DEMENTIA: Restraining dementia patients is a human rights issue.
DEMENTIA: Restraining dementia patients is a human rights issue.

Dementia restraints 'an abuse of human rights'

UNREGULATED dementia patient physical and medical restraint is still happening and at times it can be deadly.

The Queensland Office of the Public Advocate has put out an urgent call for regulatory action to stop ad-hoc and poorly applied restrictive practices, and Alzheimer's Australia is in full support.

It comes in response to the recent Elder Abuse report from the Australian Human Rights Commission and to the Australian Institute of Health and Welfare's prediction that the number of people with the disease will rise from currently about 365,000 to more than 900,000 by 2050.

The Public Advocate's office identified six concerning restrictive practices -

  • detention (eg, locking a person in a room indefinitely).
  • seclusion (eg, locking a person in a room for a limited period of time).
  • physical restraint (eg, clasping a person's hands or feet to stop them from moving).
  • mechanical restraint (eg, tying a person to a chair or bed).
  • chemical restraint (eg, giving a person a sedative).
  • electronic restraint (eg, using tracking bracelets, camera surveillance, restrictions on media devices).

"We unreservedly support the call for regulation and to reduce restrictive practices with people living with dementia," Alzheimer's Australia chief executive officer Maree McCabe said.

As health authorities recognise the incurable dementia as the second most common cause of death in Australia's burgeoning ageing population, the need to regulate the use of physical and chemical restraints becomes even more critical.

The Federal Department of Health, while it doesn't monitor the use of restrictive practices by aged care providers, expects its Australian Aged Care Quality Agency's Results and Processes Guide to provide assessors with the tools to identify and consider results and processes regarding whether standards are being met.

"This includes specific items relating to restraint," a spokeswoman for the Federal Department of Health said.

"Where any approved provider's system or practice does not meet the Accreditation Standards the Department can and does take compliance action."

This approach from the government isn't making a difference when you take into account Ms McCabe confirmation that; "We do need to legislate for this because restrictive practices such as physical and chemical restraints are over-used in aged care".

The government's additional response to the Advocate's claim that there is "widespread use in both formal and informal aged care settings", is to advise it has commissioned the independent Review of National Aged Care Quality Regulatory Processes which will examine the effectiveness of the standards in protecting vulnerable older people, including in relation to the use of restrictive practices by providers and report by 31 August 2017.  

The report outcomes will no doubt be eagerly awaited, but will it provide the necessary impetuous to see regulatory changes made?

The Advocate's office also voices its concern over, "…aged care staff do not have the knowledge and skills to managed behaviours appropriately". 

The government strategy for ensuring aged care staff are equipped to work with dementia patients is to require providers to have "appropriately skilled and qualified staff sufficient to ensure that the operate in accordance with the accreditation standards".   

It also funds the Dementia Training Program for accredited training and professional development, the Dementia Behaviour Management Advisory services and the Severe Behaviour Response teams.

However, Ms McCabe argues still the industry needs to increase the education provided to aged care staff. She said many of them working with dementia patients simply don't understand the impact on the person living with the disease.

While the displayed behaviour may appear to the carer as aggressive, to a patient it could be a response to hallucinations, undiagnosed pain or stimulation from the environment they are in.

"Pain is a typical one," she said.

"Unfortunately, because people living with dementia can't express that they are in pain, it's often not diagnosed. So, when somebody comes to move a person with dementia and the person hits out, they interpret that as being aggressive, but in fact the person is in pain and it's causing them more pain. They are trying to minimise the pain as they can't verbalise what is happening to them."  

Then add in the scenario where English is not the first language of the patient.

"Often they revert back to their original language, so not only can't they speak English, they can't then understand it," Ms McCabe said.

If there were any doubts as to the significance of regulating the use of restrictive practices with dementia patients, Ms McCabe reminds us that, used inappropriately, it can cause premature death.

"And, often anti-psychotic medication doesn't deal with the problems," she said.

"It is over-used because people don't know how to manage and support the person living with dementia.

"Restraint is really an abuse of human rights when it is done in a way that is not regulated and not appropriate." 

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