Frail elderly woman left unresponsive at home for 24 hours after healthcare provider fails procedures

A frail elderly woman was left unresponsive in her home for 24 hours after a community healthcare provider failed its procedures, according to Deputy Health and Disability Commissioner Rose Wall.

Senior woman sitting with her hands clasped. Source:

The woman, who had suffered a significant cardiac event and stroke, died shortly after being discovered.

"The client was a frail elderly woman who had multiple health problems and was classified as a high falls risk. She lived on her own and required twice-daily cares and safety checks to ensure that she was safe in her own home," a report on the incident from Ms Wall stated.

"One morning, a support worker went to the woman’s house to provide her with her morning cares and do a safety check, to find that she was not answering the door. The support worker notified Access’ Call Centre, and the "Client not Home" process was followed.

"The Call Centre attempted to call the woman’s house and next of kin, but there was no answer. A call was made to the local hospital, but it advised that the woman was not a patient. The support worker was advised to move on.

"This process occurred two more times - later that afternoon, and the following morning - when a support worker finally gained access to the woman’s home using a neighbour’s key. The woman was found in bed, having suffering a significant cardiac event and a stroke. Sadly she passed away shortly afterwards."

Ms Wall found community healthcare provider Access Community Health to be in breach of the Code of Health and Disability Services Consumers’ Rights (the Code) for failing to have adequate procedures in place when checking on its clients.

Due to this Ms Wall made a number of recommendations, including that Access Community Health provide training to all call centre and support work staff on its new "Client not Home" process, develop an alert system for those who require safety checks, and update its template to ensure that important information for emergencies, such as the location of spare keys, is recorded.

She also urged Access Community Health to apologise in writing to the woman's family.