in Rathfarnham, South Dublin.

Ms Williamson worked at the residential home, which provides mental health care to patients and residents, many of whom are elderly, from 2009 until she resigned from her position there in July 2012.

It was claimed that while working at Bloomfield, she used an ATM card without the consent of its owner, a resident with prostate cancer referred to throughout the hearing as KD. It was also claimed the nurse withdrew more than €5,000 between October 10, 2011, and May 8, 2012,using his bank card, and at one point used the card to pay for her food shopping at Asda, during a trip up North.

KD, who is now deceased, was described by the deputy CEO of Bloomfield as a “frail, elderly gentleman with significant physical health problems. He had cancer and subsequently received palliative care”.

Irregularities in KD’s bank account were eventually noticed, and the centre informed gardaí. Ms Williamson then admitted to taking the funds to gardaí – but said she only did it with KD’s permission. Following this, Ms Williamson repaid KD €6,000 and wrote a letter of apology to him. The matter of came to light in October 2012 after KD wrote to his bank regarding potential theft from his account.

The inquiry heard that KD appeared surprised and shocked when he learned about the full extent of the matter, and said he had not given anyone permission to withdraw money. KD later decided not to pursue a case through the courts, as he did not want to see Ms Williamson again.

Another case involving theft was the case of home care assistant Edel Maria Fitzgerald, who was up before a disciplinary hearing in November 2015.

Ms Fitzgerald repeatedly stole money from Elizabeth O’Callaghan, an elderly, wheelchair-using woman under her care who passed away late last year.

Ms Fitzgerald was employed by Kerry-based Home Instead Senior Care on a part-time basis between 2008 and 2014. Between June 2010 and April 2014, she provided non-medical home care assistance to pensioner Elizabeth O’Callaghan, who was in her mid-90s at the time and required 24-hour care. Although Ms O’Callaghan was mentally fit, she had to use a wheelchair.

The family knew Ms Fitzgerald — who went to school with Ms O’Callaghan’s granddaughter — and so were delighted when she began to provide home care for the elderly Ms O’Callaghan, as they thought she was someone they could trust.

Ms O’Callaghan’s daughter, Josephine Dennehey, said she began to suspect money was going missing from her mother’s purse in 2012. She queried family members and when it became apparent that Ms O’Callaghan had not been giving the money to any of them, Ms Dennehey began to suspect home care assistants. The family placed hidden cameras in the house. Footage from these showed Ms Fitzgerald taking money on numerous occasions — often €50 at a time — and she was eventually arrested on April 9, 2014, and taken to Tralee Garda Station. Ms Dennehey said she decided not to press charges out of concern for Ms Fitzgerald’s family, though this created difficulty in her own family.

Ms Dennehey said that, on the night after Ms Fitzgerald was arrested, the care assistant rang and then texted her, apologising for her actions. Ms Fitzgerald, who admitted her actions, was found guilty of professional misconduct at the nursing inquiry on November 15, 2015.

Personal stories highlight concerns around care of elderly

Raising Awareness

An Age Action spokesman said the prospect of financial abuse is quite frightening for elderly people, although many remain unaware of the issue.

“Financial elder abuse is something that is frightening for a lot of older people — the idea that the people you rely on to care for you, the people who you trust, the people with whom you’ve shared some financial information can take money away,” said Justin Moran, of Age Action Ireland.

Research from the advocacy group found that more than 50% of the older people they spoke with were not aware of the issue of financial elder abuse. Mr Moran said he hopes care homes can help raise awareness among residents, and inform them they can control their money, even if they are allowing someone to do some of their banking. This control could come in the form of putting restrictions on the account, such as limiting the amount of money that can be withdrawn or specifying which items money can be spent on.

“Ensuring that older people know that those facilities are available is really important,” said Mr Moran.

“If there was more work done by care homes and care facilities to ensure that older people knew there are ways of maximising their control over their money, money that they worked very hard their entire lives for, and that they have every right to protect — I think that would be very helpful.”

Mr Moran said that when elderly people and their families are considering care options and whether to move to a nursing home, “it’s very important that whatever decision is made, the decision is made by the older person and is supported and facilitated by the family”.

“The vast majority of older people we deal with want to stay at home as long as possible. There may come a time when they need to go into some sort of residential setting, and if that happens, then the family needs to support and facilitate that.”

He advised that when considering a nursing home, families should look at the Hiqa reports on the facility, visit it and speak with the current residents and their families about it. He also advised families, once an elderly person moves into a residential care setting, to stay in touch with that person and to listen and engage with them.

“Ensure you keep in touch with the resident, so that they feel able to tell you when things are going wrong.

“One of the challenges we found with elder abuse is that many older people don’t want to be a fuss, don’t want to cause a problem or make things challenging. They need to feel confident that if they come to their family and say, ‘I have a little bit of a concern about this, I think there’s something happening that’s inappropriate’, their family isn’t going to gloss over it, and that they’ll be taken seriously and listened to.”

Personal stories highlight concerns around care of elderly

CASE STUDIES

John de Lara

John Benedict Butalid de Lara, aged 46, from Ballyfermot, Dublin 10, worked as a staff nurse at the Royal Hospital Donnybrook, Dublin 4, for more than a decade, from 2003 until 2014.

But something seemingly went wrong somewhere along the way for Mr de Lara, originally from the Philippines, who was arrested in March 2014 for possession of crystal meth.

