Nursing care for elderly people whose mental and physical functions have declined carries the risk of accidents. How can quality of life be improved while maintaining safety? It can be said that many lessons have been learned from a particular incident.
Regarding the incident in which an 85-year-old woman at a special nursing care facility for the aged in Azumino, Nagano Prefecture, died seven years ago after eating a snack, the Tokyo High Court acquitted an assistant nurse who had been charged with professional negligence resulting in death. The prosecution abandoned its appeal to a higher court and her acquittal has been finalized.
The assistant nurse, who was asked by nursing care workers to help them in their work, handed a doughnut to the woman. A district court found the woman guilty of neglecting to check that she gave the elderly woman the correct snack, which had been changed to jelly, and fined her 200,000 yen.
The high court, however, found that it would have been difficult for the assistant nurse to know about the change of snack, which was written in a work handover report, because the document was intended to share information among nursing care workers. The ruling also acknowledged that the victim's risk of choking on a doughnut was low, concluding that the assistant nurse did not breach her duty of care under the Criminal Code.
After the incident, about 700,000 signatures were collected from across the country seeking her acquittal. If individual employees are held criminally responsible for unintentional mistakes while taking care of residents at nursing care facilities, that could end up dispiriting workers on the front line. The ruling is commendable, as it dispels concerns among employees in line with the actual conditions for nursing care workers.
Prosecutors changed the content of the indictment twice at the district court. It seems that the investigation had been insufficient and they repeatedly used unreasonable methods to prove her guilty. It is necessary to verify these factors, including how they reached the indictment.
The high court ruling pointed out that snacks and meals are "important not only for maintaining health and physical activity but also for obtaining spiritual satisfaction and comfort" for residents at nursing care facilities.
After the incident, some facilities stopped serving solid food as snacks. It is important not to deprive residents of their enjoyment by prioritizing risk avoidance. It is vital that nursing care facilities, residents themselves and their families sufficiently discuss nursing care policies.
Of course, efforts to prevent accidents are indispensable. In fiscal 2017, more than 1,500 residents across the nation died in accidents such as falling or aspiration at special nursing care facilities for the aged, which feature intensive care for the elderly, and other facilities mainly intended for rehabilitation and elderly people's return to their homes.
Behind the accidents is a serious labor shortage at nursing care facilities. It is not unusual for such facilities to end up relying on employees with little knowledge and experience because of the high turnover of staff. It is necessary to make efforts to secure human resources by improving their working conditions, and provide well-prepared training sessions to enhance their skills.
In taking care of the elderly, small mistakes can lead to serious consequences. It is hoped that basic operations are thoroughly carried out, such as ensuring that all staff members carefully follow other staffers' dos and don'ts for each resident at meals and when giving out medication.
-- The original Japanese article appeared in The Yomiuri Shimbun on Aug. 13, 2020.
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