When death is unexpected

Unexpected deaths in residential care

Image: Jakub Kriz

As a professional working in the aged care sector, we pride ourselves on being expert in end of life care, about making people comfortable, about how to support families. I wasn’t surprised by my client’s recent death. In a way it was expected - a gradual decline with a short period where she had refused food and fluid - she was peaceful.

For some though, the experience is different. An unexpected death whilst in residential care is, thankfully, unusual but the ripple is far reaching. What happens when people die whilst in residential care; from events such as choking, medication errors, suicide and physical restraints (I know we don’t use them, but what about that over bed table hooked behind the leg of chair...)?

An attending doctor will not be able to complete a death certificate and they will need to report the matter the Coroner. Investigations will need to be conducted and incident reports completed. Staff will need to be supported and open disclosure processes will need to be conducted with families. Police may come to collect statements and copies of documents. There may be legal action if an allegation of negligence is made. There may be a Coronial Inquest held to determine the cause of death or to learn from the experience. These steps are time consuming, emotionally draining for all concerned and costly.

I know that such deaths are devastating for all the people involved but let’s think about why they might happen. What are the systems and processes in place that create the opportunity for these unexpected deaths to occur? They are complex: involving the physical environment, the rules and regulations that we work within, the skill and technical knowledge of people doing the caring, how we communicate between professions and the culture to raise concerns with each other.

That said, these unexpected deaths could have all been prevented. If only we had supervised more, checked again, got a second opinion...

So this is what I’ve been thinking...do we know our care recipients as well as we can? Do we keep asking and looking and reviewing often enough to notice changes in behaviour, in attitude, in capability? Do we rely too heavily on checklists and protocols? Do we use medical and allied health professionals regularly enough to add value to quality of life? Do we ask if we should stop doing some things? Do we truly have a culture that encourages people to speak up if they don’t agree with an approach or have an idea for improving practice?

Of course, there is no right answer but maybe just raising awareness, using our judgement and being brave enough to ask a question might make a difference to someone.

[Source: Jane Boag, B App Sc (OT), Grad. Dip. Community Health, GAICD, Shared Objectives]