THE TWILIGHT ZONE [02/06/2001] PRODUCER: RICHARD LANGSTON REPORTER: PHILIP VINE Mike Intro: For many of us the prospect of growing old is frightening enough. But imagine losing your memory, your ability to think rationally, eventually becoming confused about even who you are. The least you might hope for in your twilight years is someone to look after you, watch over you. But a Christchurch family claim that wasn't always the case for their 90-year-old father. He ended his life with a murder charge hanging over his head, accused of killing a 93-year-old woman in a comfortable rest home. Tonight Philip Vine tells the story of that murder, and investigates the standard of care our old people can expect. SHELLEY WRIGHT: They're like babies. They're very vulnerable, they're very scared, they don't know where they are. They wake up and they think "Where am I?" They get out of bed and they start to roam and they're actually looking for someone. PHILIP (V/O): This is the terrifying and bewildering world of old age dementia, a world uncharted and unknown by anyone but the sufferers and their carers. For a Christchurch family it took a murder to find out what was happening behind the rest home doors. Spring last year in this attractive Christchurch rest home. One of its residents, 93 year old Doreen Grant dies in her bed. A 90 year old man, Andy, is accused of killing her. VERONICA MOORE: How could this ever happen when you entrust someone into a 24 hour care? PHILIP (V/O): Veronica Moore, Andy's youngest daughter, and her husband Brian. VERONICA MOORE: I stood in the room while my father was charged with murder which he didn’t have a clue, so maybe I’m thankful for that. PHILIP: The thought that a man and woman in their nineties from this rest home could be part of a murder enquiry is disturbing enough. But what would be revealed by police investigations and a government report, would cause Andy's family to seriously question the sort of care their elderly relatives were getting, especially at night. (V/O): Late afternoon at rest homes is known as sundown time when dementia patients try to pack up and leave to go home, though they have no idea where home is. Dementia is a sentence of gradual oblivion. It starts with forgetfulness and ends with loss of brain function and finally death. Along the way we lose all trace of the person we are or were. In his day Andy built roads on the South Island's West Coast. He got dementia five years ago. His family took turns to nurse him, but after two and a half years they could no longer cope with his behaviour. VERONICA MOORE: Probably the worst day of my life. It's not easy taking someone into care that you love. PHILIP (V/O): They chose Santa Maria Rest Home. It was warm and modern, and they were reassured by the owner, Tui Ward. VERONICA MOORE: The exact words from Tui Ward, the day we took Dad in, we took him into the room, was, "You won’t have any worries in the world. You won’t ever have to worry now, your father's in here and we look after him. There's someone on 24 hours in here." So I came out thinking, "Phew, it's great, we'll get a bit of sleep now." PHILIP (V/O): Tui Ward has been in the rest home business for 33 years. She's licenced to care for 45 residents, including 15 in a purpose-built dementia wing, Andy's new home. Soon after he was moved there Veronica and family became worried. On some visits they noticed bruises. VERONICA MOORE: There was one particular incident with my father's eye where it was hugely black and all the white of his eye was red. Was my father out of bed wandering all night, which is part of dementia, and no-one watching what he was doing? Or was my father being hit by another patient? PHILIP (V/O): Tui Ward says she told the family that this was down to an incident when Andy was hallucinating. SHELLEY WRIGHT: Lovely staff, lovely patients, lovely surroundings, lovely home, but it was a shock because there was so many people to look after. PHILIP (V/O): Shelley Wright used to work days at Santa Maria and she didn't like what was going on at nights. She arrived in the morning to discover confusion and unexplained injuries. SHELLEY WRIGHT: And there were bruises on people that we had no idea when they happened or how they happened. People being found in someone else's bed and then other people sleeping in lounges, or people sleeping on floors and someone else in their bed, wandering corridors, trying to get outside, defecating in gardens. PHILIP (V/O): Tui Ward says Shelley Wright never reported these incidents and says she only came across a few such cases in thirty years. One forty in the morning, Sunday September 3. Doreen Grant is found dead in her bed, a pillow over her face. When staff walk in, Andy is standing beside her bed. VERONICA MOORE: Don't know that we'll ever, ever come to terms with it. It's just destroyed us. And then all of a sudden you're faced with a situation like this. PHILIP: Do you think your father killed Doreen Grant? VERONICA: No, never. On the statements I have there's no forensic evidence. PHILIP (V/O): One staff member told police she saw Andy a few weeks before holding a pillow over his room-mate’s head, though she didn't write it down in the incident book. But on the night of the murder a number of other dementia patients were out of their room, including one who was later found with a knife under her pillow. Owner Tui Ward wouldn't talk to us but she gave an interview with 3 News just after the murder. TUI WARD: They wander around at night, sometimes there's three or four of them at one time, mostly it is just one or two, I would not say with any certainty that someone prior to the man's entry to the room, hadn't been and visited already. PHILIP (V/O): In a statement to 20/20, Christchurch police said they believed there was clear evidence