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Aged care needs to kick its ‘drug habit’: Judd


Dr Stephen Judd

Dr Stephen Judd at the international dementia conference on Thursday.

HammondCare chief executive Dr Stephen Judd has called on aged care providers to “ditch their drug habit” and take responsibility for the role they play in the over-reliance on chemical restraint in the care of people with dementia.

He said attempts to pass off the use of antipsychotics in aged care as simply a doctor-patient issue were “absolute rubbish” and a cop out from the sector.

“What it fails to acknowledge is that often doctors are prescribing at the behest of aged care staff,” he told the Risky Business 2 international dementia conference on Thursday.

He said denial was not a mature response to this important issue and some industry peak associations needed to stop playing the blame game.

“There’s no use in making excuses or passing the buck,” he said.

To create sector change, Dr Judd said a new way of thinking on antipsychotics was needed, which included better monitoring and review.

“As a society, we understand that if someone has an infection and is prescribed antibiotics, it’s prescribed for a limited time and then it’s withdrawn. We need to consider antipsychotics along the same lines.

“In most cases, antipsychotics should be used as treatments for a particular intervention and not as a long-term solution. They should have a start time, a review period and a finishing date.”

Dr Judd also backed a senate committee’s recommendation for GPs to review antipsychotic medication after the first three months as a good starting point.

“It would help a great deal if we could increase the pharmacological knowledge of doctors. But, this is not all about doctors.” He said all aged care providers should take steps to provide residential care that was grounded “in a deep understanding of the individual” and by adopting psycho-social interventions.

“It’s also about the physical environment – and this is something that the Senate inquiry really cottoned onto. Noise is to someone with dementia what stairs are to someone in a wheelchair,” he said.

“Powerful medication is not the only way to care for people. While they are an appropriate treatment for some people, they are not an inevitable form of treatment for everyone.”

The androgyny of aged care

In his keynote address, titled ‘Sex, drugs and rock ‘n’ roll’, Dr Judd also argued strongly for the end to what he described as the androgyny of aged care. He said the most pressing issue in relation to sexuality and dementia in aged care today was not the sexual expression of residents but their de-sexualising by organisations that cared for them.

“The issue that affects all residents each and every day is the suppression of sexual identity and expression that so easily creeps into our aged care homes.”

Dr Judd said by dressing residents in gender-neutral clothing such as tracksuit pants and paying a lack of attention to personal grooming and appearance, aged care environments often diminished the sexuality of people with dementia in aged care.

“As well as physical sexual expression, sexuality also encompasses an affirmation of gender – recognising women as women and men as men.

“Dress, grooming, hair, appearance matter because they lie at the heart of our identity and sense of self. When you look daggy, when your appearance does not reflect your idea of who you are, it’s harder to feel good about yourself.”

He told the Sydney audience it was critical to get away from practices that were convenient-but-bad, including sitting residents in front of the TV for hours, and instead provide care that was centred on the individual.

Risky Business 2 was attended by around 1000 local and international delegates in Sydney on 26-27 June.

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6 Responses to Aged care needs to kick its ‘drug habit’: Judd

  1. Eesa Witt July 3, 2014 at 12:28 pm #

    Bravo Stephen Judd. Finally someone powerful at the most senior level within the Residential Aged Care Industry has spoken out in public, what specialist Dementia Nurses and Consultants have known for many years.
    Thank you.
    Now it will make our work a bit easier to offer specialist Dementia support without Facilities hiding under the umbrella of “the Dr ordered the medication,’ and ignoring or not implementing personalised management plans by Dementia Nurse Specialists because: we don’t have the staff, it is too hard, we know what’s best for the Resident, the list of ‘can’t do’ is long and tedious.
    Now that one of its own has spoken out I sincerely hope that Organisations like Alzheimers Australia NSW and nationally, can work in supportive, advisory partnerships with Aged Care Facilities to actually walk the walk. Talking the talk has not and does not induce change.
    Over the years, too many Residents have slipped down the medication induced slopes despite complaints by distressed families and friends. Further, it should be mandatory policy within Facilities to get family/enduring guardian signed paperwork, before any antipsychotic medication is first administered.
    As a specialist Dementia Nurse I look forward to working in a more enlightened partnership with Aged Care Staff who can be educated and supported to provide better quality Dementia Care.
    Well done again Stephen.
    Regards,
    Eesa

  2. david July 4, 2014 at 7:22 pm #

    Isn’t it comforting to have so many experts in aged care ?

