By Partners Louise Cantrill, Luke Geary, David Slatyer and Darren James

We note the Royal Commission into Aged Care continued its next round of hearings this week in Sydney.

This round of public hearings is inquiring into the perspective and experience of people in residential aged care and people living with dementia, as well as hearing from their families and carers. The hearings are exploring the following topics over a period of two weeks.

1. The quality and safety in residential care, particularly for people living with dementia
2. The use of restrictive practices in residential care
3. The extent to which the current aged care system meets the needs of people in residential care
4. Good practice care for people living with dementia particularly in the context of residential aged care.

This week we have heard from a number of witnesses giving evidence of their direct personal experiences, either as the recipient of aged care services or as a loved one of someone receiving care, with respect their overall experience and treatment of staff whilst in aged care facilities. Some evidence has also been received in reply to this evidence from service providers.

Evidence

The overall themes raised in the Sydney hearings so far can be categorised under the following:

1. Staffing issues and overall treatment within facilities: A number of witnesses gave evidence that they did not receive proper treatment to suit their own or their loved one’s needs whilst a resident of a particular facility. Concerns were raised in particular with the attitude of staff, for example, a care recipient being told by staff that her back pain was “in her head”, only to later be admitted into hospital with a crushed disc.
   1. Training: Evidence from the perspective of recipients and their families was given to the effect that staff within these facilities require a higher level of training especially in how to deal with recipients with dementia.
   2. Skills: Even if the staff have sufficient training, their skills can be overshadowed by the low ratio of staff to resident. We have heard evidence to the effect that the ratio is 1 to 70 which provides pressure on staff who then in turn do a “rushed” job. At other times residents will wait a prolonged time before they are able to be attended to by a staff member.
2. Dignity: Mistreatment of residents can arise as a result of overworked staff or staff that do not have adequate training in dealing with residents’ needs. In particular, evidence was given by or on behalf of residents with dementia of a feeling that they are no living in a home but rather in an undignified institution.
3. Medication restraints / physical restraints: This theme was particularly concerning, with evidence of significant use of both physical and medication restraints. Evidence in reply from service providers did not adequately address the issue. For example, a director of one service provider gave evidence to the effect that due to funding issues, “one on one” care was not an option it could “afford” and this resulted in a number of residents being physically restrained. Even more concerning was the fact that the care provider did not seem to have adequate records of when and for how long such restraints were imposed. Personal evidence also raised concerns about the effect of physical and psychological harm which may be caused to patients, especially patients suffering from dementia.
4. Consent issues: Consent provided by family members of patients suffering from dementia was not obtained in some facilities before medications and restraints were administered. For example, a GP on the second day of the hearing gave evidence that he did not consider consent of an authorised family member before increasing dosage of Risperidone as he was under the assumption consent was already provided, but he did not take any steps to check this.

What to expect in next week’s Hearings

The themes of this week’s hearings are not surprising given the evidence that has already emerged to date. The focus remains on staffing, funding, inappropriate medication and a general feeling of a lack of respect and dignity being experienced by care recipients.

We expect the same issues are going to continue to be discussed next week with the remaining witnesses. However, we also expect that the Commissioners will hear from some service providers who are doing things differently, and may have some learnings to offer regarding how the system can be improved.