If you have been following media coverage of the sector in the last two weeks, you will be aware that the issue of chemical and physical restraints in residential aged care is now front and centre.
The ABC’s 7.30 Report aired a devastating investigation into the use of restraints at a Sydney aged care home, while The Australian newspaper has focused its attention on the use of psychotropic drugs.
The ABC story prompted Minister for Aged Care Ken Wyatt to announce the use of restraints would be “better regulated” within weeks last Thursday, the day before the Royal Commission into Aged Care’s first hearing.
We welcome his speedy response – but it is important to remember that this is a much more complex issue than just introducing new regulations.
Not always black and white
I have worked at a number of aged care facilities and the reality is physical and chemical restraints are sometimes used even though their use is controversial.
Over half of the 240,000 residents in Australian aged care facilities have some form of dementia. Some residents experience symptoms such as aggression, anxiety and agitation which can make them a risk to themselves, other residents and staff.
Others may also be at high risk of falls due to frailty and poor mobility but have no sense of the danger because of cognitive impairments.
Add to this the demands on staff and chemical or physical restraint is often seen as the only option to cope with challenging behaviours.
It can be difficult finding the balance between respecting a resident’s rights and ensuring their safety. Providers and experts have been looking for a better solution to manage challenging behaviours.
These alternatives include activities and programs to keep residents engaged such as music programs, diversional therapies, exercise programs, falls prevention programs and social activities as well as increases in staffing and supervision and setting up individual routines.
However, these generally involve a carer spending one-on-one time with the resident – which is not always possible. Providers need the budget – and staff need the training – to provide this kind of support.
Funding key to change
In any case, restraints should only be used as a last resort and with the consent of the resident and their family members.
The issue is whether they are being used inappropriately – and how do we fund these alternative ways of supporting residents with dementia?
The good news is that these questions will be canvassed by the Commissioners in their investigation of the sector – including better supporting people with dementia into the future.
Their recommendations will go towards improving the system – and hopefully ensuring the stories we have read never happen again.
If you do have concerns about the medications that your loved one is taking, ask to speak to the nurse or manager. If you want to take the issue further, you can contact the independent Aged Care Quality and Safety Commission here or on 1800 951 822.
Discussion2 Comments
Here we go again, another knee jerk policy reaction and a “One size fits all policy”. In my 35 years of aged care the use of restraint (usually chemical) was a last resort, minimalistic use approach with all consultations undertaken. Usually to prevent violence to other residents and staff. No one really wants to use it but sometimes it is in the best interest of the resident when they cannot be moved to a more appropriate facility to handle their violent behaviours.
Where is the Health care policy on Discharge nurses drugging residents in hospitals to ensure a patient “looks” calm and normal when visited, so they can offload them to an unsuspecting residential facility. The poor facility then has very little recourse and has to go through hoops to discharge them to a more appropriate facility and is then made to be the bad guy in this situation.
But but but – every commentator is ignoring a salient fact on chemical restraint – it cannot be given without a doctor’s prescription – so where are the doctors on this issue?