When police arrived at the Yallambee Lodge nursing home in the early hours of Wednesday morning, May 17, they confronted 95-year-old great-grandmother Clare Nowland in the middle of a dementia episode. She was scared and confused.
What happened next has become a global news story: a New South Wales Police Force officer allegedly Tasered Nowland, causing her to fall and fracture her skull. She was carrying a small knife and using a walking frame.
Nowland died a week later, on Wednesday, about the same time 33-year-old senior constable Kristian White was charged with multiple offences including recklessly causing grievous bodily harm.
These could yet be upgraded.
Nowland’s family are now united in grief for the mother of eight who had lived a remarkable and adventurous life – she went skydiving to celebrate her 80th birthday – while the “critical incident” has exposed significant deficiencies in two institutions: the police and Australia’s model of residential aged care.
NSW Police Commissioner Karen Webb embarked on an extraordinary media blitz following the brutal encounter and declared she was not only refusing to watch the bodycam footage that shows precisely what happened in the moment but that it was “courageous” to refuse.
“I’d argue the opposite,” she told ABC News last week. “I think it takes courage not to view it.”
Senior Constable White, who was suspended with pay before he was charged, will face court on July 5.
The Law Enforcement Conduct Commission of NSW is independently monitoring the police force as it investigates itself. The LECC, which has only operated since 2017, was the first to alert journalists to the “incident” in Cooma, a town in the south of the state, pushing out a short media statement before the NSW Police Force media unit had acknowledged anything was happening.
There are two parallel stories unfolding around Nowland’s death. Police conduct is the most obvious, but just as pressing is the question for the nursing home: Why were police called?
The answer to that is as complex as the byzantine arrangements that govern aged care in Australia.
“She had a behaviour management plan in place, staff had tried various things to de-escalate the situation and it went on for a lot longer than people realise,” a source says.
Yallambee Lodge is something of a modern rarity in that it is owned and operated by Snowy Monaro Regional Council, in contrast to other services that are fully privatised or run by churches and charities.
By many accounts, it is a “good” home.
The Aged Care Quality and Safety Commission decided only last month to re-accredit the home until 2026 after site visits in January and February, declaring the home to be compliant in every one of eight quality standards with “no specific areas identified” for improvement.
However, the assessment report does provide a clue about a critical challenge across a depleted aged-care sector: inexperienced staff and shortages.
“Consumers and representatives said staff were available to provide care and services as per their needs,” the report says.
“Management described various strategies in place to ensure staff numbers and the skill and mix of staff are adequate to meet consumer needs, including utilising labour hire workforce on three-monthly contracts and adjusting the staffing mix where required.”
In just over a month, it will become mandatory for aged-care homes to have a registered nurse (RN) on site full-time, winding back the clock on a Howard-era change that removed the requirement from legislation in 1998. There are currently not enough RNs for all aged-care homes to meet the new baseline standard.
According to internal modelling from the Department of Health and Aged Care, about 20 per cent of all residential aged-care providers across the country currently do not have an RN on site 24 hours a day, seven days a week. In order to meet the new legislative benchmark, the department estimates an additional 869 RNs by headcount will be needed.
Department of Health and Aged Care assistant secretary Mark Richardson told a provider forum last month that the government expects about 5 per cent of services in regional and rural areas with fewer than 30 residents to receive an official exemption, for a year, as long as they have “alternative” strategies in place.
“We also recognise that external pressures can present challenges to providers in attracting and retaining a suitably skilled and competent workforce, particularly in rural and remote areas, to support the aged-care sector’s transition to the 24/7 RN responsibility,” he said.
Yallambee Lodge has about 40 beds and is not exempt, although it advertises itself as offering 24/7 RN coverage. This measure is just one metric. Yallambee is well above targets for total care minutes offered to residents – 230 minutes per resident per day compared with the benchmark of 177 minutes – but is below the minimum target for RN care at 29 rather than 37 minutes.
The Royal Commission into Aged Care Quality and Safety exposed a dramatic shift in the move from experienced and qualified RNs to cheaper, poorly trained and often precarious personal care workers. The slide began in the late 1990s when a typical nursing home was funded for 308 RN hours. This dropped to 168 hours in 2020.
As a proportion of all direct-care employees, RNs fell from 21.4 per cent of staff to less than 15 per cent, while personal care workers, or PCWs, increased their share of work from 56.5 per cent of the aged-care workforce to 71.5 per cent in 2016.
In at least one way, the question of why staff at Yallambee Lodge might have called the police is contained within these statistics.
Jane Newbound, a registered nurse who has spent the past two decades working across a range of senior roles in the aged-care sector, tells The Saturday Paper that in some circumstances aged-care staff just do not want to assume the risk of something going wrong when they can potentially “outsource” a problem to hospitals, paramedics or police.
“You’re just you on for 80 residents and you’re the only RN on afternoon shift. You’ve got one, maybe, EN [enrolled nurse] if you’re lucky, and the rest are all PCs [personal carers],” she says.
“[They] might be brilliant, but they are PCs so they’re not going to be able to do that complex clinical care. Somebody either has a fall or someone gets unwell. Your first response is, ‘It’s just me for 80 people; who’s going to look after the other 79? I’m going to send this person out.’
“So you ring an ambulance; you fight like crazy sometimes to get the ambulance to actually come and take the person.”
Newbound notes that, under mandatory reporting requirements, staff are obliged to involve police if a resident has gone missing. These “unexplained absences” are frequent occurrences in nursing homes. Clare Nowland went missing for about an hour on the same morning she was later met by police. Calling authorities for a disturbance, however, is markedly rarer.
