Foxton, New Zealand — A tragic incident involving a man with multiple sclerosis has raised serious questions about the quality of care provided in a local residential facility. The man, referred to as Mr. B, died in May 2022 after choking while being fed in bed, prompting his family to file a complaint that led to a detailed investigation by the Health and Disability Commissioner.
Mr. B, who was in his late 20s, had lived at Lonsdale Total Care Centre for approximately six months. He was not only affected by multiple sclerosis but also faced mental health challenges, severe vision impairment, and required assistance for all daily activities, including eating and repositioning himself. His family expressed concerns over his overall care, particularly noting that he had not been allowed to shower during his stay, although Lonsdale staff claimed this was at his request due to personal preference.
Compounding their concerns, Mr. B’s family questioned the decision to confine him to bed largely due to a broken hoist. Up until late March 2022, staff had utilized a standing hoist to lift him out of bed as needed. However, Lonsdale stated that the hoist was not used due to safety issues related to Mr. B’s involuntary movements, which posed risks during transfers.
A prior choking incident had raised alarms, and a safety plan was implemented to have Mr. B sit upright while eating. Despite these measures, the investigation revealed that the choking risk had not been adequately addressed in his care plan. The report’s author, Carolyn Cooper, indicated there may have been a failure to seek a specialized assessment to further mitigate this risk. This oversight led to Lonsdale being found in breach of the Code of Health and Disability Services Consumers’ Rights.
The unfortunate events surrounding Mr. B’s death prompted his mother, Ms. B, to voice deep regret regarding her decision to place him in Lonsdale’s care. Feedback from healthcare professionals indicated a disconnect in personalized care guidance, suggesting that the care team, while responsive to Mr. B’s needs, lacked clear protocols, which could have heightened risks for him and other residents.
In the aftermath, Lonsdale has made strides to address the findings of the report. The facility has implemented enhanced documentation practices and revised care evaluation processes to better serve its residents. Lonsdale’s general manager, Mark Buckley, expressed condolences to Mr. B’s family, labeling the incident as distressing for all involved.
Changes since the incident include improved planning, better communication, and an upgrade to patient management systems. Furthermore, Lonsdale has transitioned to a new medical practice that focuses more on age-related residential care agreements and has appointed additional management support to ensure better supervision and care quality.
With these reforms, the facility is committed to preventing similar incidents in the future and ensuring a higher standard of care for all residents.