    Granted, the increasing use of antipsychotics requires careful review; we require skilled physicians and diligent care staff to avoid inappropriate use and maintain diligent monitoring when they prescribed.

    And therein lies the problem. GP’s who will attend aged care facilities aren’t thick on the ground; we take what we can get. Care staff, often stretched and unskilled, are expected to manage increasingly complex behaviours while providers push to remove RN coverage from high care facilities (a move supported by the ACS). It’s been a long time since I’ve met a dementia ‘expert’ that’s actually done an 8 hour shift in a high care dementia unit…so its very easy for them to simply prescribe labour intensive ‘behaviour management strategies’ and then complain the staff dont follow their instructions.

    On occasions, a resident who has an uncontrollable storm raging in their head, will require medicating. Increasingly, when we call for help, dementia specialists simply say ‘manage’ the resident…brilliant! Why don’t you hang around for a few days and show us how easy it is. Old facilities with four bed wards, unsuitable environments, no activities and care staff with poor English all add to the complexity of caring for our frail residents.

    Try admitting someone with severely challenging behaviours to the dementia experts, Hammond Care. They wont accept them. It’s easy to get great results when you’re only dealing with clients that occasionally lose their car keys.

    Eesa, I sincerely hope your work gets easier…then you might be able to manage two residents simultaneously.

    Banging on about antipsychotics will not change anything unless we ensure adequate skilled staffing to provide the care and behaviour management strategies that will negate their use.

  3. Tricia July 9, 2014 at 1:11 pm #

    Bravo and well said when you have 14 residents sundowning and 2 staff to redirect and try to provide toileting, feeding, dressing and all the other cares that are required, its not an easy task. unless there is dedicated time for those residents and a greater ratio of staff, behaviour management is a joke.

  4. Michelle July 10, 2014 at 12:10 am #

    Mr Judd’s blanket statements are divisive and do little to address the underlying issues of inadequate training and sufficient staffing; the real hurdles to competently managing challenging behaviour.

    Does he really believe doctors simply prescribe medications at the behest of care staff ? If so, Mr Judd would better serve residents by identifying and reporting these practitioners for the obvious disregard of their ethical and professional obligations.

    There is a widening disconnect between dementia ‘experts’ and the reality of life on the floor. Hammond Care (self-appointed gurus on all things cognitively impaired) are becoming particularly tiresome; pontificating with such elitism is condescending and unhelpful.

    Perhaps there’s too much money available for dementia research…everyone’s an expert, every academic is conducting studies (robotic seals, anyone?) but there’s nobody on the floor. There’s no cash or glamor in the fundamentals (they’re soooo boring).

    Stop all the hand wringing. This is how we fix it….staffing, training and environment.

    Can I get a grant now?

  5. Kim July 11, 2014 at 12:53 pm #

    Where do I begin?
    One aspect not considered by either side is the effect on other residents . To have to share your home 24/7 with someone who shouts, confronts you or goes into your room and removes your precious possessions is scary. Without a dramatic increase in staff levels, and therefore costs, the antipsychotics used for difficult behaviour management are very necessary.

    The whole system needs review, not just a part and providers would do well to look at building design, equipment design, routine methodology, the list is endless.
    Work on the floor, ask those on the floor, and listen! Listen without prejudice and pre-conceived ideas. Listen with a view to improving management not paperwork. You will not fix anything if you do not listen to your floor staff.
    Hope this helps but I doubt it will.

  6. Janice July 11, 2014 at 10:11 pm #

    This is a difficult topic for all involved. I have worked in this field for almost 30 years in both long term care and homecare as an RN in 4 countries. The issues are the same everywhere and at the centre of all of this is a human being with a disease which is terminal in nature and increases their dependence on others. What I have found over the years is that there are some care providers (family, RN PCW) who get it right no matter what the difficult circumstances. The people I have found the most challenging are those who refuse to acknowledge that by changing their own behavior they can change the behavior of the person they are caring for . They refuse to see the bigger picture. They always scream their staffing levels are the worst, their situation is harder than anyone elses and they have the hardest behaviours to deal with. There is a connection here – a lack of self awareness- a refusal to do differently and a reluctance to truly put the client at the centre of care and remember why you are there. Stop moaning, get a better attitude and lead yourself first and you will lead people to deliver better care. In the long run the time saving is huge, you develop a sense of fulfillment and the people you lead and care for look to you for positive role modeling. Staffing levels throughout the four countries including Australia are the same in this area. Aged care is neither well funded nor well considered and you are not in any worse situation than anyone else , just others are doing it better with thought and consideration for those we serve

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