Auckland District Health Board Taikura Trust Aranui Home and ...

Health and Disability Commissioner
January 2007, from a Hospital 2 social worker to a Hospital 3 psychiatric consultant,
it was noted that Ms A did not have a welfare guardian. 12
23. On 27 June 2007, Ms B noted that following liaison with social work team leader Ms
F and Mr D, she had been advised to apply for a personal order to place Ms A in a
residential facility. Ms B requested medical statements from Dr C and senior medical
officer Dr H to support this application. The same day, Ms F emailed one of the
application documents to Mr D for him to review. He amended the document and
returned it to Ms F.
Assessment by Dr H
24. Dr H’s statement (written 27 June) noted that Ms A suffered from a significant
cognitive impairment, likely due to alcohol-related memory deficits, possible
normopressure hydrocephalus and, most recently, cryptococcal meningitis. He stated
that despite treatment for the latter condition, her memory and judgement impairments
had not improved. Dr H noted that she also suffered from significant gait instability
and urinary incontinence. He stated that it was his professional belief that Ms A had
irreversible marked impairments in both her short- and long-term memory, as well as
in her judgement. He considered her prognosis to be quite poor, and that she was not
likely to be able to make informed decisions regarding the care of her property or
herself. To that end, he supported the appointment of a welfare and property guardian.
He stated that Ms A also had significant need for permanent placement as prior to
coming into hospital she had been chronically and intermittently homeless.
Further assessment by Dr C
25. On 16 July, Dr C reviewed Ms A. He found no change in her cognitive status when
compared to her baseline assessment, despite resolution of her meningitis. On this
basis, the assumption was that her condition was largely irreversible. Dr C confirmed
that he would prepare a report in support of the PPPR Act application. He noted that
placement would probably be in a rest home or private hospital, depending on the
level of nursing care required. 13
26. Dr C completed the medical report on 19 July. He noted that following Ms A’s
admission, the working diagnosis had been long-term alcohol abuse and dependence
with secondary alcohol amnestic disorder. In addition, over the previous two years
imaging studies suggested hydrocephalus and, during her last admission, a chronic
12 Ms E recalls that she was asked to sign some documents when her daughter was admitted to a home
in 2005. HDC has found no evidence that an enduring power of attorney for care and welfare existed
then, or at any other time.
13 People under 65 years with a physical, sensory or intellectual impairment who need residential care
usually live in supported, community-based accommodation. Some people under 65 are accommodated
in aged residential care facilities. There are four main types of aged care facilities: rest homes (Stage II)
are for people who need a reasonable level of support but who do not require 24-hour access to
qualified nursing care; private hospitals are for the long-term care of people who need ongoing nursing
care; dementia rest homes (Stage III) are for those people whose confusion and behaviour is such that
they require a secure (locked) environment; and specialist long-term care (or psychogeriatric) hospitals
are for those people who require both regular nursing care and a secure environment.
6 3 November 2010
Names have been removed (except Auckland DHB, Taikura Trust, Aranui Home and Hospital/Oak
Park Dementia Unit and the expert who advised on this case) to protect privacy. Identifying letters are
assigned in alphabetical order and bear no relationship to the person’s actual name.