An aged care worker has given a harrowing account of the night one resident killed another with a walking stick at the Illawarra facility where she still works.
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Kathryn Nobes, one of the witnesses at the Sydney hearing of the Royal Commission into Aged Care on Wednesday, said she'd been diagnosed with PTSD after the incident in the dementia unit.
"I looked down the corridor and saw the resident walking towards us," she said. "The resident was holding a walking stick in his right hand, like it was a club.
"...I noticed that the resident had blood on his knees and some blood on his hands. ...I think I also saw blood on his face around his mouth."
The 62-year-old said staff initially thought the resident - who she said had a history of violence - had been injured from a fall, or had had a nose bleed and staff cleaned the blood off him.
However, a short time later, Ms Nobes said another worker came running up to her and a colleague and said: "While I was at break, there has been a murder. The resident has murdered another resident".
Ms Nobes said she was then directed to prepare supper for the other residents, as relatives of the two residents and police began to arrive.
"When walking to the tea room, I walked past a woman who was crying uncontrollably. I now know this was the wife of the resident."
Ms Nobes gave a statement to police the next day. She returned to work in March in another area of the Illawarra facility, which cannot be named due to a non-publication direction issued by the Commissioners.
Ms Nobes said she was speaking to the Royal Commission because she believed the working conditions for workers in aged care had a serious impact on the quality of care they were able to provide to the residents. "I am also concerned about the safety and well-being of the care workers," she said.
Ms Nobes said she had herself been "repeatedly assaulted by residents" since starting work at the facility in late 2015.
"I have received blows, kicks, headbutts, twisting of the skin on my arms, grabbing and squeezing of my hands and arms, attacks with faeces, verbal abuse and threats," she said.
" ... One of my most disturbing assaults happened while toileting a male resident. Another (worker) had taken him to the bathroom, got him to hold on to the rail adjacent to the toilet, and pulled down his trousers and incontinence pad.
"...His pants were full of faeces. In an instant, he let go of the rail, made fists of his hands and plunged them into the faeces. He quickly turned towards me and punched me in the breasts. I spun around and he continued to punch me in the arm and in the back. I ended up with his faeces all over my shirt."
Ms Nobes said care workers were subjected to racial verbal attacks from residents; while there were regular incidents where residents urinated or defecated in public spaces and exhibited "inappropriate sexual behaviour".
"I remember there was one male resident who thought everything was a urinal," she said. "One worker told me that he had urinated over the nurses' counter and into the keyboard she was using. This was an issue when a resident urinated on another resident's walker in the dining room at dinnertime."
Ms Nobes said it was not uncommon for residents with dementia to show levels of violence: "I fear that this type of incident will be repeated".
She said she believed that staff working with dementia residents needed more training in how to deal with aggressive and violent behaviour.
"You were just sort of expected to deal with it. When I informed my in-charge that I had been assaulted by a resident, the in-charge shrugged their shoulders and said "That's dementia."
"This has happened on different occasions. I think there was an overriding culture in aged care of simply shrugging it off."
Ms Nobes advocated for more training on how to de-escalate a potentially dangerous situation, as well as how to stay safe and not be physically hurt.
She also felt there was insufficient staffing at the facility - and said she had sometimes had to look after 18 men by herself for part of her shift: "I didn't feel safe".
For security reasons, she added, staff should be able to lock the doors of each bedroom "as many residents with dementia roam the corridors and intrude on other residents' rooms".
Ms Nobes also told the commission that she had spoken to residents who did not have dementia, who had all told her they were happy at the facility and felt it was staffed with caring and hardworking workers.
As well she praised her employer for providing a program enabling staff to receive counselling from a qualified counsellor: "I have found this very helpful in dealing with the stress and psychological trauma of my job".
