Twice during the last week I’ve been reminded sharply about the importance of advocacy in the lives of older people.Advocacy is a simple concept: it means standing by another person who needs support to confront a more powerful person or institution. The more vulnerable a person, the more he or she may need an advocate to address neglect, bullying or abuse, whether intentional or not. Even the strongest among us may need the support of other people when we are ill and in hospital.
Anyone can advocate for another person, regardless of the relationship between them. At one level, a lawyer who represents a client in court is the client’s advocate; parents regularly advocate on behalf of their children to a variety of people; and a student who stands up to a bully on behalf of a weaker child is also an advocate.
A few months ago I posted about a friend of mine who was a patient in a private hospital. As a retired registered nurse with considerable experience in aged care, I could see clearly that my friend was not receiving the care she required and to which she was entitled. In addition, as a patient in the hospital, she suffered several serious mishaps . These could have been prevented with better assessment and attention. They have impacted severely on her recovery and her on-going quality of life.
Several issues relating to the care and treatment of my friend were apparent, and I believed they should be addressed by nurses, doctors and other staff who were responsible for her care. One that worried her most was that she was moved from ward to ward several times without explanation. On one occasion, she was left sitting in a chair following a general anaesthetic because the bed to which she was being moved in another ward was still occupied.
I began to think it was highly probable that poor care of older patients might be endemic in that hospital. One of the additional positive outcomes of advocacy is that hospitals and other institutions often amend their practice as a result of well-measured complaints. This leads to better care for everyone who is or will become a client or patient.
Because my friend is not only an older person, but was also very unwell at the time, I discussed her position with her, and then wrote on her behalf to the chief executive officer of the hospital.
My written complaints were not addressed with me by hospital management, but several staff members entered into discussions with my friend (although she was very ill) and one ward nurse had a brief conversation with me.
As she was still ill and a patient in the hospital, likely to remain so for some time and perhaps even to be readmitted in the future, she was not prepared to discuss the issues with staff on the floor, even she was unhappy with the care she was receiving. She was afraid that there would be repercussions if she complained.
‘Patients can be punished if they say anything the staff doesn’t like,’ she told me. ‘As old nurses, we both know that.’
As my formal complaints to the hospital had not been addressed to my satisfaction (or that of my friend) when she left the hospital, I took the matter further. A third party told me in a telephone conversation that ‘the hospital thought’ that all the complaints had been resolved. And in spite of my first letter clearly stating I was acting as my friend’s advocate, they thought I was ‘just a friend!’
Some of the important lessons that I learned in ten years as a professional advocate were that anyone act as an advocate on behalf of another person; advocacy goes into the fray as hard as it needs to; and does not give up until the end of the matter. Obviously that hospital has not learned the same lesson. The story continues…
Another old woman who is much loved by a number of people lives in residential aged care facility. Last week, following a visit by one of her friends, there was a discussion about apparently poor care the old woman had received recently. I suggested the friends could address the matter with the director of nursing, or they could contact an advocacy agency for support. The friends thought that the woman’s family should be told of their concerns and the decision to deal (or not) with the concerns should be left to them.
In my experience, staff members in most aged care facilities and hospitals recognise their duty of care; they want to provide the best attention and treatment for their residents and patients. Often, a timely word to a senior staff member from whoever witnesses problem behaviour results in prompt resolution of the issue. There is often a written complaints procedure that will help if the complain is not resolved immediately.
Bystanders who do nothing to assist a vulnerable victim of neglect or abuse become part of the problem.
In Western Australia, for more information about the rights of residents and assistance with making a complaint about a residential aged care facility or a Home and Community Care Service, contact Advocare Incorporated.
For assistance with a complaint about a hospital, contact the Health Consumers Council
There are similar organisations in other Australian states.