Use of physical restraints unjustified, royal commission hears
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.
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.
To stay up to date on the latest about the Royal Commission into Aged Care and Quality go to our special coverage. We will also be issuing regular Royal Commission Roundup reports which you’ll receive in addition to your weekly e-newsletters.
Comment below to have your say on this story
Subscribe to Australian Ageing Agenda magazine and sign up to the AAA newsletter
I used to be apologetic about academics but now I often just get apoplectic and this academic’s observations and opinions explain my transformation.
Not all residents of aged care fit the mould of the very short, very elderly grandmother nor does all the training in the world accompanied by overflowing staff numbers prevent, or adequately control, certain types of residents who are aggressive or abusive (usually through no fault of their own). Physical restraint should only be used as a last resort and with the approval of a medical practitioner but it should not be subject to a blanket ban.
Attracting staff to aged care would get even harder.
Physical restraints in aged care are not used to protect workers from abuse but to protect the residents from falling and injuring themselves. A person might be in a wheelchair for instance and had multiple falls and might then be changed to a tilted chair that keeps them safe but which is a restraint as they cannot get out of it. A chair might be pushed in close to the table to make sitting in it safe for the resident.Unfortunately people with dementia forget that they cannot walk anymore and often try to which results in falls. I think that the Royal Commission needs to listen to people who have worked a shift in aged care. The doors are locked due to the fact that all facilities have residents with dementia who would be at great risk if the doors were not locked. I wonder if this professor has ever stepped in, or spent much time in an aged care facility.
I beg to ask, has this professor actually spent time in an aged care facility? In an ideal world where all residents are 90 year old short little frail ladies, yes we would not need physical restraints! Restraints are a last resort for those at risk of injury to themselves and other residents/staff. Managing the use of restraints appropriately and reasonably is the actual factor that needs to be in focus. I hope that the royal commission is getting their expert advice from industry experts (with working experience) and not some people who are doctors with certain titles.
I agree with all the comments above. I could not say it better. Thank you.
I am concerned at the ageist stereotype perpetuated by this professor. I agree that ideally, residential care should aim to provide for a persons needs and wants. The reality is that there is nowhere near enough financial resources to even scratch the surface, let alone the physical resources. We have cookie cutter care facilities trying their best to provide for a diverse population of people that are lumped in together by virtue of their age.
Blanket orders are just a continuation of cookie cutter expectations, and are as inappropriate as the stereotypical attitudes behind them.
I agree with all of the above comments. For the safety of those elderly folks with dementia who will go through unlocked doors often on to busy highways, front doors that are locked are essential for their safety. However they do need to have an appropriate safe & interesting outdoor area that does not look like they are locked in, an area that they are safe from harm & they are free to come and go to but not on to busy highways, bushland, lakes & rivers. Most facilities do not have people restrained for hours on end or even at all but will have restricted access to the main entrance/exits.
And those who are making these statements to the Royal Commission need to actually visit different aged care facilities across cities/country/remote/states and spend time, like a week at all times of the day and evening, actually experience what it is like.
So constantly having to use a lifter to remove them from the floor when climbing out of a bed with no rails onto a very thin crash mat that only half their body lands on is ok or if they dont stay in bed we place them in a tilted water chair that they can not climb out of is the alternative so there will be multiple people left in flotation chair at night is what i can see