Aug 01, 2018

Chemical and physical restraint used: Adelaide nursing home sanctioned

An Adelaide nursing home has been sanctioned by the Department of Health, after a review found it was not using chemical and physical restraints appropriately.

An audit by the Australian Aged Care Quality Agency found that North Eastern Community Nursing Home met only 38 of the required 44 quality standards.

According to the audit, the nursing home did not have effective wounds management processes, was unclean, restricted access to outdoor areas, and was not appropriately lit.

“Severe risk” warning

A further review by the Department of Health found that only one standard was not being met, and consequently imposed sanctions on the nursing home. The department declared the reasons for the sanction were that the nursing home posed an “immediate and severe risk to the health, safety and wellbeing of care recipients at the service”.

The department’s concerns focused on the nursing home’s behaviour management procedures.

The AACQA found the nursing home was using chemical and physical restraints without trying alternative behaviour management strategies.

Sanctions imposed

The sanctions mean that North Eastern Community Nursing Home will not receive Commonwealth subsidies for six months, and must retrain staff and employ an adviser to help turn the operations around.

North Eastern Community Hospital CEO, Michele Smith, told HelloCare, “The welfare of care recipients is the first priority of the North Eastern Community Nursing Home.”

The nursing home has held two information evenings for families to talk through the matters identified in the AACQA audit.

“NECNH held two information sessions with families of residents following the release of the audit report last month, to discuss the findings and fully communicate what NECNH is doing to address issues identified in the audit.

Resident’s behaviour has been assessed, and new measures have been introduced to reduce the need for restraints. External clinical advisors have been appointed to help the nursing home navigate the changes required by the agency.

“In the four weeks since the release of the report NECNH has begun the behavioural reassessment of all residents and has engaged experienced, external clinical advisors to assist in meeting the requirements of the agency. NECNH has also ordered new low-to-ground beds to reduce the need for bed rails, and additional alarmed safety mats next to beds, to alert staff when high-risk residents are mobilising. These measures are all designed to help us implement a restraint-free environment at NECNH.”

“Making good progress”: CEO

Ms Smith said the nursing home is making “good progress” in addressing the matters raised by the AACQA.

“NECNH values the dedication of its staff and is working hard to provide additional training as quickly as possible. We are also working positively with the agency and are making good progress through our clinical advisors towards addressing the issues raised in the audit report.”

Sanctions on the rise

Peter Vincent, Director of Aged Care Management Australia, a consultancy that helps sanctioned nursing homes turn their operations around, told HelloCare there has been a pick up in the number of nursing homes being sanctioned as the government takes a tougher approach.

“There is a significant increase in the number of facilities showing as non compliant and sanctioned. This is clearly because the agency have been instructed to be more aggressive,” he said.

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  1. I have recently resigned and retired early after 27 years as an RN with extensive experience and Post Graduate education in community and (mainly) Residential Aged Care.

    I am in regular contact with my ex work RN colleagues who are aged in their 30’s – 50’s.

    All are at near breaking point with the even more than impossible work load since the Oakden scandal which has triggered an even more over the top response with Managers.
    They now demand an even more ridiculous, totally unreasonable and non evidence based level of documentation the rationale very obviously mainly being ‘damage control’ to satisfy the aggressive tactics of the accreditors.

    Managers have now largely taken the many years of assessment skills away from the experienced RN’s by demanding a completely over the top, time wasting response to very minor events that previously were left to the judgment of the RN.
    Managers are demanding hospitalisation for minor events that have been successfully managed for years regardless of any clinical evaluation proving that hospitalisation was not necessary.

    There’s only one guess as to the result, further bed crisis within the acute sector not to mention much extra unnecessary stress for Ambulance personnel

    This is turn is taking even more time from the already impossible work load of the RN regardless of how
    conscientious she/he is.

    I can tell you that now more than ever RN’s who chose to stay in this sector are being forced to quietly ignore more and more needs of the residents within their care to complete the unnecessary documentation demanded so the end result will ultimately be a further decline in quality of care and an even more dishonest system of lies and deceit.

    Unfortunately some of the articles written on this site and generally all through the media give the impression of ‘ the terrible Aged Care system not meeting the Standards’ however the entire current system has been generally been caused by unqualified people standing back and judging and making many of the ridiculous decisions to contribute to the current broken system.

    Please include the frontline observations of the people who actually work in the system in your articles and not just from the perspective of relatives and outsiders

    Just one more thing. Yes it would be wonderful if Nurses would reduce chemical restraint but in the real world how do they cope with ambulant people with dementia who are verbally and physically aggressive and who also have a short term memory loss of maybe 2 or 3 minutes..?

    Yes, sure the ideal is to apply behavioural management strategies, diversion, redirection etc prior to chemical restraint but usually the carer or Nurse leaves and this resident is up and at it again often just a few minutes later interfering with or threatening /hitting other residents. This means the facility must employ 1 carer to a ratio of 2 of these residents at the very most.

    The RN then has the extra documentation., incident reports etc that takes further time away from directing needed resident care. If the resident instigates multiple incidents in a shift, guess what? The RN has to complete this documentation over and over again within the one shift! Multiply this by trying to care for multiple other residents at the same time.

    I say this after years of experience of referral and assessment to Geriatricians, transfer to Older Persons Mental Health wards of Public Hospitals and behavioural Management assessments most of which are to different degrees unsuccessful.
    People usually retain these behaviour traits to differing degrees and most often it’s only a physical decline that forces the person to become more manageable

    Of course most organizations have never had the foresight to build safe areas within their facilities where this type of resident can be placed where they’re not harmful to others or even allow the ‘old fashioned’ chair with a tray table that acts as a restraint even for a short time- that’s viewed as ‘cruel restraint’ whereas it really is just old fashioned ‘common sense’ as well as being a protection for the resident and other residents that deserve to be protected.

    Us nurses don’t need a crystal ball to see the future, it’s so blindingly obvious that for multiple reasons if nothing changes from the current approach the future for Residential Aged Care will continue to deteriorate.


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