As members of the gardaí searched a flat in Donnybrook, Dublin 4, that day, Mr de Lara arrived at the residence. Seeing the gardaí, he put a bag of something into his mouth, which he later spat out.

The substance in the bag was later identified as just over 2.4g of crystal meth.

Following his appearance before the district court in July 2014, the charges against Mr de Lara were dismissed. However, after his superiors at the Royal Hospital Donnybrook heard of the matter, Mr de Lara was fired.

He was the subject of an NMBI disciplinary hearing in late 2015, and then in February of this year, when the inquiry concluded.

He has since taken an unfair dismissal case against his former employer, which was heard for the first time at the Employment Appeals Tribunal in May of this year. The case was due to come before the EAT again last Tuesday; this did not happen, and it will be re-listed at a date as yet undetermined.

Eileen Mary Mulligan Kiernan

Eileen Mary Mulligan Kiernan was employed as a nurse at the Maple Court Nursing Home in Castlepollard, Co Westmeath, for more than a decade, from October 2002 until July 2013.

She came to the attention of her superiors when two care assistants claimed in a whistleblower form that Ms Mulligan Keirnan regularly slept on the job for more than an hour.

Healthcare assistant Ann Daly said that, before completing a whistleblower form in May 2013 in relation to Ms Mulligan Kiernan, she never said anything because the nurse used to say: “If I go down, you go down.”

Ms Daly said that, after she made the complaint, Ms Mulligan Kiernan sent her text that read: “Why did you tell such lies? I never did anything to you.”

Ms Mulligan Kiernan did not attend the public inquiry into these allegations, which was held in December 2015, but she strenuously denied them in a letter read at the proceedings.

In the letter, Ms Mulligan Kiernan said she loved her job and that she was a caring person whom the residents loved.

She wrote that she had an eye problem that required drops, and she needed to close her eyes for a few minutes after she applied the drops, but that she was fully alert during that time.

Elizabeth Claffey

Nurse Elizabeth Yvonne Williamson Claffey was thrust into the public eye in April of this year after it was claimed that she stole money from a terminally ill cancer patient.

The incidents took place while she worked at the Bloomfield Care Centre, in Rathfarnham, Dublin.

Ms Williamson worked at the residential home, which provides mental health care to patients and residents, many of whom are elderly, from 2009 until July 2012. Prior to that, she worked as a nurse in both Ireland and Scotland since 1999.

It was claimed that, while at Bloomfield, she used an ATM card without the consent of its owner, a resident with prostate cancer referred as KD.

It was also claimed that she withdrew more than €5,000 between October 10, 2011, and May 8, 2012, using KD’s bank card, and at one point used the card to pay for her food shopping at Asda, during a trip to the North.

After irregularities in KD’s bank account were noticed, the gardaí were informed, and Ms Williamson admitted to taking the funds — but said she only did it with KD’s permission.

Following this, Ms Williamson repaid KD €6,000 and wrote a letter of apology to him. KD decided to not pursue the case.

During her evidence to the inquiry, health care assistant Shirley O’Toole, who worked with Ms Williamson at Bloomfield, praised the nurse.

“It was brilliant working with Ms Claffey. She was an excellent boss,” Ms O’Toole said.

Allan Lasam Sanchez

Nurse Allan Lasam Sanchez was working as a nurse at the Carysfort Nursing Home in Dublin when an elderly woman, referred to as Ms C, aged 86, fell on the night of July 7, 2013.

Although Mr Sanchez helped Ms C, who suffers from dementia, back up and into bed, he failed to adequately examine her or recognise the full effects of the fall.

It was only in the morning, after the daytime staff arrived, that Patient C was taken to St Vincent’s hospital, where it was discovered she had a fractured hip. She has since suffered from mobility issues.

Patient C’s children attended the inquiry into Mr Sanchez, which was held in May of this year, although the nurse himself did not attend.

At the proceedings, expert witness Catherine Dunleavy said she believed Mr Sanchez did not pick up on what was happening for Ms C on the night in question in part because he had so many patients to look after.

At the time, just one nurse would be on duty during a night shift, attending up to 52 residents.

“One nurse for 52 residents is not enough to safeguard residents’ needs,” Ms Dunleavy told the inquiry.

Edel Maria Fitzgerald

In November 2015, home care assistant Edel Maria Fitzgerald was found to have repeatedly stolen money from Elizabeth O’Callaghan, an elderly woman under her care .

Ms Fitzgerald, a psychiatric nurse from Tralee, was employed by Kerry-based Home Instead Senior Care on a part-time basis between 2008 and 2014. Between June 2010 and April 2014, she provided non-medical home care assistance to Ms O’Callaghan, who was in her mid-90s, forced to use a wheelchair, and required 24-hour care, although she was mentally fit. She died last year.

When the family discovered Ms Fitzgerald was stealing money, they informed the guards and she was arrested in April 2014. However, Ms O’Callaghan’s daughter, Josephine Dennehy, decided to not press charges. Ms Dennehy said on the night after Ms Fitzgerald was arrested, the nurse rang her, and then texted her, apologising for her actions.

At the inquiry, Kirsty Kavanagh, for Ms Fitzgerald, said her client “accepts she has done wrong” and “has suffered greatly over the last 12 months”. She said Ms Fitzgerald “is disgusted with herself as a result of her own conduct”.

Tim Healy, chief executive of Home Instead, told the hearing he was “completely gobsmacked’ when he heard Ms Fitzgerald had been accused of stealing money. “My experience of Edel Fitzgerald, except for this episode, had been superb.”

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