Australia: Chemical Restraint Persists in Aged Care

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An older woman at a nursing home in Narrabri, New South Wales, Australia.
© 2017 Karen McFarland/Shutterstock

(Sydney) – The Australian government should end nursing homes’ use of chemical restraints to control the behavior of older people with dementia, Human Rights Watch said today. One year ago, in March 2021, the Royal Commission into Aged Care Quality and Safety issued its final report, calling for urgent reforms to protect older people from unnecessary chemical restraint.

A Human Rights Watch review of non-compliance reports for aged care facilities across Australia from July 1, 2020, to June 30, 2021, found use of chemical restraints in more than 150 aged care facilities, despite regulations first introduced in 2019 that aim to minimize the use of restrictive practices. Chemical restraint is the use of medications to control the behavior of aged care residents without a therapeutic purpose.

“The Australian government should ensure that policies for older people respect their dignity and human rights,” said Elaine Pearson, Australia director at Human Rights Watch. “Policies minimizing the use of restraints to modify behavior are failing to protect older people, showing the need for an outright ban on chemical restraints.”

Human Rights Watch in 2019 documented the use of chemical restraint in aged care homes in Australia. In its final report in 2021, the Royal Commission found the overuse of restrictive practices to be a major issue that affects the liberty and dignity of people receiving aged care.

Many Australian aged care facilities have used chemical restraints on older people, without informed consent or documentation that it was obtained, Human Rights Watch found. Some aged care facilities which did not meet compliance standards failed to regularly monitor the use of drugs that are administered for chemical restraint, failed to provide individual care plans with ways to manage behavior without the use of chemical restraints, and did not provide alternative strategies to ensure that chemical restraint is a last resort.

The Aged Care Quality and Safety Commission is responsible for monitoring and investigating aged care provider compliance with the restrictive practices regulations, and can take enforceable regulatory action including withdrawing accreditation when providers fail to comply with responsibilities.

In July 2021, ABC News reported that a nursing home in Newcastle had allegedly failed compliance standards after auditors discovered that 90 percent of residents had received psychotropic drugs without written consent. In response to a letter from Human Rights Watch inquiring about the practice, the company said that “after careful consideration, we have decided not to participate due to the highly sensitive nature of the subject matter and out of respect for the privacy of the aged care residents we serve and support.”

According to an Aged Care Quality and Safety Commission audit report, at an aged care facility in Sydney in November 2020, a resident called out and informed compliance auditors of being in pain and requiring assistance. Care staff allegedly responded by automatically giving the resident a psychotropic medication to address the calling out behavior, rather than providing support and managing the pain itself. The aged care facility responded to a Human Rights Watch request for comment, saying that the company has a strategy for achieving zero chemical restraint by June 30, 2022. It also said that among other measures taken since the February 2021 audit report, it had updated its restrictive practice policy in line with the latest legislation.

The Aged Care Quality and Safety Commission, in response to a February 2022 inquiry from Human Rights Watch, said that for the year July 1, 2020, to June 30, 2021, 347 aged care services were found to be non-compliant with the three requirements of the Quality Standards that may indicate issues with chemical restraint. However, as these requirements are broader than the use of restraints, the commission could not specify at how many of these facilities chemical restraint was identified as an issue.

The commission should publish annual data on the number and names of aged care facilities where they document chemical restraint, Human Rights Watch said.

The Quality of Care Amendment (Restraints Principles) were introduced in mid-2019, with updated regulations introduced to replace them on June 30, 2021. While the principles clarify that using chemical restraint is a last resort, it falls short of an outright ban on the practice.

An independent review released in March 2021 said that while there were some indications that the use of restraint in aged care facilities was declining, it was not possible to draw definitive conclusions about the effectiveness of the Restraints Principles due to limited data and the short timeframe the regulations had been in place.

The use of chemical restraints in aged care homes is closely related to inadequate staffing and training. A key recommendation of the Royal Commission was to set out minimum staffing times for qualified staff in aged care facilities. The Covid-19 pandemic has exacerbated the existing strain on aged care staffing.

The Australian government should act to end the use of chemical restraints as a means of managing or disciplining older people in aged care. Aged care facilities should instead develop individualized support for older people experiencing emotional distress or pain that do not involve restraints. Meaningful penalties should be imposed on aged care facilities for failure to obtain informed consent for the use of chemical restraints, Human Rights Watch said.

“Ending the abusive practice of chemical restraint will not be achieved by policies that merely minimize its use,” Pearson said. “The Australian government should ensure aged care providers that wrongly administer medication to restrain older people are held accountable for their actions.”

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