May 08, 2019

Aged care resident physically restrained and medicated without consent

The royal commission has heard a respite care resident at Garden View nursing home in Sydney’s Merrylands was regularly restrained and medicated without consent during his nearly two-month stay.

Michelle McCulla and Natalie Smith recalled the harrowing treatment their father, Terry Reeves, received at Garden View nursing home during a respite stay while their mother travelled overseas.

Mr Reeves was given antipsychotic medications without the family’s consent and was physically restrained in a chair with a lap belt for up to 14 hours.

Dementia resident restrained on at least 30 occasions

Ms McCulla told the royal commission her family found Mr Reeves physically restrained on approximately 30 occasions. The restraint used was a ‘lap belt’, which consisted of Mr Reeves sitting in a seat, with a belt tied around his waist and through his legs.

“Every single time I visited he was in a restraint except for one day when he was completely unconscious in a bed,” Ms McCulla said.

Disturbing footage of Mr Reeves being physically restrained was aired on the ABC earlier this year, prompting the federal government to announce a crackdown on the practice of physical restraint.

Risperidone prescribed without consent

Ms McCulla also told the royal commission her father was given risperidone without the family’s consent, but she suspected was being medicated.

She said the family would not have consented to giving Mr Reeves risperidone, because he had taken the medication once previously and had responded badly to it.

“I didn’t know as a fact that he was being given risperidone,” she said. “I suspected that he had been given something as he was… drooped, he was drooling, he could no longer focus on us. It wasn’t normal.”

Mr Reeves was moved to ‘East Wing’, a locked dementia ward. Ms McCulla said she didn’t know of the ward when they were making the decision to have Mr Reeves stay at Garden View.

Ms McCulla said when she first saw her father at East Wing, he was there with other residents and all were restrained.

“I found a small room, perhaps 11 metres by five or six metres,” she told the royal commission. “There was a line of chairs and everyone was restrained in lap belts along that side of the wall.”

“My father was in a chair with his back towards me restrained in the chair. He had another resident next to him restrained in a chair and then there were quite – maybe two or three in tub beds also restrained.

“I crouched down in front of my father. He was asleep or he had his head in his chest, eyes closed, drooling. I tried to wake him and I shook his legs. He was shivering. He only had a singlet on. It was quite cold that day and it was all wet with saliva at the front. He had no shoes on. He was in the lap belt.”

Ms McCulla also described a traumatic experience involving six staff members toileting Mr Reeves.

Staff told the sisters Mr Reeves was being restrained for his own good, to stop him walking around and to stop him from being aggressive.

On Monday, Mr Reeves wife, Lillian told the royal commission that her husband was never given permission to receive risperidone, but after the family brought him home, they received a note from the pharmacist about the antipsychotic medication.

When they brought Mr Reeves home, Mrs Reeves said he was “very unwell” and it took him 5 days to become more “upright”.

“There was one day that he just laid on the floor and we think it was withdrawals,” she said.

So after coming home, Mr Reeves had to move into permanent care as Mrs Reeves was diagnosed with cancer. Fortunately, his new home has been a more positive experience.

The home is “wonderful”, Mrs Reeves said.

“They don’t restrain. They don’t medicate. He’s free to walk around the halls. He walks a lot. He’s allowed to walk out in the gardens. They supervise. He’s had no falls. He walks very well. But he never came back 100 per cent after being at Garden View.”

Mr Reeves was “totally incontinent” when he came home and never regained continence.

Staff reveal errors

Garden View nursing home registered nurse, Jayanthi Kannan, told the royal commission nurses sometimes filled out resident restraint charts at the end of their shifts to the best of their recollection, and it was possible they may not have been accurate.

Ms Kannan said when residents were put in physical restraints they were checked hourly and two-hour breaks were given.

Dr Kenneth Wong admitted to the royal commission it was illogical to give Mr Reeves risperidone when he knew it increased the risk of falls.

“When I saw him in the corridor, he was acutely distressed,” Dr Wong said. “He was confused, he was wandering down and obviously suffering from agitation and delirium probably, and according to nursing staff, half a risperidone, a quarter risperidone was not effective in modifying his behaviour.”

Dr Wong explained that he prescribed risperidone at night hoping it would help Mr Reeves sleep.

Kee Ling Lau, director of Garden View, said the nursing home could not afford one-to-one care. She said the home did not seek help for Mr Reeves from DBMAS or the Severe Behaviour Response Team.

“It follows, that Garden View did not do everything that it could have done to investigate other options for managing… Mr Reeves’ behaviours, before imposing physical restraints on him?” Mr Gray, counsel assisting the royal commission asked Ms Lau.

“It’s true to say that,” she replied.

Image: Michelle McCulla during her hearing at the royal commission.

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  1. Can anyone explain why residential aged care facilities are not calling on DBMAS or the Severe Behaviour Response Team for support in their care of people with dementia

    1. I called on the Severe Behaviour Response Team for advice on how to deal with challenging behaviour and the response I got was pathetic and indifferent. As an individual,I cared enough to seek the help and was badly disappointed by the attitude of the persons I spoke with. Maybe nursing homes don’t approach them because they prefer to drug and restrain them instead – much easier – or because they are not interested in seeking advice as it will take away from from the AINs. Perhaps the response to a service provider might have been different to that which they were prepared to offer to an individual carer but the two I spoke with in the lower north shore area only added to my stress. I resolved the problem by doing my own research and learned what I needed to know from reports provided by experts in the field in UK, USA and medical specialists in Aust.

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