In an interview with HelloCare, Janet Anderson, the head of the Aged Care Quality and Safety Commission, spoke candidly about how recent changes that were made to the residential aged care quality standards provided a shift in focus, and would now place more importance on a residents preferences regarding their own care.
While this has been welcome news for the majority of Australians, there can be no doubt that this will add further complication to an environment that was already struggling to cope with expectation, because added choice, also means added risk.
A number of aged care providers are currently in the midst of finding the right balance between safety and encouraging their residents to exercise personal freedoms, and one subject that has become a recurring theme is the risk associated with elderly aged care residents wanting to lock their doors.
Surprisingly, there are currently no solid rules or regulations regarding door locking in residential aged care facilities, and a statement provided by the Department Of Health highlights why some providers are currently struggling to navigate this issue.
“The issues surrounding whether residents are able to lock their doors in residential aged care is a complex matter. This is a matter for aged care providers to negotiate with consumers individually, taking into account any risks and any relevant jurisdictional laws, and the consumer’s needs and preferences.”
There are a number of different methods currently being used by aged care providers to combat this issue, all of which come with their own varying degrees of risk and impact on a resident’s personal privacy.
Some providers allow residents to lock their doors but provide staff with a key in case of emergency, others allow residents to lock their doors but only provide keys to certain staff members, some facilities have locks but will only lock the doors when a resident will be away from their room for an extended period of time, and there are even some providers who don’t have locks on their doors at all.
Privacy is a large part of an individual’s personal freedom, and living in a shared community environment like an aged care facility can provide limited opportunity for private time – but is privacy more important than the potential of risk and ensuring safety? And if so, who should make that call?
Emeritus Professor from La Trobe University, Rhonda Nay, has dedicated a lifetime to improving the care outcomes for elderly Australians, and according to Rhonda, the best way to approach this issue is trialing it.
“I think it’s entirely appropriate that residents can lock their doors provided they have the capacity to unlock them and get out,” said Rhonda.
“You can trial it and ask the person to see if they can get themselves out, obviously you don’t want them locked in there if they can’t get out. Every home has a master key so if there was a fire and you really had to get in you could, but your everyday normal person couldn’t walk in if that resident was having sex or something.”
“People have the right to do whatever they want in their own room, and provided they have demonstrated that they can get out, then I don’t see any problem with someone wanting to lock their door.”
Despite the seemingly simple nature of the request, a locked door could prove to be the difference between life and death in some situations.
In the event of a fall or medical emergency, an open door increases the chances of drawing attention to a problem, while a locked door could result in a resident not being found until someone comes knocking.
Despite the potential severity of the outcomes in these types of situations, Professor Nay believes that the dignity of choice should always be upheld as long as the resident or their appointed guardian can accept the risk involved.
“There is a dignity associated with choices at any age. These choices must be respected and supported as far as possible. Common sense and clinical judgment have to be used. Before taking risks the person needs to know possible adverse consequences and accept them,” said Rhonda.
“Privacy is a real issue in aged care at the moment. The level of privacy provided to aged care residents is poor, there might be signs saying ‘please knock before you enter’ but then, there are a lot of staff who knock and go straight in – and this can take a toll on a person’s dignity.”
“People with dementia have varying of dementia can have varying degrees of ability to make choices and I think that we need to maximise their capacity for choice and to have a voice regarding what happens to them.”
Choice and voice are the two number one concerns for elderly people. They want to have a voice regarding what happens to them and they don’t want other people deciding what is best for them, and that applies to dementia – their motto is ‘nothing about us, without us.’
The facility in which I work has doors which are able to be locked from the outside and opened from the inside even if they are locked. It’s a fire safety system feature so that residents can always escape if there is a fire as some of them are not cognitively capable of opening a locked door.
The more regulated and hard set the rules are, the more it doesnt work for anybody. As Prof Nay says, it is not a one size fits all, and neither should it be.
I talk to many residents who say they lock their door because they have other residents coming in when they are there or not there and interfering with their belongings. They choose to lock their door to keep other residents out. This must be considered as well.
Other residents I have spoken to grew up without locks while others have always locked doors as the norm.
There are also ways to monitor residents in their room that are less invasive, for example with movement and floor sensors. I am seeing more of these strategies coming in where providers can meet the standards and residents feel in control of their life and environment.
Door locking!
Should residents be able to lock their rooms? 60% of nursing home residents have dementia, don’t they have rights? How much time do you think staff will spend looking for their keys? Do you want to descriminate between residents?
Staff spend enough time looking for dentures, glasses, handbags, watches, combs etc… image looking for keys.
Commentors continually over simplify residential care, the frustration levels for residents that can’t get into their room, can’t find the key, even those that forgot they ever had a key and can’t understand why they are locked out.
If you don’t know what you’re talking about, don’t talk.
Has this rule changed? Does the resident (dementia or not) now have no right to lock her own door, to stop people from going into her room so she feels safer?