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Report calls for end to chemical restraint of residents


A new report about the use of chemical restraint in residential aged care facilities in three Australian states is calling on the government to ban the practice and mandate training for staff on dementia and alternative methods.

The Human Rights Watch report ‘Fading Away’: How Aged Care Facilities Chemically Restrain Older People with Dementia launched at Parliament House in Canberra on Wednesday is based on interviews with family members, doctors, nurses, experts and advocates.

The report looked at the use of antipsychotics, benzodiazepines and sedative-hypnotic drugs, which are sometimes called tranquilizers, sleeping pills or sedatives, as chemical restraint in 35 aged care facilities across Queensland, New South Wales and Victoria.

The researchers found that residents were restrained with sedatives and antipsychotic medications in all three states.

The reports includes interviews with 89 individuals including 37 family members of aged care residents, such as Mark Viney, whose father David lives with mild dementia and the effects of a major stroke in a facility in Queensland.

Mr Viney said his father slept excessively and had difficulty eating, swallowing, and sitting upright after being put on medication to control his behaviour in 2017.

After Mr Viney complained, the facility took his father off the drugs and Mr Viney said his father was himself again by the end of three days.

“He was telling jokes and laughing. I hadn’t seen him that way for months. He can remember things,” Mr Viney said in the report.

Human Rights Watch is calling for legislation to prohibit the use of chemical restraints to control the behaviour of older people with dementia or for the convenience of facility staff.

Report author Bethany Brown said it risked older people’s health and insulted their humanity when they were silenced by drugs rather than given person-centred support.

“The Australian government should prohibit chemical restraint and penalise aged care facilities it finds violating that prohibition,” Ms Brown said.

The report comes during a parliamentary inquiry into restraints called after recent controversial government legislation to minimise chemical restraint in aged care. And it follows evidence presented at the royal commission about the misuse of chemical restraint in Australian residential aged care facilities and research on how to successully reduce antipsyhotic use.

Advocate calls for cultural change and training

Advocacy organisation Aged and Disability Advocacy Australia, which partnered with Human Rights Watch for the launch of the report, backs calls for the prohibition of the chemical restraint practices.

Geoff Rowe

ADA Australia CEO Geoff Rowe said he hoped the report’s findings would help drive action to end unnecessary chemical restraint in the aged care sector.

“It has to be a last resort, not a first resort,” Mr Rowe told Australian Ageing Agenda.

The government needs to invest time and resources into finding ways to improve the lives of older people through more dignified means than chemical restraint, he said.

“We are keen to make sure that ideally there isn’t a need for chemical restraint in aged care.”

That can only happen through a cultural change and staff training, he said.

ADA Australia supports HRW’s calls for the new legislation to include:

  • mandatory training for all aged care facility staff in dementia and alternative methods and skills to de-escalate unwanted behaviour and support the needs of people with dementia
  • adequate minimum staffing levels to provide support to older people
  • adequate enforcement mechanisms to protect older people’s rights.

Peaks support minimisation but not ban of restraints

Aged care peak Aged and Community Services Australia has come out in support of strong laws to prevent the inappropriate use of medications.

“Doctors, aged care providers and government need to work together on a plan that makes all types of restraint as rare as possible – we are on the same page with this – restraint is the last resort,” said ACSA CEO Patricia Sparrow.

Patricia Sparrow

Ms Sparrow said the first response to challenging behaviours should always be psychosocial support and person-centred care.

ACSA supports the temporary, regularly-reviewed and consented use of chemical restraint as a last resort and only if its harm or potential risk is less than the risk of non-restraint.

“We need to build the industry up to better handle the kind of extremely confronting and difficult behaviours that sometimes mean restraint is prescribed – and for doctors and families to partner with them and take responsibility for their role as well,” she said.

ACSA will work closely with Human Rights Watch and the government to reduce restraint to the lowest levels possible, she said.

Fellow aged care peak Leading Age Services Australia also supports the minimisation of restraints along with appropriate reporting processes as part of any legislation regulating restraint.

Sean Rooney

“LASA seeks to minimise the use of restraint, with any such use a last resort after exhausting all other available options,” LASA CEO Sean Rooney told AAA.

“Any decision to use either physical or chemical restraint must involve the resident’s or their substitute decision maker’s consent, and advice from health care professionals such as GPs, and the care homes’ staff.”

He said all medication use in residential care was a shared responsibility between GPs, pharmacists and care workers.

“LASA has recommended to Government the development of appropriate, standardised processes for recording, reporting, monitoring and reviewing physical and chemical restraints as part of any legislation regulating restraint, while calling for appropriate funding to ensure providers are adequately resourced to give the care that older Australians need and deserve,” he said.

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3 Responses to Report calls for end to chemical restraint of residents

  1. Dr Juanita breen October 18, 2019 at 9:09 am #

    Both LASA and ASCA were stakeholders in a national project ‘RedUSe’ delivered to 150 aged care homes throughout the country which was funded by the department of health. This dedicated program used audits, staff education and interdisciplinary medication review targeted at reducing antipsychotics and benzodiazepines. These advocates were integral to its success as were the staff at the homes that participated. This issue won’t be addressed with legislation, prescribing restrictions and standards as that approach has proved ineffective for the last 25 years. Substitutes and work arounds are sought instead.
    Targeted strategies, interactive training, awareness of other ways to manage behaviours and a structured program of reducing these medications- and stopping them – has proven evidence of effect. 40% of residents taking these meds at the beginning of the program were ceased or had doses substantially reduced at 6 months.
    These sort of results won’t occur with good intentions or soft regulation. Focused attention and educating staff about harms and minimal benefit is key.

  2. Linda Austen October 18, 2019 at 12:38 pm #

    AS a nurse working with residents with dementia for over 30 years, I can say that :

    1: the medications do not work unless you actually put someone to sleep
    2. mixing a lot of confused people in together doesn’t work either, so dementia specific areas don’t work as intrusive, noisy people upset and set others off and can become victims of other residents.
    3. Dementia is always changing , so initiatives/ care planning also need to be changing
    4. if residents are resistive to care, then the families and others need to recognise that to attend to them adequately may need family involvement and not criticism if the resident if difficult to approach/ frightened.
    5. Nursing homes cannot always manage challenging behaviours and if there is not enough support, places for assessment etc, then they will not accept these people in the future and they will have no where to go. it is already happening that residents with dementia are being put onto the bottom of the waiting list. that is the reality.

  3. Country carer October 18, 2019 at 2:59 pm #

    The family needs to be actively involved with caring for their family member. Dementia is hard on everyone and every person is different. Families place their trust in doctors that they are prescribing the right medication, but if something doesn’t seem right, please speak up and say something! Family members who are critical of all the staff at a care facility might need to consider caring for their family member themselves. It is a sad effect of living longer that our elders spend their final years in a twilight zone often away from the family that loves them but can no longer cope with them.

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