The restraint debate is a window into the future challenges of the aged care sector, writes Patricia Sparrow.
The conversation about restraint has tested aged care in a fundamental way. For families, carers and providers alike: it’s raw and personal. It’s hard to talk about.
But there are lessons to be learnt from this debate that have formed a window into the challenges we will face in the future. As Australia ages, we can’t afford to ignore them.
We all put an immense amount of trust in providers when our loved ones move into residential care. It’s a trust that comes with very high expectations, and is extremely hard to heal once damaged.
Often, this process occurs in stressful and emotional circumstances. Poor planning, lack of good information, health issues and financial problems pile up to create a situation where many families feel like they have very few options and even less choice.
You wouldn’t think it from the way many aged care issues are being reported, but people who work in the sector empathise with this better than anyone because we try to help families through the process every day.
And those of us who work in aged care also have stories about a relative or friend who struggled to navigate the system. We understand the complexities. We feel the confusion and pain these families are experiencing deeply.
This is the backdrop that has framed debate on restraint. It’s certainly one of the most challenging issues, because the reality of advanced dementia or end-of-life stages can be extremely confronting.
If a loved one’s health deteriorates rapidly or we witness extreme and unpleasant behaviour, this can be even harder.
The heartache of this situation lends itself to an understandable punitive reaction. But unfortunately, restraint is not an issue that can be dealt with purely through rules. It simply isn’t that simple.
Let me be clear, ACSA supports the regulatory changes on restraint and is working hard to make sure they are implemented fully. We developed new policy to assist in this.
Restraint must only be used as a last resort, and if the harm or potential risk of the restraint is less than the risk of non-restraint. It should only ever be used as a temporary measure and subject to regular review.
That said, the way the debate unfolded is a worrying sign that a pattern of knee-jerk policy reactions could become the norm in our sector. And with lack of clarity around who must obtain consent for example, even the restraint issue is hardly done and dusted, despite new rules.
It’s a natural human reaction to get angry when things go wrong or are unexpected. And let’s face it, that can indeed have its place. We need to own up to failures when they do occur, and improvements need to be made constantly.
Cracking down for the sake of cracking down however is not the answer. In fact, this can be counterproductive if we use it as a panacea for much bigger challenges.
As our ageing population grows and we live longer, our health needs are becoming increasingly more complex. We are entering entirely new territory. The biggest challenges are still ahead of us.
In the debate on restraint there was no discussion about the complexities of supporting residents with advanced dementia and impairment generally. No large-scale community education about how to better prepare for ageing. No response to industry calls for urgent funding to meeting staffing needs.
Unfortunately, it is far easier to announce a new code or guideline. While often this is needed, on its own it leaves the funding and structural issues hanging.
Our focus during the royal commission is a fundamental rethink of the way we approach ageing and aged care. We need better rules, absolutely. But just as important is innovation and having the entire community involved.
For the sake of all of us who hope to grow older, we need to reject a precedent that promotes rushed policy and rules above good policy, effective regulation and a sustainable system.
Patricia Sparrow is CEO of aged care peak body Aged & Community Services Australia.
An edited version of this article first appeared in the current edition of Australian Ageing Agenda magazine (July-August 2019)
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Well said Patricia, great piece of writing, Thankyou,I hope that the peak bodies can ensure proper debates and planning on these issues. People hear the word restraint and go into ‘how horrible’ mode, not realising of course that if the person wasn’t restrained they would be breaking bones from major falls on a daily basis, and then there would be the repercussions of that! Aged Care is never simple, and it is very individual for each person, the same as Mental Health, it is always ‘least restrictive’, but when it comes to protecting the patient, other patients and staff, then sometimes you need to use chemical or physical restraint, it is just how it is. You just need to ensure it is a last resort and you only do it as long as necessary.
Thanks Patricia for tackling the hard stuff. I also fear the issue of “last restraint” needs more exploration…. is it due to lack of enough or appropriate staffing, design of buildings, the persons behaviour due to reacting to other people around them or possibly a hallucination… the possibilities are endless. Staff turn over does not help either as knowledge of triggers goes with them, as well as any relationship that might have been valuable in this situation. Let’s continue to understand and explore why people are reacting and how we can reduce it, well before restraint is part of the discussion. I worked at Wilsmere in the 70’s, restraint was the first response. A time not to revisit! Go well.