Why is childcare penalised – but not aged care – when a person goes missing?

Though physically well, still tall and strong, my grandmother was living with dementia at the time. She had only recently moved to Sydney after living for half a century on a remote property in country New South Wales. She didn’t know the city well. 

The thought of her on the streets, alone, was deeply concerning.

The nursing home where she lived raised the alarm first, we were informed, and then the authorities were brought in. After scouring the area and finding nothing, all we could do was wait for news.

Eventually we received a call from the police, notifying us that a kind stranger had spotted my grandmother, obviously out of place and becoming distressing, on a train halfway across the city.

This caring soul struck up a conversation with my grandmother, and, realising she was lost, chaperoned her to the train guards. My grandmother was eventually returned home – to our great relief.

Always immaculate and proper, my gran arrived back at the nursing home with a hamburger and a bottle of beer in a plastic bag – untouched I’m pleased to report.

We were so lucky she was found; many who go missing from aged care facilities do not have such good fortune.

Here at HelloCare we hear many stories of older family members going missing, sometimes never to be found again, or their bodies found days later. When a frail and vulnerable older person goes missing from an aged care facility, we know the consequences can be catastrophic.

Childcare centre faces charges after toddlers escape

So, I read with interest on that a childcare facility in Werribee, Victoria, faced charges after two of its students, both toddlers, escaped the confines of the preschool’s walls, and ran out onto a busy road.

This story got me thinking, why do the operators of childcare centres face charges when a person in their care goes missing, but aged care operators do not?

Still digesting the Royal Commission into Aged Care Quality and Safety’s interim report, I wondered could it be because our society has “drifted” into an “ageist mentality”, as the commissioners suggest?

Are we accepting a lower standard of safety for older adults than we do for children simply because we don’t value them so highly? Perhaps.

Or is the answer more nuanced?

Aged care is not a prison

Of course, there is a key difference between aged care and childcare: residential aged care provides a home for residents, whereas children only attend childcare during the day. When the place you receive care is also your home, we would probably accept there are fewer regulations about what you can and can’t do? It’s not a prison, after all. 

If an aged care resident wants to walk out of their home, surely they should they be able to?

The dignity of risk

The new Charter of Aged Care Rights states aged care residents have the right to “safe” care. Yet they also have the right to have “control over … choices (that) involve personal risk”.

Aged care residents should be given the ‘dignity of risk’. But when residents become cognitively impaired, such as if they are living with dementia, it can be difficult to determine the exact point at which they are no longer able to accurately assess risk. 

The balance between providing safety and delivering dignity of risk at the same time is a complex area of aged care.

Of course, children have rights, too. According to the Human Rights Commission, children have “special” rights because of their “vulnerability”. 

The United Nation’s Convention of the Rights of the Child states the “institutions, services and facilities responsible for the care or protection of children shall conform with the standards established … particularly in the areas of safety”.

Children inherently ‘take risks’ – climbing trees, rolling down hills, jumping off walls – in part because they don’t fully understand the consequences of their actions. Though we know this type of ‘play’ is good for children because it teaches them how to engage with the world, we also know children don’t fully understand the consequences of their decisions, and we often need to make decisions on their behalf to keep them safe.

We don’t always make the same assumption for older adults, though sometimes it might be the case.

Perhaps this is why we don’t see harsher penalties for aged care providers when residents ‘escape’.

Would harsher penalties when aged care operators ‘lost’ a resident mean residents are safer? Perhaps, but what would the cost be? The residents’ freedom?

After my grandmother returned to her aged care facility, she wore a bracelet that alerted staff when she approached the front door. The next time she left the nursing home was when she moved into a hospice. Some might say wearing a device was an infringement of my grandmother’s rights, but I was grateful it kept her safe.

What do you think: Should aged care operators face charges or penalties if a resident goes missing?

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  1. Having had many years experience as a RN in Aged Care I can confirm that all the residents I’ve known that have ‘escaped’ have been let out the main doors by visitors, absolutely none were because of neglect.

    Some residents present very well even though cognitively impaired and visitors not thinking assume they are a visiting husband or wife of a resident and take no notice of them leaving at the same time as themselves,

    This happens at times even though there was a notice on the door to be careful not to let anyone out but themselves. Of course these residents also often know the right thing to say to avoid suspicion.

    This is definitely not a matter of undervaluing older people as compared to children as it’s something almost always out of the control of the staff of the facility.

    Unless a staff member is employed to sit at the doors permanently there is no way this scenario is preventable as visitors are the problem here.

    Like I said, in 24 years I have not known one ‘escape’ by a resident to be caused by neglect on the part of staff even though it is possible but extremely rare.

    Let’s not automatically blame staff who are among the most hard working in any profession today and who are working ( many hours unpaid ) in the case of RN’s & E’N’s under the most difficult circumstances.

  2. There are very good reasons because of the differences between aged care and child care.
    An aged care facility is the private home of a resident. The resident most likely has once ejected voluntarily to live at the home and therefore has the right to exit. They also have the right to be at risk.
    As opposed to a child care centre where there are minors who are not responsible for decision making by law and otherwise. They are taken to to the centre for the purpose of being cared for while learning g. The centre is secured at all times in every way to deliberately prevent exit .
    They are fully and totally in the care of the staff with no choice to leave.

  3. Do we want our aged care facilities to have high fences locked with security cameras and speaker access both inside and out. Like prison. My belief is that unless warranted, ie dementia units, we need to keep aged care for the living like a home. Where I work half the residents still go out either on local bus services or drive themselves. I would demand the people that restrict my parents into a life of confinement become residents themselves. Keep in mind there are a lot, probably the majority of homes run very well with all experiencing the odd resident that on a shopping trip or similar gets lost. Actually my mum did this once whilst in her 50’s living at her own home. Turned out to be a UTI with simple AB’s and a week was fine never repeated her offence.

  4. As many resident’s living with dementia often feel the need to leave the facility, to go home, get tea for the family or like one gentleman 5 pm was when he meets his mates at the pub before tea. Aged Care facilities are not prison, but homes. The use of alert bracelets and enough staff to allow time to attend the pub or church would be very important for all. I often see residents missing out on outings or wanting to just go for a walk but due to the lack of staff unable to.


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