that Andy was responsible for Doreen Grant's death, that other members of the public were at risk and they had no option but to bring him before the courts. VERONICA MOORE: That to me was a prime example of the police not understanding dementia, not interested in knowing about dementia. PHILIP (V/O): Doreen Grant's family didn't want to take part in this programme, but they've said they didn't want charges laid. In October last year in the secure unit at Princess Margaret Hospital, Andy was formally charged with murder. VERONICA MOORE: I couldn't look at my father while he was being charged, I just had my arm around him. PHILIP (V/O): A judge arrived at the hospital for a special court hearing. VERONICA MOORE: I wheeled him in, in a wheelchair with rosary beads and his baby doll. He woke as I pushed him in under the table and he said "Blahblahblah" which was a muddled nothing. PHILIP (V/O): The hearing was adjourned for a psychiatric report. It described a man with severe dementing illness, who had no idea he was married or had three daughters. He had no idea of the time, the date or even his own age. Basically he was unfit to plead. VERONICA MOORE: My father, in the last few weeks before died at Princess Margaret, had to be fed of course, because he was starting to go blind, he couldn’t see what he was eating or couldn't find his mouth, and he was seen to even pick up a box and start to eat a cardboard box. So what does that tell you? PHILIP (V/O): It wasn't until Veronica Moore got hold of statements from staff, that she began to understand for the first time what life had been like for her father in Santa Maria's dementia wing; wandering patients, fights between residents, alarms going off and being ignored by staff. The statements revealed that on the night of the murder, there were two staff looking after 44 residents. The owner Tui Ward told police they knew to check the dementia wing every half an hour, but according to the Ministry of Health that wasn’t written policy in the home. And it appears that the two women on duty hadn’t checked the patients in Andy's wing, for about two hours. VERONICA MOORE: And why, when they were asked, did they not check the wing every half an hour, by the police? "Because we are too busy doing breakfast trays and vegetables and things for the next day." SHELLEY WRIGHT: There are so many other things to do other than people. You know like, there's cleaning, and there's beds to be made, and there's commodes to clean and floors to vacuum. PHILIP (V/O): Shelley Wright's now in a job where she says she has more time for patients than she did at Santa Maria. (I/V): How can it be that someone was murdered at that home? SHELLEY WRIGHT: Well I think it could be because there wasn't sufficient amount of staff looking after those dementia patients. PHILIP (V/O): Tui Ward says rest homes and dementia units provide 24-hour supervision, not continuous one-on-one care. TUI WARD: It's happened once in 33 years, which is a one in a million chance probably. What has happened is something that could happen in any dementia home in New Zealand. There is nothing different that we could do and there is nothing that I could suggest right at this minute that would have changed that. SIMON O'DOWD: What you have is a position where staff supervise a whole facility. PHILIP (V/O): Simon O'Dowd, President of the Residential Care Association. (I/V): So you're saying to me, as an industry, you're quite happy for dementia patients to be left on their own for up to two hours at a time. SIMON O'DOWD: If you put it to me that dementia patients were being left on their own for two hours, of course we wouldn't be happy about that. PHILIP (V/O): Police didn't prosecute the home. They told us they investigated but there was not enough evidence. The Ministry of Health found Santa Maria met the minimum standards of the law, but in a special audit the Health Funding Authority found 37 shortcomings, including incidents of assault and sexual harassment between residents, incidents that the staff weren't trained to handle. And it said the staff levels at night were putting residents at risk. VERONICA MOORE: You are playing with people's lives here. Do something about it. PHILIP (V/O): Tui Ward challenged the findings, and she says that many of them were wrong. However in a second audit the home failed in some areas again. Tui Ward made changes and says her home is safe. She got the HFA stamp of approval at the end of March on the written understanding there would be a staff member to be constantly on duty in Andy's wing. (I/V): The HFA said there must be someone in the dementia wing at all times. Would you anticipate that that would be the case? SIMON O'DOWD: My understanding is that the home you're referring to is compliant with its contract. PHILIP (V/O): Veronica Moore was sceptical that things had changed. We sent in an actor to volunteer for work at Santa Maria. FRANCES: I first of all went in for a morning shift, and it seemed like a very nice, clean, good looking type environment. Seemed very busy, there were a lot of people everywhere. PHILIP (V/O): But on her first night, with a secret camera, she arrived to find all of the staff in a kitchen, including the woman who was supposed to be next door on duty in the dementia wing. FRANCES: There were often situations where there was no-one in Dementia, particularly when we were working in the kitchens. That could be up to half an hour before somebody wandered in to have a look, or before somebody had made noises in Larch, to check it out. And I mean many times through the night there seemed to be all of us who were on, in other parts of the building. PHILIP (V/O): Our actor, Frances, after just two shifts and no formal training, was offered paid work by Tui Ward, despite the HFA's insistence