Kostelka: Too little Nursing Care for Dementia Patients

Too little Nursing Care for Dementia Patients

ORF-Series "Bürgeranwalt" (“Advocate for People”) – Broadcast of September 13th 2008

In the broadcast of the ORF-Series "Bürgeranwalt" („Advocate for People“) –from September 13th 2008 Ombudsman Peter Kostelka revealed once again the issue of the impeded access to nursing care.

Ombudsman Kostelka presented the case of 84 year old Mrs. R, who worked as a cook and today recieves a pension of approximately € 600,-. Due to her heart insufficiency, diabetes, impaired hearing, a damaged musculosceletal system, incontinence and heavy dementia (typus Altzheimer) the old lady is dependent on somebody who takes care of her around the clock. The complainant is unable to walk autonomously, has to be fed, washed and swaddled. Due to her almost complete mental confusion, disorientation and lacking willingness to accept necessary help she has already endagered and hurt herself a several times in the past. Having completely lost her short term memory talking to the patient has become impossible. Her 86-year old husband backs her wife whereever he can, but has more and more to ask for external help, since he can´t cope with the situation any more. The former baker and confectioner recieves a monthly pension of € 1.300,- and addressed to the Ombudsman fearing that the couple´s common life and housing can not be financed any more unless more nursing care will be awarded.

Mrs. R. recieved nursing care of level 2 since May 2006 and now recieves nursing care of level 4 (€ 632,70) from the Austrian Pensionnsurance Authority (PVA).

At Oct. 25th 2007 Mrs. R again asked for an elevation of nursing care, which was re-jected by the PVA meaning that an extraoridinary demand for nursing care is not necessary in the case of Mrs. R. . Against this decision a complaint was brought in at the Labour- and Social Court Vienna. A general medical expertise asked for by the court confirmed a monthly demand of care in the extense of 218 hours. The neurological expert witness recorded, that due to Mrs. R´s. increasing decubitus and the increasing immobility it has become necessary, that a nursing person is present in the flat of, although not in her room Mrs. R.

Due to cure the decubitus and to prevent the danger of inflamation Mrs. R. has to be relocated regurarly during the night and has to be washed after every defecation. The next hearing at court to discuss the medical expertise will take place in October 2008. Mr. R. can´t wait until somebody realizes, that his multimorbide wife has to be helped.

In the broadcast Ombudsman Kostelka highlighted, that the equation of physic and mental (psychiatric) diseases guaranteed by law also has not yet been implemented in practice. The Ombudsman has already criticed the insufficient expertise by unqualified doctors and the virtual discrimination of mental or psychic persons when it comes to their nursing care grading in its last report to the Austrian Parliament.

According to Ombudsman Kostelka it has become more important than ever to ask not only for general medical but for highly qualified expertise when it comes to the grading of dementia patients.

There are approximately 100.000 dementia patients in Austria, who are predominantly cared by their families at home. This very often brings the families to their physical and mental limits resulting in a lower physical vitality, negative changes in the personality of them and the consciousness of the treating person, refusing and agressive behaviour against treatment and decreasing communication and interaction with family members. Furtheron treatment causing disgust (e.g. the changing of incontinantal material, the cleaning of cloths and furniture from defecation) is not an opportune conversation issues and burdens the work and the everyday life of the treating person.

Ombudsman Kostelka showed the representative of the PVA being present the neurological expertise, according to which Mrs. R. was entitled to recieve nursing cure of level 5 since the day of application and of level 6 since May 2008 and called upon a rapid reaction The PVA-Representative initially did not agree, but finally offered a compromise going into that direction.