Report reveals use of chemical restraints in aged care

The Royal Commission of Inquiry’s report questions why Australia allowed the use of chemical restraints in aged care

The Royal Commission recommended urgent government action to address – rather than merely “minimise” – use of chemical restraint, typically administered drugs that control the behaviour of older people with dementia.

“The Royal Commission report shines a spotlight on the horrific impacts of chemical restraint in aged care, which has become almost normalised in Australia,” said Bethany Brown, researcher on older people’s rights at Human Rights Watch. “The government should act on the Royal Commission’s report by urgently banning chemical restraint so that older people in aged care can live healthy, dignified lives.”

Australia’s Royal Commission of Inquiry into Aged Care Quality and Safety released a three-volume interim report, “Neglect,” on October 31, 2019. It documents serious concerns in several areas of aged care, including restrictive practices such as chemical restraint. The report concludes that “the prevalence of restrictive practices in residential aged care is unacceptable” and that “the ongoing and common use of restrictive practices in aged care represents severely substandard and unsafe care.” The Commission said restrictive practices can violate the fundamental rights of older Australians and carry risks of serious physical and psychological harm.

The Royal Commission’s findings on chemical restraint reinforce the October Human Rights Watch report documenting chemical restraint of people with dementia in 35 Australian aged care facilities. Human Rights Watch found that instead of providing support to older people with dementia, facilities use drugs to control their behaviour. Many of the drugs used to control people in aged care facilities are antipsychotics that are not approved in Australia for older people with dementia. In addition to the physical, social, and emotional harm for older people restrained with these drugs, the use of these drugs in older people with dementia is also associated with an increased risk of death.

The Royal Commission’s report found that the overuse of restrictive practices in aged care comes from a lack of knowledge about restraints, their impacts, and alternatives among care workers, nurses, and doctors. The report also said there is insufficient staff in aged care to provide support to older people, lack of informed consent for medications, and lack of effective rules and regulation of restraints. The Royal Commission highlighted the need “to respond to the significant over-reliance on chemical restraint in aged care” as an urgent priority among the issues the commission identified.

The government announced the Royal Commission in September 2018 in response to concerns about abuses in aged care publicised in an ABC investigative TV program, Four Corners. The Royal Commission has conducted hearings across the country. In Sydney in May, it heard oral statements from 45 witnesses and received 693 documents, including 54 witness statements, about residential care and dementia care, including chemical restraint. It will issue its final report and recommendations in November 2020.

The Australian government had also responded to reports of restrictive practices in aged care by urgently issuing a new regulation in July, the Quality of Care Amendment (Minimising the Use of Restraints) Principles 2019, which the government contends will protect people from harmful restraints. The Royal Commission’s interim report criticized the regulation, saying that, “The Principles add to, rather than overcome, concerns regarding regulation of physical and chemical restraint, including on issues of consent.”

A parliamentary committee is conducting an inquiry into that regulation’s compliance with human rights standards.

The government has not announced changes to the regulation. After the release of the Royal Commission’s interim report, Health Minister Greg Hunt announced a new permissions system for health professionals prescribing risperidone, an antipsychotic drug routinely used as a chemical restraint, when its use extends beyond three months. For broader reforms, he said, “Our approach is to look at the elements outlined in the royal commission and to adopt them.”

International human rights law prohibits inhuman and degrading treatment. In 2013, the United Nations Committee on the Rights of Persons with Disabilities criticised Australia for allowing practices that would subject people with disabilities, including older people with dementia, to “unregulated behaviour modification or restrictive practices such as chemical, mechanical and physical restraints and seclusion.” The committee said that Australia should end these practices.

The Australian government should prohibit the use of chemical restraints to control the behavior of people with dementia, or for the convenience of staff, in line with its international human rights obligations. The authorities should instead make sure that any medical intervention takes place only with free and informed consent, and that medications are administered only for therapeutic purposes. The government should make it a priority to provide positive support and intervention for people with dementia, including in aged care facilities, and ensure that there are adequate numbers of trained staff to provide this support.

“Older people in aged care in Australia don’t always get the support they deserve, and are given drugs instead,” Brown said.

“The Australian government should heed the Royal Commission’s call for urgent action by prohibiting chemical restraint and penalising aged care facilities that violate that prohibition.”