The government will require that aged care residents are assessed by an appropriate person before physical or chemical restraints can be used, under new regulations that will be brought in from 1 July 2019, the government has announced.

But a dementia care expert has told HelloCare the new regulations still appear to be too “soft”.

The new regulations were foreshadowed by the Aged Care Minister Ken Wyatt in January, and will be signed into law next week.

What are the new regulations?

Under the new regulations, providers must have an approved health practitioner assess the resident before physical restraints can be used.

Before chemical restraints can be used, the medical practitioner or nurse who is prescribing the medication must assess the resident.

Alternative options to restraints must also be tried and documented, and once restraints are used, they must be regularly monitored.

Residents or their representative must also give their informed consent before physical restraints can be used, except in cases of emergency, under the new regulations.

Regulations appear “soft” says dementia expert

Dr Juanita Westbury, Senior Lecturer, Wicking Dementia Research & Education Centre, told HelloCare the new regulations “seem very light on” and “soft”.

“Any attention on this area is welcome and much needed,” she said, but added she would like to see more information, including who will enforce and monitor the regulation and what will the penalties be in the event of non-compliance.

“One hopes assessment would already occur before any intervention is used, especially one that could incur serious risk of harm and restriction of civil liberty,” she said.

Rather than assessment, a “documented detailed treatment plan would be more beneficial”, Dr Westbury said.

Dr Westbury also questioned why informed consent was not required for chemical restraint.

She noted that documenting alternative options to restraint that have been used is already done in most care homes.

More training for aged care staff and prescribers is needed about alternative options and services, such as the Dementia Behaviour Management Advisory Service, Dr Westbury said.

Dr Westbury said restraint monitoring must have specific requirements.

“To translate to effective care this needs to be more specific in that residents using restraint will be monitored for effectiveness and side effects – and use time-limited (3 months for antipsychotics, 2-4 weeks for benzodiazepines and other psychotropics),” she noted.

Dr Westbury said the Australian Commission on Safety and Quality in Health Care’s recommendations provide “meaningful regulation change”. The ACSQHC recommendations include measures such as having a pharmacist medication review every six months, and limiting PRN medication use.

For more information about the ACSQHC recommendations visit their website.

Use of physical restraints one of three aged care quality indicators

Aged care managers and staff have a range of tools and guidelines available to them to help them achieve safe, high-quality care and practice safe medication management, Mr Wyatt said.

Use of physical restraints is also one of the three quality indicators that will come into effect on 1 July 2019. The other two quality indicators are pressure injuries and unplanned weight loss.

The Aged Care Quality and Safety Commission will begin publishing the data on quality indicators by the end of this year.

Mr Wyatt said, “Protecting our senior Australians, ensuring their safety, health, well-being and quality of life when they are receiving aged care, is a top priority.”

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