|The case is one of over 100 breaches of the law at nursing homes in the years 2021 and 2022. A survey news has carried out of over 200 complaints from relatives in nursing homes for these years shows that in over half of the complaints, the nursing homes broke the law. The offenses occur all over the country. One of the cases is from 2021. One September day, Margrete and Jørgen Goderstad are sitting by their father’s bed in the nursing home. The father breathes heavily as he doubles in the bed horse. – Could dad have a new infection? Should he be examined, the children think. The family was not informed that he had not taken antibiotics. Photo: Privat She asks the nurse, who comes into the room for a check. The answer from the nurse surprises her and her brother. – Don’t you know what’s going on? the nurse must have asked, according to the children. – The four palliative drugs have been started here. He is in a process where he is going to die, the answer should have been. The family believes they were never informed of this. A day and a half later, 82-year-old Halvor Goderstad died at the Strannasenteret nursing home in Tvedestrand. Margrete Goderstad with her father, Halvor. The mistakes the nursing home makes are a breach of the responsibility requirement. Photo: Privat Later, the State Administrator will conclude that the nursing home broke the Health and Care Services Act, as they did not inform either the patient or relatives. Nursing homes break the law When an unwanted incident occurs at a nursing home, or a patient or relative feels that the treatment was not good enough, a complaint can be made to the State Administrator. news has gone through 203 complaints from relatives or residents to the State Administrator for the years 2021 and 2022, which meet the reasonableness requirement in the Health and Care Services Act. In 109 out of 203 complaints, the State Administrator concluded that the nursing homes broke the law in their handling. That is, in more than half of the complaints. – It is surprising that there are so many offences. Some of these examples are very serious. A surprising number of offenses following complaints about nursing homes, says associate professor of public law at UiO, Anne Kjersti Befring. Photo: Martin Leigland / news So says Anne Kjersti Befring, associate professor of public law at the University of Oslo. She has health law as her specialist field. – It shows that we have major challenges with the quality of nursing homes, says Befring. Of those living in nursing homes today, three out of four are over 80. They are ill, many have cognitive impairment, and most are dependent on staff to take care of them. See an overview of all complaints. Zoom in on the map for more information. Click on each case for details of the complaint: news’s survey shows that there are five types of offenses in particular that are repeated by the State Administrator: This is how we found the figures The Norwegian Health Authority has delegated supervisory responsibility for nursing homes to the State Administrators. If a patient or relative wishes to complain about the treatment from a nursing home, this is sent to the State Administrator. news has asked for access to all complaints about nursing homes to the 10 State Administrators who comply with the responsibility requirement in the Health and Care Services Act. After dialogue with the State Administrators, we asked for access to all complaints for the last two years, i.e. 2020 and 2021. As the State Administrators do not have the opportunity to look up all complaints due to the archive system, there will be appeals that have not been received. This is a manual extraction, and the number of complaints in the last two years is most likely more. The 203 complaints are thus a selection of complaints. We wanted to get information about how sound the health service at the nursing homes is, and limited the insight to deal with these matters. The state administrators then conducted a search for appeals dealing with Section 4.1 of the Health and Care Services Act. It reads as follows: “§ 4-1. Responsibility Health and care services offered or provided in accordance with the law here must be responsible. The municipality must organize the services so that: a. the individual patient or user is provided with a holistic and coordinated health and care service offer, b. the individual patient or user is provided with a worthy service offer, c. the health and care service and personnel who perform the services are able to comply with their statutory duties and d. sufficient professional competence is ensured in the services. The King in Council may, in regulations, make further provisions on the municipality’s duty under subsection one letter d.” – Didn’t get a message Siblings Jørgen and Margrete Goderstad still think a lot about what happened in the days before their father died two years ago. They remember a warm autumn day, a Friday in September. Two days before, Halvor had been discharged from hospital after an infection. Jørgen and Margrete are visiting, they are drinking coffee in the sun and enjoying themselves. – We saw no signs that anything would get worse, says Margrete today. Margrete Goderstad thought her father was receiving full treatment for infection, but the nursing home had stopped it without informing. Photo: Lars Thomas Nordby / news On the same day, the nursing home ordered “the four relieving medicines” for the father. These are medicines for pain, restlessness and anxiety for people who are about to die. The nursing home will later explain that this was done in case something happened the following weekend. The family believes they were not told that these medicines had been prepared. On Saturday, Halvor does not want to take the antibiotic tablets, which the hospital has said he must. The reason is that he has difficulty swallowing, according to the family. But the nursing home should not have offered liquid antibiotics either. Nor do they inform the family that the treatment is changing. Over the course of the evening, instead, Halvor receives morphine – for pain. It is the first of four relieving medications to be given. – If he didn’t want to take the medicine, as it says in the medical record that he should have, why didn’t they call the hospital? Or us who are five minutes away, asks Jørgen. Jørgen Goderstad is happy that they complained to the State Administrator and were upheld. Photo: Lars Thomas Nordby / news – When Margrete said something to dad, he always listened! She could have said: Dad, you have to take the medicine. We could tell Dad the consequences of not taking medicine! – Were not clear enough, Tvedestrand municipality is speaking out on behalf of the nursing home. They acknowledge that the next