When elderly people retreat from public view, it can actually be a sign that help is required.
The NSW coroner investigating the death of Marcia Clark in 2014 has highlighted the risks when people who need care retreat from public view. The Coroner, Magistrate Teresa O’Sullivan, said carers need strong support systems, and they can sometimes struggle to look after themselves, let alone look after someone in their care.
Ms O’Sullivan was investigating the adequacy of the care Mrs Clark received in the months before she died.
When Mrs Clark died at the age of 83, she was suffering from dehydration, malnutrition, and infection, in large part caused by the inadequate care provided by her daughter, Nardia.
When paramedics attended Mrs Clark on 17 July 2014, they noted that Nardia was “unkempt, dirty, seemed confused, and was a poor historian when it came to describing her mother’s history.”
Nardia appeared to be “exhausted, stressed, and struggling to care for herself, much less Mrs Clark towards the end of her life.”
The Coroner said the paramedics were “assaulted” by the smell in Mrs Clark’s room, and found her “emaciated”, lying on a bed wet with urine and faeces that appeared to have accumulated over days.
When Mrs Clark was taken to Taree Base Hospital, she was found to be in pain, suffering from hydration and was malnourished. She had numerous pressure sores, even on her ear, and one so severe it required surgery.
However, the hospital considered Mrs Clark to be “at high risk of dying” and so it was decided, after consultation with Nardia, that Mrs Clark would be cared for under a palliative care regime.
Mrs Clark died three days after she was admitted to hospital.
No rushing to judgement
Ms O’Sullivan said it was understandable that questions would arise about how Mrs Clark could have been reduced to such a “pitiful state”, but said that rather than “rushing to judgement”, it was important to consider “how things come to such a low ebb”.
Ms O’Sullivan said Nardia appeared to have little “insight” into her mother’s condition, and wasn’t really able to explain why she hadn’t called for help sooner.
Nardia said her mother had Parkinson’s Disease and Dementia, but there had been no formal diagnosis of the conditions.
Mrs Clark did not leave her home in the last seven months before she died. Ms O’Sullivan said the evidence suggests that Nardia, like her mother, “did not want strangers coming into the home and in fact seemed to want to close off the home from the outside world.”
“Loving and respectful”
Mrs Clarke last saw her doctor, Thai Doan, in December 2013, and after that point Nardia simply relayed to him how her mother was.
Dr Doan said he observed a “loving and respectful” relationship between mother and daughter.
The Coroner, Magistrate Teresa O’Sullivan, said there was no “malicious intent” in the care that Nardia provided, but she said it was clear to her that Nardia had become “overwhelmed” by her responsibilities as a carer.
In a tragic end to an already deeply sad story, two years after Mrs Clark died, Nardia went missing. Her body was found in bushland some months later.
What can you do when care becomes unmanageable?
Ms O’Sullivan said in hindsight it is obvious that Mrs Clark required a home assessment to determine whether or not she could continue to be cared for at home by her daughter.
University of Sydney medical professor Susan Kurrie and Kerry Marshall from the Elder Abuse Hotline appeared at the inquest.
Professor Kurrie said the Elder Abuse Hotline is trialling a program in which it can provide more than just advice and referrals, and can actually take on cases.
The Coroner did not make any recommendation, because she said reform is already underway at both federal and state levels.
“This doesn’t mean that Mrs Clark’s death is unimportant.
“It is important because it throws into stark relief the risk that arises when older people retreat from public view into their homes, whether due to physical infirmities or mental illness or for some other reason.
“It highlights the need to think critically about care arrangements for older people and to keep in mind the fact that arrangements will need to change over time because people are likely to need increasing care over time.
“It suggests that family members, doctors and others need to be curious about how carers are actually coping in reality and beyond the veneer they present to the outside world.
“And it emphasises the need to place the best interests of the older person at the centre of decision making around their care, if they are no longer able to make such decisions for themselves.”