Paul Gilbert, ANMF (Vic Branch) Assistant Secretary, presenting at the 2020 aged care physical and chemical restraint symposium
- There are less aged care staff today per resident than there were in 1990 and registered nurses are caring for three times more residents. (Paul Gilbert, ANMF (Vic Branch) Assistant Secretary)
- The group home ‘cottage model’ of residential aged care provides the highest quality care for people with dementia, with lower psychotropic medications use and lower costs than traditional aged care. (Professor Susan Kurrle, Director Geriatrician, Hornsby & Bateman’s Bay Hospitals)
- Nearly 60 per cent of Australian nursing home residents receive care hours that would be considered ‘unacceptable’ – rated one or two stars – under a US five-star nursing home rating system (Anita Westera, Research Fellow, University of Wollongong)
- If you’re going to administer medication that is going to change a person’s behaviour, you must have the resident’s consent or their guardian’s. It is the prescriber’s responsibility to seek that consent but aged care nurses and personal care workers can face sanctions if consent hasn’t been secured. (Rodney Lewis, Senior Solicitor, Elderlaw Legal Services)
- In common law the use of any kind of restraint would constitute a criminal offence if not properly authorised. Health professionals must obtain prior informed consent before carrying out any medical treatment, including the use of restraint. Restraints can be used in an emergency or out of necessity until proper lawful authorization is obtained but ‘necessity’ is time-limited (Colleen Pearce, Office of the Public Advocate)
- The Minimising the Use of Restraints Principles introduced on 1 July 2019 do not measure up against a framework that would protect residents’ human rights. Concerns include no explicit objective to eliminate use of restraint; lack of monitoring and oversight; and lack of clarity of how the principles interact with existing legal frameworks, such as Victoria’s Medical Treatment Planning and Decisions Act 2016 (Colleen Pearce, Office of the Public Advocate)
- It is common for aged care residents in Australia to be administered sedatives: the University of Tasmania RedUSe project found that 37 per cent of aged care residents in 150 homes around Australia were taking sedative medications. (Dr Juanita Breen, Senior Lecturer at the University of Tasmania’s Wicking Dementia Research and Education Centre)
- Psychotropic medications need to be prescribed ‘with extreme caution’ because of possible side-effects including seizures, reduced white cell count, cardiovascular and cerebrovascular adverse events, falls and uncontrollable muscle movements. (Palliative care nurse practitioner Juliane Samara)
- Aged care staff often believe physical restraints benefit residents but there are negative psychological and physical side-effects – humiliation; confusion, anxiety and depression; cuts and bruising; pain; anger, withdrawal and aggression; pressure injuries; muscle weakness; clots; incontinence and increased risk of falling. (Professor Susan Kurrle, Director Geriatrician, Hornsby & Bateman’s Bay Hospitals)
- People who have experienced trauma (like war veterans, child abuse survivors, victim/survivors of domestic violence and members of the Stolen Generation) can have flashbacks and hallucinations as they near the end of their lives. All aged care assessments should include a trauma history. (Juliane Samara, palliative care nurse practitioner)
