Jul 07, 2021

90% of residents sedated without consent as nursing home fails accreditation

Nurse clipboard resident

Following an audit by the Aged Care Quality and Safety Commission in early April 2021, a report was released at the beginning of May.

The report showed that 35 of the 39 residents were being given psychotropic medication. 

Though all have diagnoses and conditions that are suitable for the medications prescribed, there was no written consent from family for the residents to take the medication.

The acting residential care manager said the home had “a new psychotropic awareness form for all consumers receiving psychotropics,” and that this would be implemented once a new manager began at the home.

Other complaints outlined in the report, which is available on the commission’s website, included:

  • One family member was very “dissatisfied and distressed” about the pain management and palliative care provided to her mother.
  • One family member was “unhappy” about food at the home, and food was not always in line with the residents’ needs.
  • The assessors found that staff were “not able to manage the behaviours of a consumer who wandered, was intrusive and entered consumers rooms, particularly after hours”.
  • Review of care planning documents showed that clinical care is “not best practice, is not tailored to the needs of the consumer and does not optimise health and well-being”. 
  • Palliative care and pain management for one consumer was found to be inadequate.
  • There was a lack of timely referral to behavioural specialist services. 
  • Pain is not monitored or evaluated effectively for residents. One consumer said that she is constantly in pain with no relief and no one has asked how she is. Family members said they had to “advocate” on behalf of a resident for pain relief.
  • Two residents had wounds that had deteriorated. Wound reviews were not always adhered to and they did not have specialist wound reviews.
  • Consumers noted that staff are always very busy and there are times when they must wait a long time for someone to help them. 
  • The home was also found to be non-compliant with infection control standards.

Back in December 2020, in the midst of the pandemic, the commission suspended site audits, and to ensure continuity of accreditation, the Department of Health granted “exceptional circumstances” to the home, extending its accreditation until 7 July 2021.

The home continued to be monitored by the commission during that period, according to the My Aged Care website.

Professor Joseph Ibrahim is the head of the Health Law and Ageing Research Unit at Monash University.

He told the ABC the problems with psychotropic use have been “well known” for more than two decades.

“The royal commission made it one of its top priorities in its interim report back in 2019 and yet we are still seeing the issues, really quite prominent now,” he said.

“What we know is it is widespread, it is not any particular home or any particular doctor. It is through the whole sector.”

Professor Ibrahim added, “The rules that have been put in place are just not effective, nor are they consistent with respecting the human rights of an older person with dementia.”

HelloCare has not named the home in question. We have covered this story to demonstrate the issues facing aged care, not to identify specific homes or providers.

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  1. Close the facility down and charge the manager, provider… No excuses! But our government & the aged care regulator don’t care about older people in Aged Care Facilities 😓

    1. Just where would you house the residents if you close the facility? I’m not suggesting that the situation is acceptable, however there are practicalities that have to be considered.

    2. Wouldn’t it be more appropriate to find out if the residents have been properly medicated and are living a better life because of the medication.
      No question, nursing home staff are aware of their documentation requirements and by all means I support appropriate documentation but let’s look at it from the residents quality of life for a second.
      Can someone ask why the documents weren’t completed please? Were they part done or did the assessment team not like the way the paperwork was done?
      Or,did they just not do anything. Another thing to consider is the knowledge that the prescriber is responsible for gaining consent..yet they leave it to the facility to do.

  2. Every manager in this business is aware of their obligations in relation to the process required for the use of psychotropic medication. However, not the same can be said of the medical officers who prescribe these types of drugs. Often they refuse to complete the forms and obtain consent, or cease the medication because they do not want to go through the process of obtaining consent. And this occurs irrespective of the residents clinical need to actually have the medication. Just as we now record antibiotic use and polypharmacy, it is evident that staff in aged care facilities are held to account for prescribing practices of doctors due to the inability of bureaucracy to monitor and regulate their practices.

  3. It’s interesting to read many of the complaints listed when the headline reads overuse of mind altering medication.
    Firstly doctors prescribe medications and yes nursing homes provide a considerable amount of the information used by doctors to make their recommendations but ultimately doctors know what they are doing.

    Pain management complaint suggests an under use of medication.

    Uncontrolled intrusive behaviour and aggression suggests an under use of medication.

    Palliative care inadequate suggests an under use of medication.

    Nursing homes are in a very difficult situation with behaviour medication. In the wider community including hospital a resident/patient can easily be prescribed medication that can control a plethora of symptoms with appropriate drugs. But nursing homes are encountering many residents entering care with high needs, stronger and high aggressions but their hands are tied because of the exaggeration about over use and doctors are now unable to prescribe appropriate medication. A gerontologist is required now for this and access is very slow and difficult. Elder persons mental health departments refuse to treat dementia residents, safe units for aggressive residents are chronically short in supply. Mental institutions are like hens teeth and regrettably quite violent people end up in nursing homes without appropriate recognition by authorities of their needs.

    As to the other complaints I can well imagine that they are very busy trying to keep residents safe from each other.
    How do these staff safely shower, feed and entertain residents with high behaviour issues? Someone is suffering with the new medication restrictions and most often it’s the residents,they surely don’t like to be constantly upset, angry, lost, confused and unfortunately they end up being segregated instead of properly medically managed.

  4. Without knowing the actual diagnoses of the residents in this facility and likely all or most LTC facilities are abusing the residents by ignoring the deleterious effects including sudden death from the inappropriate use of drugs such as antipsychotics and antidepressants of which all have serious to lethal consequences to elderly persons with dementia.
    In Canada the use of antipsychotics and other drugs listed on the Beers Criteria ought not to be used excepted on the diagnosis by a qualified physician of psychosis or schizophrenia.
    This inappropriate use of drugs in a population that is frail and not likely to benefit from these drugs often due a sudden death and experience numerous serious and some permanent side effects which are often missed or dismissed by staff who do not have the knowledge about these drugs and side effects.
    I see the abuse of these drugs on vulnerable people who are unable to consent and likely would not consent to these drugs as they rarely have a positive effect and more likely they will suffer the long list of side effects. Most family or duly authorized people have little understanding of the effects of these drugs and hope that the medical person prescribing these know what they are doing so will agree to the use.
    I believe there ought to be a board made up of knowledgeable medical representatives and public with extensive knowledge must agree or not to the use of these drugs
    Non-pharmaceutical interventions are the usual first go-to before using lethal side effect drugs. But given there are such shortages of qualified staff on LTC to monitor the side effects and few staff to provide care plus the inappropriate environment of most LTC facilities that exacerbate confusion and desire to leave and go hone, it is well documented that proving a real hone-like environment and providing social care needs to those with dementia there is little need to use these drugs at all. Therefore there are many other things that would limit the use of inappropriate drugs on a population where these should rarely be used.

  5. If I drugged someone in society against their will or of their family I would be up on criminal charges. Please explain to me why this law does not apply to Aged Care Facilities. Are they above the law? The Aged are not put into care for their rights to be taken away. We all know why this is happening……lack of staff. Better to illegally drug people than look after them properly. Shame on these homes for illegally doing this. Prosecute the owners and their Registered Nurses.
    When will our government stand up for the Aged and stop supporting these disgusting practices?


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