Jan 18, 2019

Beware “unintended consequences” of chemical and physical restraint regulation


The Minister for Aged Care has revealed that new regulations for the use of chemical and physical restraints in nursing homes will be announced in a matter of weeks.

The announcement came on the eve of the Aged Care Royal Commission, and also in the wake of horrifying reports on the ABC of use of restraints in nursing homes.

The 7.30 report showed residents being restrained with belts and “dosed up” on medication. The report said that, unlike the UK and the US, Australia currently has no rules on how restraints are used.

In Australia, antipsychotic medications can only be prescribed by a doctor, and the resident and their family are supposed to be involved in the decision making at all times.

But the ABC report shows consent from family “rarely happens”, and is often only discovered when it appears on the bill.

More training needed

Dementia researcher Dr Juanita Westbury told HelloCare the trouble with legislation is it can have “unintended consequences”.

“You have to be really careful how you do this,” she said. “It can’t just be instituted in two weeks.”

“I think legislation is part of the solution,” Dr Westbury said. “But there also has to be training on what you can do.”

She said the message needs to be more about properly assessing the person in each case and finding other solutions that work, whether that be taking them out for a walk, checking they’re not in pain, making sure they have plenty to do, and ensuring they aren’t lonely.

Dr Westbury also said sometimes a small amount of medication can be used, and that in some circumstances withholding medication can actually “cause harm”.

Dr Westbury also said she’s like to see more of a conversation about what is the appropriate care in these cases, and have better education for aged care staff, doctors and families.

She said staff aren’t properly informed about the current guidelines and more training is needed.

US regulations had serious unintended consequences

Dr Westbury said there were several harmful unintended consequences when heavy regulations on antipsychotics were introduced.

Use of other sedating medications, such as benzodiazepines and anticonvulsants, rose sharply. Nursing homes also stopped taking residents who they expected would be too difficult to care for. There was also a doubling of diagnoses of people with schizophrenia because the tough new rules exempted people with severe mental illnesses.

“I do have concerns about legislation,” Dr Westbury said, “especially if it’s been quickly put together.”

Better education of GPs, aged care staff, and families is the key to improved outcomes, she said.

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