“You would do it only in really extreme cases,” Newbound says. “If the person has something dangerous [or] if they have attempted to injure or harm another resident, because sometimes staff do have breaks or are in a room providing care and there’s no one on the floor. You are put at risk; you are threatened.”
These are painful realities of working in aged care, but Newbound is not assembling an exculpatory narrative. A 43-kilogram great-grandmother with a walking frame, even with dementia and even with a steak knife, is no siege.
“Absolutely staff need more training,” Newbound says. “Absolutely they need to understand how to de-escalate [a situation]. Absolutely we need to do much more with mental health, care and preparation. And management of major psychiatric illnesses. And that’s the thing we don’t do well in aged care: the people with the severe behavioural disturbance.”
That, of course, is an ever-growing share of the total nursing home population. “You are asking aged-care people to manage hospital-grade matters with at best one-fifth of the funding,” Newbound says. “It can’t be done.”
NSW Police Force won’t show the public footage of Nowland being shocked with a Taser. Another case, however, gives a flavour of the distress the mother of eight must have encountered before she fell to the floor and sustained the injuries that ultimately killed her.
In 2020, Rachel Grahame, then 81 years old, was a resident of St Basil’s Randwick in Sydney. She lived with mixed Alzheimer’s and vascular dementia and had associated “behaviours” that required qualified staff to intervene. However, not a single staff member in her dedicated dementia unit had received any dementia-specific training.
Grahame’s daughter, Emma Grahame, tells The Saturday Paper that her mother would be sent to emergency at a local hospital for no reason other than “that she had dementia”.
“So Mum ended up in emergency at Prince of Wales Hospital three times during that year that she was in St Basil’s and every time she got there … Prince of Wales said, ‘Oh, there’s nothing wrong with her; she’s got dementia,’ ” she said.
In October, however, the police were called. They restrained Grahame with two sets of handcuffs. Bodycam footage of that moment became essential in a civil court case against the NSW Police Force.
In the vision, Grahame can be heard yelling out and howling in pain. She is clearly scared. The images are haunting.
“She was in the dementia support unit. They called the cops into the unit,” Emma Grahame says.
The facility was investigated after Grahame’s family complained and the Aged Care Quality and Safety Commission found the service breached 35 of the then 42 quality standards for care. To this day, and despite the clear police footage of the incident, St Basil’s Randwick claims there is “no evidence” that Rachel Grahame was ever handcuffed.
Curiously, the service’s own CCTV footage of the encounter is missing the entire portion where the police are involved and only cuts back in when Grahame is being loaded into an ambulance, without handcuffs.
St Basil’s Randwick is a top-tier home, demanding a residential accommodation bond of more than $1 million.
“We thought we had found an amazing place because it presented well, but it was terrible,” Emma Grahame says.
“And we only felt empowered to complain because we got Mum out of it. She just she never went back there.
“After we took her out, we asked for them to pack her belongings up and send them to us or we’d come and pick them up. They dumped them in garbage bags, including, you know, rotten apples, bits of chocolate, piss-soaked shoes, all just thrown into black garbage bags.”
So often lost in stories of mistreatment and misery in aged care is that the victims were and remained human beings. They have rich, complicated lives and are entitled to dignity. Grahame, for example, was a librarian who became a historical researcher when she retired.
“She was a marvellous craftswoman – one of her quilts is in the Macquarie University’s Australian history museum,” her daughter says. “She was a very highly intelligent and engaged person, a great theatre-lover.”
Her family thinks she saw every theatrical production in Sydney in the past 60 years. None of that seemed to matter when the insidious behavioural manifestations of dementia met a woefully resourced aged-care sector.
There is a common thread linking the death of Clare Nowland and the treatment of Rachel Grahame, one that goes beyond the involvement of police.
Under the Australian government’s new “star rating” system for aged-care services, both St Basil’s Randwick and Yallambee Lodge are given an overall rating of four stars. In short: from the outside, these look like the good homes.
“This is a flawed business model,” Newbound says, talking about the sector more broadly. “It is a business model that is open to fraudulent activity and to abuse. Until governments direct some attention onto shoring up how Australian taxpayers’ money is actually being spent in these organisations, nothing will change.”
Minister for Aged Care Anika Wells is currently trialling new aged-care standards, recommended after the royal commission, and these include a specific requirement to ensure “all workers are regularly trained in relation to core matters such as … caring for people living with dementia”.
The Aged Care Quality and Safety Commission is investigating what happened at the Cooma home. The federal government is investigating how the commission does its job more broadly. A capability review of the regulator was handed to Minister Wells more than a month ago but has not yet been released.
“If we find that the provider has not met their legal obligations, we will take action to hold them to account,” Commissioner Janet Anderson said in a statement after Clare Nowland was Tasered.
“If at any time the Commission identifies an immediate or severe risk to residents living at the service, we will move quickly to ensure that they are safe.
“My thoughts are with Ms Nowland, her family and others impacted by this incident.”
On Wednesday night, NSW Police posted a three-line statement to Facebook: “It is with great sadness we confirm the passing of 95-year-old Clare Nowland in Cooma tonight...
“Mrs Nowland passed away peacefully in hospital just after 7pm this evening, surrounded by family and loved ones who have requested privacy during this sad and difficult time.
“Our thoughts and condolences remain with those who were lucky enough to know, love, and be loved by Mrs Nowland during a life she led hallmarked by family, kindness and community.”
This article was first published in the print edition of The Saturday Paper on May 27, 2023 as "Charges laid in aged-care Taser killing".
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