that staff looking after dementia patients must be trained, or undergoing training. FRANCES: Basically, she said to me that she wanted to pay me and it didn't really matter about my experience. PHILIP: And she realised throughout this that you'd had absolutely no training in dealing with dementia patients? FRANCES: She definitely knew that had no training with dementia patients or the elderly. PHILIP (V/O): Frances was told it was a struggle to get staff at the weekends and sometimes the whole home was run by just two people, the same situation the night of the murder. The second night, 2am, her camera found no staff in the dementia wing. At 5am the person on duty is the untrained daughter of the senior caregiver, called in at the last moment. She's asleep. When we put it to Tui Ward that there is not always a staff member in the dementia wing at all times, she said, "Every night a staff member has been delegated to work in Larch Wing, and if that person is not available. a senior person from another wing does the job." The night staff involved also faxed us, saying they work in Larch Wing according to the conditions of the Health Funding Authority, and they're confident Santa Maria provides good care. VERONICA WRIGHT: Here we are paying 650 dollars a week for our father to be entrusted into the specialist dementia wing. What are they doing with the money? PHILIP: It would have only taken one person to have been there. SIMON O'DOWD: Quite true. It would have only taken one person to be there in any circumstance. PHILIP: Let's talk for a moment Mr O'Dowd about the fatality that happened in your home. SIMON O'DOWD: Patrick O'Rourke. PHILIP: Yes. SIMON O'DOWD: He had an accident, yes. PHILIP (V/O): Christchurch man Pat O'Rourke was a resident in a rest home part owned by Simon O'Dowd. Doctors had told his family he had mild dementia. The home says it has no record of this. They don't specialise in dementia care. The 67 year old died in hospital after going alone into the home's smoking room. GAIL O'ROURKE: The smell was just, the smell was the worst part. It was just burning flesh. PHILIP (V/O): His daughter Gail O'Rourke. GAIL O'ROURKE: It just made you feel sick. I had to go out a couple of times. PHILIP (V/O): Pat O'Rourke had used a lighter to burn loose thread on a cushion or his tracksuit which burst into flames. GAIL O'ROURKE: He should never, ever have been really allowed to smoke on his own unless there was someone there that was capable of watching him. Because when he had a stroke he lost his hand, sort of wasn't any good for anything really. He could use it but it would just flop, and it was this hand he held his cigarette in. PHILIP: Wasn’t he in the smoking room, left alone? With a cigarette lighter? SIMON O'DOWD: Yes, he had gone into the smoking room, yes. PHILIP: Here was a man who had a history of burning himself. He had holes in his clothing, from burn marks. He was left on his own. SIMON O'DOWD: He wasn't left on his own, he was supervised. PHILIP (V/O): That supervision was by the rest home manager, who was outside when Pat O'Rourke started the fire. He ran in and put it out with his hands. He was also taken to hospital. SIMON O'DOWD: The reality is, it isn't possible under the current system that we have, it isn't possible to provide a level of care for residents to the degree that you're talking about. PHILIP (V/O): He blames the government. Rest homes receive an average of 95 dollars a day for each dementia patient. That's nearly 35,000 dollars a year. CAROL SEARLE: I have no evidence at all that rest homes are closing because they're not receiving sufficient funding. PHILIP (V/O): Carol Searle from the Ministry of Health. CAROL SEARLE: In fact we are constantly receiving applications from new people who want to come into the market, and existing rest home providers wanting to increase the number of beds. PHILIP (V/O): Whether you believe the government or the rest homes about the reasons for the state of the industry, some of those who work in homes for as little as 9 dollars an hour, are only too aware of how far they are from the ideal situation. SHELLEY WRIGHT: They need people there, they need people reassuring them. Like I said, they're just like children, and the sad thing is, at least children know who their mother are and their father are, and like these people with dementia can be consoled by a stranger. That's all they need, is just an arm around them and to be told, everything all right come back to bed. PHILIP: Is this an industry that we can place our trust in? CAROL SEARLE: I think it is because the majority of rest homes around the country provide a very good standard of care. PHILIP (V/O): But Veronica Moore's experience shows how badly things can go wrong and she wants to see a fixed staff ratio of carers to residents, as in preschools. She wants it put in law, and she wants the Ministry of Health to start being tougher on homes. (I/V): Family's are looking to you, the Ministry, to wield the big stick. CAROL SEARLE: Well if there is a situation that is brought to our attention where there is concern about resident safety, then we can go in straight away. PHILIP: What would you say if I said to you we have evidence that there are not staff at all times in a dementia wing. CAROL SEARLE: I would say, please give me that evidence so we could pursue it. PHILIP: What would you do? CAROL SEARLE: We'd go in straight away and have a look at staffing registers and rosters. PHILIP (V/O): But after two audits on the home where her father was labelled a murderer, Veronica Moore's trust has been worn out. If any of her sisters or mother get dementia, she’s certain of one thing. VERONICA MOORE: We would fight to the bitter end to keep out mother close to us, because could never, ever trust any home ever again.