A missed opportunity to improve practice around the use of restraints and consent in residential aged care: Limitations of the Quality of Care Amendment (Minimising the Use of Restraints) Principles 2019

Abstract

In September 2018, in the wake of extensive media coverage and sanctions placed on a significant number of residential aged care facilities (RACFs), the Hon. Ken Wyatt, the Minister for Senior Australians and Aged Care, announced a Royal Commission into Aged Care Quality and Safety. The Royal Commission commenced on 11 February 2019 and has had, to date, a strong focus on both overuse and inappropriate use of physical and chemical restraint and the lack of consent for the use of restraint in aged care. Minister Wyatt was outspoken about his desire to tackle these issues and on 2 April 2019 made the Quality of Care Amendment (Minimising the Use of Restraints) Principles 2019. Section 96-1 of the Aged Care Act 1997 (Aged Care Act) provides that the Minister may, by legislative instrument, make Quality of Care Principles, providing for matters required or permitted by Part 4.1 of the Act. The Quality of Care Amendment (Minimising

Australia's problem with obtaining consent for psychotropic use in older people

“…Perhaps the most evident barrier to good practice with regard to consent is the complexity of Australian consent laws. 7 This has been compounded by the Quality of Care Amendment (Minimising the Use of Restraints) Principles 2019 (Amending Principles) legislation, which amended the Quality of Care Principles 2014 (Quality of Care Principles), with the intent of limiting the use of chemical and physical restraint and improving consent, although instead may have codified poor practice 13 . As a result, in November 2019, the Quality of Care Amendment (Reviewing Restraints Principles) Principles 2019 (Amending Principles) further amended the Quality of Care Principles 2014 (Quality of Care Principles).…”

Single‐site employment (multiple jobholding) in residential aged care: A response to COVID‐19 with wider workforce lessons

“…The SSE-GP Support Hub's critical role suggests a central dedicated contact point providing prompt consistent information, advice, referral, monitoring and issues-tracking could be critical to other sectorwide initiatives, perhaps such as minimising the use of restraints. 12 The second implication arises around employee MJH prevalence, declaration and registration, the costs and benefits of MJH to both providers (including absenteeism, rostering) and employees (including fatigue, turnover, commitment), and the optimum proportions of casual, fixed and part-or full-time employees. Understanding MJH is fundamental to better workforce planning and management.…”

Human Rights and Empowerment in Aged Care: Restraint, Consent and Dying with Dignity

“…These included dementia-specific training for health and age care staff, particularly around changed behaviours; more tailored resources for people living with dementia and their families regarding psychotropic medicines and complimentary information for aged care staff; changes to the fee structure for prescribers so that they are duly compensated for the time needed to adequately care for patients living in residential aged care. Prime amongst recommendations is the inclusion of practice change and policy development around consent for psychotropic use, including revision of the Quality of Care Amendment (Minimising the Use of Restraints) Principles 2019 [23] and making use of the new electronic prescribing system to embed documentation of consent at the time of prescribing [6]. In addition, one of the significant outcomes of the Royal Commission is the final marrying of aged care with human rights and a commitment from policy makers to approach reform of the Aged Care act through a human rights lens with dignity, respect, and preferences front of mind [1].…”