Podcast: Elder Abuse Report: recommendations on aged care



Marie-Claire Muir (MCM): Hi I’m Marie-Claire Muir, Communications Manager at the Australian Law Reform Commission. I’m here with Dr Julie Mackenzie who is a Senior Legal Officer at the ALRC. She’s been involved in the Elder Abuse Report, Elder Abuse—A National Legal Responsewhich has just been released. Hi Julie.

Dr Julie MacKenzie (JM): Hello.

MCM: You were focussed particularly in the area of aged care, now we’ve heard a lot of stories and media reports over the past 12 months and longer about abuse and neglect happening in aged care facilities, most recently and probably at the front of most people’s mind is the Oakden facility in South Australia. We’ve been hearing reports of, as I said, neglect, of inappropriate restraint and force, even sexual assault. What are the rec’s that we’ve made in the area of aged care that you hope might make a difference and bring to a resolution the sort of things we were hearing about at Oakden?

JM: So we’ve made a suite of recommendations in aged care that we feel will enhance the response to incidents of abuse and neglect in aged care. Initially, we’ve made a recommendation that there be a serious incident response scheme brought into aged care. Now there’s already a process in which there is a required reporting of certain incidents of assault in aged care to the Department of Health. What we’ve suggested is that this reporting be replaced with this new serious incident response scheme which would require providers to report allegations of serious abuse and neglect to an independent oversight body, but also, crucially, to report on their, the provider’s, response to those allegations of abuse and neglect and that that response be monitored by that independent oversight body. So we really think that there needs to be a greater focus on, a greater emphasis on, the particular responses being made to these particular incidents of abuse or neglect.

We’ve also suggested that there be an expanded definition of what is required to be reported and responded to by the provider, including what is often described as resident on resident assault. We’ve heard a few highly publicised reports of even fatal assaults by one aged care resident upon another. Now often these residents have some form of cognitive impairment, like dementia. We’re suggesting that it is important that these be captured and reported on and appropriately responded to, to ensure that there’s a safe place for older people when they’re in aged care facilities.

The other thing we’ve recommended, and it’s linked to this serious incident response scheme, is enhanced employment screening for workers in aged care. So we’ve recommended that there be screening of a person’s suitability to work in aged care based on relevant criminal history, but also incidents, relevant incidents, from our new serious incident response scheme. So capturing relevant non-criminal information so we won’t end up in a situation which we sometimes heard about over the course of the inquiry where a person who perhaps has exhibited some inappropriate behaviour in one aged care facility moves on to another before anything formal can occur in relation to that person. So attempting to provide a greater and enhanced safeguarding for older people through making sure that the people that are working in aged care are the right people.

MCM: So would it be right to characterise that as being akin to the Working with Children Register?

JM: Yes that’s right. It’d be a similar type of scheme as the working with children check and there’s a similar scheme that’s been proposed for the National Disability Insurance Scheme as that’s been rolled out as well, a screening system for people working in the NDIS. So we’re recommending something similar for aged care.

MCM: Great. Ok, other areas of reform?

JM: One thing we heard in response to the Oakden review was also inappropriate use of what gets called ‘restrictive practices’. So that’s forms of restraint like physical and mechanical restraint, holding someone down, using lap belts on wheelchairs for instance, locking someone in a room. Also something we heard a lot of concern about in aged care are what gets called chemical restraints, so that’s use of sedatives or anti-psychotics. What we’ve recommended is there be legislative regulation of the use of restrictive practices in aged care with the aim of reducing or even eliminating their use. So we’ve recommended that the use of restrictive practices be subject to a number of conditions, but broadly used only as a last resort and also, when used, that they’re the least restrictive form of restraint. So used for the least amount of time possible and also the least restrictive for that time period.

MCM: Another issue I know came up a bit in consultations and in the submissions that we received was around staffing levels and sometimes understaffing in aged care facilities. What has the ALRC said about this?

JM: Leading on from restrictive practices for instance, there was a concern that restrictive practices were sometimes used to manage residents when there weren’t sufficient staff, or that neglect could be a result of understaffing. So there was a real concern that abuse or neglect could result from inappropriate or insufficient levels of staff. What we’ve recommended in response to this is that there be an independent evaluation of staffing models and levels in aged care and that the results of this independent evaluation be used then to inform accreditation processes, so when facilities are audited using the results of that independent evaluation to access whether or not the staffing levels are adequate to meet quality standards.

MCM: OK, well thanks Julie very much for talking us through that. There are some other recommendations in the aged care area and there are also recommendations about elder abuse in a whole range of areas, for example banking, guardianship and financial administration, superannuation, a range of other areas. You can find the full suite of recommendations and the report which includes discussion around that on the ALRC website at www.alrc.gov.au. Thanks.