Documents submitted to the Royal Commission reveal the government’s tough stance on the use of chemical and physical restraint in aged care was whittled down during negotiations.
An article by the ABC today has revealed emails submitted to the royal commission show how the then aged care minister, Ken Wyatt’s determination to improve regulation of the use of chemical and physical restraint was watered down over the course of negotiations.
The minister’s ambitions were initially revealed in an email from Mr Wyatt’s chief of staff, Paula Gelo, written the day after the airing of the ABC’s Four Corners report on the overuse of chemical restraint in aged care.
Ms Gelo says the minister wants to “ramp up” the areas of “medication management” in residential aged care.
The next day, Paula Gelo, the minister’s chief of staff, issued another email, highlighting the minister’s keenness to address the issues.
The negotiations continue over the next few months, with discussions taking place first with a group of ‘critical friends’ which included representatives from the Leading Age Services Australia, Aged Care and Community Services, and others.
Then the Department of Health established a clinical group, led by the department’s head doctor, chief medical officer, Professor Brendan Murphy, and with six aged care providers, lobbyists, a union representative, and one consumer group, according to the ABC.
In the dozens of emails submitted to the royal commission, this one from Prof Murphy stands out because it raises the question of consent for chemical restraint. In the final regulations, consent is not required, instead, staff only need to inform family that the medication has been administered.
Two weeks later the final regulations were released by the minister, without the need for consent for chemical restraint.
The new regulations can be found here.
Dr Juanita Breen (formerly Westbury), senior lecturer at the Wicking Dementia Research and Education Centre, told HelloCare, “The ABC has revealed again the lack of regard this government shows for our older residents in aged care homes.”
“My greatest concern is that the new principles for chemical restraints do not require informed consent.
“This is a basic human right. Residents or their legal proxy need to be told of the modest benefits alongside substantial risks of these sedating medications – and of alternatives to use. And they need to agree to their use.
“The reason that it would not be workable for homes or prescribers is not acceptable and simply untrue.
“In the USA, informed consent for chemical restraint is mandatory (legislated in 2012 during Obama’s watch) from prescribers. Consent also needs to be confirmed by each home provider before these drugs are administered.
“If the US can do this why can’t we?
“The abstention of informed consent for chemical restraint was pushed by the clinical committee against the minister’s advice, government guidelines, peak bodies recommendations, and The Australian Commission for Safety and Quality in Health Care.
“I guess this committee composed largely of doctors, a few nurses and one pharmacist knew best.
“What about the protection and rights of residents? Sadly disregarded.”
Professor Joseph Ibrahim, is a consultant specialist in geriatric medicine, who teaches and researches patient safety and aged care at the Institute of Forensic Medicine and is head of the Health Law and Ageing Research Unit at Monash University.
Prof Ibrahim told HelloCare, “I would have liked them [the new regulations] to be more rigorous.”
“It’s fine to make a new law,” he said.
“But you need to address the underlying causes [of why people are using chemical and physical restraint], and you need to provide monitoring, and enforce laws with penalties to get them to behave in the way you want them to,” he said.
Prof Ibrahim said, just as we have laws in occupational health and safety and on our roads to encourage us to behave in certain ways to keep ourselves and others safe, it should be no different in aged care facilities.
We understand and accept that road and OHS laws are monitored and penalties imposed when we deviate from them, he said, and it should be no different for the use of restraints in aged care.
Professor Ibrahim said he’d like to see research into why aged care staff are resorting to using restraints in aged care facilities in the first place. “Do people have the resources they need? Do they have the training and education they need?” he asked.
Dementia Australia’s CEO Maree McCabe told HellloCare, “There is more to be done in a legislative, operational and cultural sense to address the use of chemical and physical restraint.
“There remains a gap between person centred principles and practice.”
But she acknowledged that these are “complex” issues.
“There are instances where the use of chemical restraint is appropriate. We acknowledge the interface between family, the role of prescribing doctors, pharmacists, and care staff can be complex,” she said.
The people that are concerned about the reduction in the use of physical and chemical restraint clearly have not observed these practices up close and personal. The inappropriate use of chemical and physical restraint is widespread and is basically horrific. Tying people up and sedating them in order to save on staffing is just immoral pure and simple. These practices including seclusion should have been banned decades ago because they are not therapeutic, traumatise patients and everyone involved and don’t work.
Hopefully some of the group involved will visit a facility or go into a memory support unit and witness a nurse being assaulted, as that is the only reason I have seen chemical restraint used to help calm a resident down. We also have environmental restraints, which are in place to prevent the door from being opened and the resident with dementia from wandering out onto the street, should that be stopped as well.
Good clinical practices and referrals to DSA are the first and best options. We have less than 5% of residents on chemical restraints in my workplace, and it’s assessed monthly. I think it’s over-sensationalised.
Before the Royal Commission, it was more relaxed, but now residential facilities have to report it, so it is very regulated. People need to stop slamming aged care providers and staff—it’s not fair.