of kin should have been better informed, and that Halvor should have been offered medicine in liquid form. – What we were not good enough at was informing the next of kin at the moment we inserted one of the relieving drugs. We were not clear enough about that, says Liv Siljan, sector leader for health, family and rehabilitation in Tvedestrand municipality. Read the full response from Tvedestrand municipality further down in the case. Tvedestrand municipality acknowledges that they made a mistake when they did not inform about the assessment of starting with palliative medicine. Photo: Lars Thomas Nordby / news Getting worse Beyond Sunday, Halvor gets worse. The family is called by Halvor’s cousin, who was visiting. – Then I met a very scared and nervous father, says Margrete. Halvor niholder in the bed horse. They see that he is in great pain. – Margrete, I am so afraid of dying, said Halvor when Margrete arrived. The children stay in the nursing home. Only late at night are they told that the father has been taken off antibiotics, and now the four relieving medicines are given. He has received medication through a button in his stomach. The family experienced that it was as if Halvor was fighting against what he was ingesting. – Dad was not ready to die, says Jørgen. Jørgen and Margrete Goderstad complained about the treatment their father received in a nursing home. The state administrator concluded that the nursing home had broken the law. Photo: Lars Thomas Nordby / news They still find it difficult that someone can make such a serious decision without consent or information, neither to Halvor nor the next of kin. The following night, Halvor dies with his family around him. – We understand that dad was an aging man, and that things can happen urgently, but all lives must be respected to the end. The offenses Halvor Goderstad’s case is not unique, the survey of complaints shows. In 74 out of 203 complaint cases, the patient was dead when next of kin complained. Most of the complaints are about the nursing home not taking good enough care of the resident. For example, consider whether the resident could be at risk of falling, and thus hitting himself. The complaints are spread all over the country. Here are some examples: Fall injury at a nursing home in Alta In Alta, a resident was left on the toilet in a wheelchair. When staff did not come, the resident tried to get up to go to the toilet – but fell. The resident later died from his injuries. No risk plan was drawn up, and no record was made that the fall had occurred. Relatives did not receive good enough information about events, which they were visiting on the same day. Resident in Kristiansand fell – was not registered in the record Resident at a nursing home in Kristiansand fell, but this was not registered in the record or the deviation system by a nurse. There was no information on how to proceed from the evening shift to the night shift, which meant that the resident was not sent for an X-ray and treatment given. The resident was instead left with a fractured femoral neck for two days. Resident received medication for delirium instead of increased staffing Resident with delirium in connection with dementia was treated with medication to avoid anxiety. The complainant believed that many drugs were the causes of the resident’s symptoms. The medication was discontinued and the resident showed improvement. The state administrator believes the nursing home did not provide proper health care by replacing the need for increased staffing with medication, which worsened the resident’s condition. The state administrator thought this was probably not the only example in the municipality. Resident lay with a femoral neck fracture for 16 days Resident in Karmøyfalt and suffered a femoral neck fracture. This was only discovered after 16 days. From the time the patient fell until the fracture of the femoral neck is detected, it is described daily, often several times a day, in the record that the resident expresses pain and uneasiness when being cared for, touched and changing position. Broke the law It is almost two years since Halvor died at the Strannasenteret nursing home. In November last year, the conclusion came from the State Administrator in Agder that the nursing home had broken the law, after the family complained about the treatment. The nursing home has changed routines following the State Administrator’s conclusion. Photo: Lars Thomas Nordby / news The state administrator states that Tvedestrand municipality breached the responsibility requirement in the Health and Care Services Act, as they did not inform either the patient or next of kin of a change in situation. They also broke the law by not keeping a good enough record, so that it was difficult to see what kind of treatment and medical follow-up Halvor had received. – We should have offered him these drugs (antibiotics, journal note) in liquid form, and we weren’t good enough at that, says Liv Siljan, section leader for health and care in Tvedestrand municipality. She speaks on behalf of the management at Strannasenteret nursing home. They apologize for the treatment Halvor Goderstad and his family received, and that the information given to the next of kin was not better. Liv Siljan, section leader in Tvedestrand municipality, apologizes for the treatment Halvor Goderstad and his family received. Photo: Lars Thomas Nordby / news Silja says at the same time that this is difficult, as the patient was not deprived of his competence to consent. – When he made it clear that he did not want the medication, this was something we respected. We do not have the opportunity to forcibly medicate patients. Any forced medication is a very serious intervention that must be applied for. Siljan says they took it seriously and started the process of correcting mistakes as soon as the complaint came in, and they were in dialogue with the State Administrator. They have also raised it with all employees and the management team in the sector. The legacy of “Halle” Sommer is heading towards autumn, but things are still blooming on the farm in Tvedestrand. The farm was Halvor Goderstad’s great pride. The former head of agriculture in the southern municipality, also known as the dairy farmer “Halle”, was a hard worker, according to the children. Someone who always helped others. Today it is the son who has taken over the farm. – This was his life’s work, says Jørgen, as he ensures that the cows get their due. Jørgen Goderstad has taken over the farm from his father, Halvor. Margrete is visiting the childhood home. Photo: Lars Thomas Nordby / news
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Nobody said dad was about to die – news Norway – Overview of news from different parts of the country
