Apr 02, 2019

New regulation of chemical and physical restraints in aged care announced, but are they enough?

The government will require that aged care residents are assessed by an appropriate person before physical or chemical restraints can be used, under new regulations that will be brought in from 1 July 2019, the government has announced.

But a dementia care expert has told HelloCare the new regulations still appear to be too “soft”.

The new regulations were foreshadowed by the Aged Care Minister Ken Wyatt in January, and will be signed into law next week.

What are the new regulations?

Under the new regulations, providers must have an approved health practitioner assess the resident before physical restraints can be used.

Before chemical restraints can be used, the medical practitioner or nurse who is prescribing the medication must assess the resident.

Alternative options to restraints must also be tried and documented, and once restraints are used, they must be regularly monitored.

Residents or their representative must also give their informed consent before physical restraints can be used, except in cases of emergency, under the new regulations.

Regulations appear “soft” says dementia expert

Dr Juanita Westbury, Senior Lecturer, Wicking Dementia Research & Education Centre, told HelloCare the new regulations “seem very light on” and “soft”.

“Any attention on this area is welcome and much needed,” she said, but added she would like to see more information, including who will enforce and monitor the regulation and what will the penalties be in the event of non-compliance.

“One hopes assessment would already occur before any intervention is used, especially one that could incur serious risk of harm and restriction of civil liberty,” she said.

Rather than assessment, a “documented detailed treatment plan would be more beneficial”, Dr Westbury said.

Dr Westbury also questioned why informed consent was not required for chemical restraint.

She noted that documenting alternative options to restraint that have been used is already done in most care homes.

More training for aged care staff and prescribers is needed about alternative options and services, such as the Dementia Behaviour Management Advisory Service, Dr Westbury said.

Dr Westbury said restraint monitoring must have specific requirements.

“To translate to effective care this needs to be more specific in that residents using restraint will be monitored for effectiveness and side effects – and use time-limited (3 months for antipsychotics, 2-4 weeks for benzodiazepines and other psychotropics),” she noted.

Dr Westbury said the Australian Commission on Safety and Quality in Health Care’s recommendations provide “meaningful regulation change”. The ACSQHC recommendations include measures such as having a pharmacist medication review every six months, and limiting PRN medication use.

For more information about the ACSQHC recommendations visit their website.

Use of physical restraints one of three aged care quality indicators

Aged care managers and staff have a range of tools and guidelines available to them to help them achieve safe, high-quality care and practice safe medication management, Mr Wyatt said.

Use of physical restraints is also one of the three quality indicators that will come into effect on 1 July 2019. The other two quality indicators are pressure injuries and unplanned weight loss.

The Aged Care Quality and Safety Commission will begin publishing the data on quality indicators by the end of this year.

Mr Wyatt said, “Protecting our senior Australians, ensuring their safety, health, well-being and quality of life when they are receiving aged care, is a top priority.”

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  1. I agree with Dr Westbury , this is an area that must be monitored, but someone out side the facility. most Dr’s do not have adequate training around dementia some don’t have any so they are not appropriate to make the decision to administer restraints of any sort. staff education must become the first and major starting point to improve dementia units. a big start would be unlock the doors a lot of behaviors occur because people do not like being locked up. most residential facilities have an outer perimeter that could be monitors with one way in and out. so much more civilized.

    1. to achieve what is being proposed there will need to be motza dollars invested into aged care for care staff, NOT for cars, admin, CEOs etc BUT for care staff, for those who do the hands on, who deal with the behaviours, the wandering the falls prevention etc.

  2. When I worked in Aged Care residents were routinely restrained and sedated. There simply wasn’t enough staff some of the time to do anything else. Better care is going to require a lot more trained registered staff.

  3. In well run facilities everything that the Minister (and more) already happens. The “and more” refers to education for all carers; regular care conferences including customers and their representatives and GP; regular prescribed restraint reviews, and restraint as an absolute last resort. Once again the issues with a few result in industry-wide condemnation. Why? Because it is much easier and more news worthy than the relevant government funded bodies highlighting the frequency of this problem arising. The base assumption is that if an issue is on Four Corners it must happen everywhere – it doesn’t. As for the ABC asking people to come forward with their concerns this simply reinforces a mentality around an individuals “five minutes of fame” – look Mum I was on the telly…. Stop bashing an industry that does a sensational job given its challenges, constraints, and regulatory work book bigger than the King James Bible. Compassion, understanding and empathy is needed for a decent system and needs to be applied to everyone involved.

  4. At the moment, all residents of aged care facilities that have keypads at the front doors are actually under unlawful physical restraint. The problem is that there is very little difference in the way that cognitively aware vs cognitively impaired residents are treated. And as with all elder abuse, no regulatory body like the Complaints Commissioner or the Accreditation Agency or the police acted on this at all. VCAT and OPA both made submissions to the Law Reform Review into Elder Abuse in 2017 along these lines. No amount of regulation protects anyone unless someone enforces it. In cognitively impaired residents, the first sign of a problem behaviour is treated with anti psychotics – prescribed by a doctor – so how can anyone think that this new standard is stronger, it’s almost the same. I agree, too soft by miles but it comes back to the old problem, no staff and no properly trained staff to assist the person who is most likely in pain or distress for a valid reason that they cannot communicate effectively to the staff

  5. I have retired
    , however I worked as a Registered Nurse in Aged Care for many years. We were required to document begaviours. do an assessment on the resident’s behavior, then any physical restraint required would be discussed by the R.N.with the G.P. and next of kin. Then reviewed monthly and a reassessment 3 monthly. Si who will be “suitable” now to assess. Aged Care could always do with more funding and training for the staff
    .
    ,

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