May 16, 2019

Nursing homes medicate residents because not enough staff, royal commission hears

The royal commission looked at the use of psychotropic medications in aged care on day six of the hearings in Sydney.

Dr Juanita Westbury, of the Wicking Dementia Research and Education Centre, said her study led her to believe that aged care facilities have differing “prescribing cultures… where some homes are very quick to rush to the medication for management, whereas other homes are much more prudent.”

Dr Westbury’s research found that some nursing homes had psychotropic prescribing rates of nearly 50 per cent, while others’ rates were much lower.

“In some homes, you had 45 per cent of residents taking an antipsychotic every single day, but, on the other end of the scale, you had some with 6 per cent of residents,” she said.

Psychotropics prescribed too often, for too long, without consent

Dr Westbury said psychotropics were often used for years, when they are generally only supposed to be prescribed for use for short periods.

She said one study found the duration of use for antipsychotics was 2.1 years. “That’s quite different form the recommended three months,” she said.

Dr Westbury said some medications were being prescribed at doses that were too high. Benzodiazepines “were often used at higher doses than recommended,” she said.

Dr Westbury said her work had enabled aged care facilities to reduce their prescribing levels of antipsychotics and benzodiazepines, but an extension of her trial was refused funding by the government and her recommendations were not implemented.

Some doctors believe psychotropic medications don’t have serious side effects, she said.

“Most of the doctors that I spoke to kept on emphasising that they were only using them at very small doses and that really at that minimal dose, surely they wouldn’t have a high risk of side effects. Some of the doctors told me that they felt a lot of the risks were overblown, overpublicised,” she said.

Families often weren’t consulted before their loved one was medicated, Dr Westbury said.

“A lot of them said the first time they found out that their relative… was taking these medications was when they received their pharmacy bill.”

In earlier hearings, the royal commission has heard a number of cases involving overuse of psychotropic medications, and failure to receive consent to administer the medications.

Staff shortages lead to use of chemical restraint

A panel of highly experienced nurses explained to the royal commission that they sometimes use physical and chemical restraints because there simply are not enough staff for them to manage residents with high needs.

The panel consisted of experienced registered nurse, Elizabeth (surname withheld), Maggie Bain, a retired diversional therapist, Suzanne Wilson, an assistant in nursing, and Susan Walton, also an assistant in nursing.

Elzabeth said chemical restraint is used in residential aged care “because there’s not enough staffing”.

“Rather than give proper care, you just sedate people so then they’re not annoying you,” she said.

Chemical restraint means “everyone looks fine… they’re all clean and tidy and they’re not crying out. But they’re not actually getting… the care they need and being treated like a person with needs,” Elizabeth said.

Elizabeth said using physical restraint was an unacceptable practice.

“If somebody’s being agitated, you can just give them some space; that’s not an excuse to tie them up. And that if they are lashing out, you can actually isolate them so that they’re not hurting you or themselves or some of the other residents,” she said.

The panel also discussed other aspects of the care they provide residents in aged care facilities.

Ms Walton told the commission no extra staff are employed to when palliative care is required.

She also said she didn’t think assistants in nursing should be giving out medications because they don’t understand how the drugs might affect people.

“I think my role should be providing the care and interacting with the resident,” the AIN said.

Image: Dr Juanita Westbury, Wicking Dementia Research Centre, University of Tasmania.

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  1. What a lot of nonsense. From what I understand doctors like being doctors and the instances of over subscription is like abuse and neglect, exaggerated.
    Medication is prescribed generally to calm agitated residents that are highly anxious or aggressive making care options minimal. Nurses on the floor are being punched, pinched, spat on and sworn on each and every day, is this acceptable… Not to me.
    Residents with high dementia unfortunately often aren’t the people they were in their youth. Their entire personality often dramatically changes to a point where lots of families can’t accept and that’s tough on them.
    On occasion families choose to blame the facility for the change but that is not true. Sometimes it’s convenient or easy to blame or imagine the change to ease their guilt. I don’t believe they have anything to feel guilty about, they put their loved ones in a caring place because they can’t do the job. What they need to do is recognise the difficulty and help the carers,
    By the way, AINs don’t prescribe medication, most facilities use a blister pack medication system which is packed by a pharmacist under doctor direction. Med comp nurses can deliver that medication under supervision, these are all documented and signed for.

    I think the public have been lead to believe that these medications are being handed out like smarties. Every one will believe what they choose to believe but when it’s my time I want to be in a caring facility and not struggling on my own at home. Where else could you get accommodation, light, heat, food, laundry and around the clock care for $160 per day… mostly paid by the government?

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