Physical restraints do not improve quality of life and they should be banned from use in residential aged care, a medical expert has told the aged care inquiry.
Professor Joseph Ibrahim, head of the Health Law and Ageing Research Unit at Monash University, told the Royal Commission into Aged Care Quality and Safety on Thursday that providers should not be allowed to use physical restraints on residents.
“There is no evidence I’m aware of, and I’m happy to be proven wrong, that physical restraints improve your life or protect you from anything,” Professor Ibrahim told the inquiry.
“The use of restraints generally is sadly still widely accepted, though people will all react abhorrently when they hear about it, but it’s still used.”
When physical restraints are talked about publicly, it is usually in regards to them being used to protect health workers from physical abuse, such as from people on the drug ice, he says.
“A 90-year-old grandma that’s five-foot three, that’s a bit upset is not likely to come at you and hurt you substantially and justification for restraining that person, which usually makes their condition worse, makes no sense. It’s disrespectful and really ought not be allowed,” Professor Ibrahim said.
“The only possible justification is if there’s an imminent threat to life that you might restrain someone,” Professor Ibrahim said.
The regulations on restraints allow residents to be restrained for prolonged periods of time, which often results in them being forgotten, he said.
While physical restraints usually refer to tying someone down or restricting their movement, being locked in an aged care facility should also be considered a form of restraint, Professor Ibrahim said.
“If I’m locked into a facility I would consider that a form of restraint personally, and I think that if we’re going to respect choice, respect people, then we need to be addressing that whole idea about locked doors and why are they locked,” Professor Ibrahim said.
Elsewhere Professor Ibrahim said residential aged care should not be sold as a “home” because the model restricts what residents are able to do and does not afford residents the dignity of risk or making their own choices.
“[We say] here are 25 activities, from bingo to completing a jigsaw puzzle, to a reading book, to watching the midday news, which is a suite of things that is on offer, but it never addresses the question of ‘What do you actually want and can we help you achieve that?’
“We get away with that … because we say people have dementia and if they have dementia they can’t decide anything for themselves, which again is just wrong. We get away with it because we say it’s going to be dangerous for you. Or that it’s difficult for us to do, or the doctor has not recommended it,” he said.
A place to age well
Elsewhere, Professor Ibrahim told the inquiry that residential aged care should be a place that older people enjoy.
“I believe that residential aged care is a place where older people should be able to go and enjoy their life,” Professor Ibrahim said.
“If you have to go to residential care, it usually means you’ve survived to 80. You’ve usually got three to five diseases. You’ve lost your home, left your family behind. You’re coping with having dementia or severe arthritis. You’re coping with having people support you with your day-to-day living and toileting.
“I would have thought at that point in life you deserve to have something decent happen to you, and so I think that residential aged care should have the goal that it’s a place where people can at least enjoy their last few months or years before they die,” he said.
Professor Ibrahim also called for a clear and nationally consistent definition of aged care for the sector. He said the purpose of schools, prisons and hospitals was clear to the public and it should be the same for residential aged care.
“The only definition we’ve got is based on the approved provider status and those that are accredited.”
“If we don’t have a clear definition that we all understand, we can’t measure it and if we can’t measure it, we can’t call people to task about the nature of their work, and that’s where we’re currently stuck,” Professor Ibrahim said.
The hearing concludes on Friday.
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