A Government report has demanded better care at Packwood nursing home after a family complained their relative developed a three-inch bed sore while under its $3,500-a-month care.

Yvonne Moniz said her 84-year-old mother-in-law was found with food stuck in her mouth, wearing soiled clothing and reeking.

She said the family noticed an uncaring, unprofessional behaviour behaviour towards Mrs. Elizabeth Moniz. who was admitted to King Edward Memorial Hospital on July 8 last year suffering from a serious ulcer on her leg, dehydration and malnourishment. She died shortly after.

The daughter-in-law said: "She was also suffering from extremely bad bed sores, one of which was almost three inches round and very painful, I am sure. To quote one nurse, she could almost fit her fist inside this bed sore. There were two others an inch wide. They didn't all happen overnight. Yes she had a bad ulcer on her leg - that was all the more reason to get help.

"Unfortunately mum succumbed to death still in hospital some five weeks later, after lots of loving care and attention on Gordon Ward. She did not deserve to die the way she did."

Mrs. Moniz is also angry about the way Government handled the matter.

The family wrote to the Packwood board's Chairperson, Lady Swan on 8 August 2002 and sent a copy to Health Minister Nelson Bascome and Chief Medical Officer Dr. John Cann.

She said: "We had several conversations with the chairperson between July and November 2002 during which an investigation was promised.

"We also received an acknowledgement of our letter from the Minister, again with the promise of an investigation.

"That was on August 15, 2002. The Chief Medical Officer never responded at all."

Late last month The Royal Gazette inquired where the report was and Dr. Cann said the report had been posted to the Moniz family.

When it still had not arrived last week, Dr. Cann said there had been an error and that the report had been posted.

Yesterday the report, with a April 17 postmark, finally arrived at the Moniz's home. She said Dr. Cann had said the report had accidentally been filed when it should have been posted.

Mrs. Moniz said: "Why did it take so long? We never heard anything since November. Only when we went to the press to make it it public did anyone come back to us."

The reported was dated in December. Dr. Cann did not return calls yesterday. The report noted Mrs. Moniz suffered from diabetes, incontinence, immobility, a leg ulcer, poor nutrition and occasional confusion.

The report said a doctor had noted changes in Mrs. Moniz's condition.

The report urged:

educating staff on continence care and preventing pressure sores

annual staff performance appraisal linked to training

periodic review of nursing care to ensure all shifts are up to scratch

proper notification of family of changes in resident's conditions.

In nursing and personal care the report urged:

Each resident has a personal physician

Ensuring any changes in resident's general condition result in notification to their physician as soon as possible

Reviewing toileting and continence care with periodic assessment and individualised management

Ensuring adequate oral and general hygiene

Providing physical activity programmes.

Pressure Sore Management

The report recommended provision of skin care

The use of supplies and devices to relieve pressure and promote healing

Identification of at risk patients

Clear documentation that the resident has a problem

Prompt notification to a physician or therapist and prompt evaluation and management.

Yesterday the nursing administrator in charge when Mrs. Moniz was at the Packwood home said the home had been complying with all those recommendations after she wrote a report herself which was shared with Lady Swan and Government following the Moniz family's complaint.

Julia Tucker-Raynor, who has since left Packwood, said: "As far as I am concerned her care was good. All that they are saying was done. Doctors were notified. I don't know why they have written that (report).

She said the pressure sores were down to Mrs. Moniz's nutrition, poor circulation and diabetes.

"There were many contributing factors. It wasn't negligence. The care at Packwood is excellent. I am not saying the care is perfect but it is second to none."

She said there was activity co-ordinated for seniors but some did not wish to take part or were not mentally cognisant.

She said patients had special pressure relief mattresses with sheepskin put under their bottoms as well as elbows and feet for extra softness.

Asked about the food still in Mrs. Moniz's mouth she said: "She was a very stubborn lady. When she did not want to spit something out she would not."

However Mrs. Moniz said: "I don't want any other family to suffer what we did. This gives us some closure after going on for so long. Hopefully things will improve."

She said the doctor used by the nursing home was never contacted about the bed sores until the day before her mother in law was admitted to hospital.

Last night Dr. George Shaw declined to talk about the Moniz case because he said he needed permission from the family.

But he defended Packwood and said staff there did a hard job under trying circumstances.

Lady Swan said her staff had prepared a report last summer. She said: "I am surprised it took this long for Dr. Cann to respond to this."

She said the family's complaint had been taken seriously.

"When you get a letter like that it is natural you want to see something like that doesn't happen again. We are saddened it happened. We run a pretty good facility and have caring staff. We acted on it it as quickly as we could.

"I can't say it won't happen again - you have human frailty - hopefully we have plans in place where it doesn't. They are supposed to document everything."

She said in hindsight Mrs. Moniz should have been sent to the hospital sooner.