The small group home, or ‘cottage’ model is the best model for residential aged care for people living with dementia, Professor Susan Kurrle, Director Geriatrician, Hornsby & Bateman’s Bay Hospitals, told the ANMF (Vic Branch) 2020 aged care physical and chemical restraint symposium.
A study of 541 residents living in 17 not for profit homes in four states showed that those living in small group homes had a higher quality of life, less hospitalisations and less use of psychotropic medications than residents of larger, traditional nursing homes.
The total annual cost of providing care in a domestic model was $14,270 less annually than for the standard model.
Professor Kurrle said that within the small group home model, people with dementia could go outside, take part in household duties, and enjoy the company of their families and pets.
The Investigating Services Provided in the Residential Care Environment for Dementia (INSPIRED) study was published in the Medical Journal of Australia in June 2018.
Professor Kurrle told the symposium that as of 1 July 2019 use of physical restraint is one of the three mandatory quality indicators that has to be reported by every aged care facility.
From July to September 2019, ‘intent to restrain’ was observed 25,101 times in Australian nursing homes. (Intent to restrain is any intention to restrict a resident’s voluntary movement or behavior using a restraint device, removing a mobility aid, using physical force or any other action or device.)
Physical restraint devices were observed in use 63,217 times.
Professor Kurrle described the case study of a 65-year-old man diagnosed with dementia whose wife placed him in a nursing home. ‘Bob’ was agitated and trying to escape. The man’s wife paid for a carer to take him on excursions out of the nursing home but on these excursions he began to ‘see’ his wife with her ‘new partner’ and would run away from the carer. Bob was prescribed rispiradone which reduced the man’s delusions and distress but he developed Parkinsonian effects which put him at risk of falls; staff began to physically restrain him.
The Dementia Behaviour Management Advisory Service assessed him and he was sent to a psychogeriatric facility, and placed in a specialist dementia care unit. After ten months he returned to his home town, and was prescribed mirtazapine, an antidepressant with a sedative effect. Bob is much happier and although he requires assistance with meals, he is active and able to go on excursions outside the nursing home.
Side-effects of physical restraints
Professor Kurrle said staff often believe 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.
How do you reduce physical restraint?
Non-slip floors, hip protectors, better lighting and signage, less noise, adjustable beds, correct mobility aids and home-like design could all be employed to provide a calm and safe environment for residents to reduce the need for physical restraints.
Other factors to reduce aggression and anxiety among residents and prevent use of restraints are:
- Individualised approaches to care routines
- Constantly monitoring comfort of residents and regular medical and medication reviews
- Making sure residents are well-nourished and hydrated; treating infections
- Nurturing good relationships and contact – familiar staff, engagement in activities, therapeutic touch, intergenerational contact, pets.
Sign up for high quality ANMF (Vic Branch) seminars and workshops related to aged care residents’ mental health and medication:
Mental health first aid for nurses and personal care workers in aged care with Diana Anderson on 25 March
‘Delirium, depression, dementia: distinguishing the dreaded Ds’ with Associate Professor Rosalie Hudson on 29 April
‘Mental health first aid for nurses and personal care workers in aged care’ with Diana Anderson on 19 June
‘Pain and the older person: partnership precedes prescription’ with Associate Professor Rosalie Hudson on 24 June