Australia: Urgently Address Aged Care Abuse

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The Australian government should immediately act on the recommendations of the Royal Commission into Aged Care Quality and Safety to improve rights protections for older people, Human Rights Watch said today. The commission, in its final report released on March 1, 2021, called for the government to fundamentally reform the aged care system to refocus on the support needs of older people “instead of the funding requirements of aged care providers.”

As it undertakes these reforms, the Australian government should take a human rights-based approach to policies and services for older people, ban the use of chemical restraint in aged care homes, and better assist older people who wish to live at home, Human Rights Watch said.

“The Royal Commission into Aged Care’s final report makes clear that the current aged care system is failing older people in numerous ways,” said Elaine Pearson, Australia director at Human Rights Watch. “Multiple investigations and reports have confirmed widespread abuse and neglect in aged care homes. The Australian government should urgently carry out the commission’s recommendations to protect the dignity, health, and human rights of older people.”

The Royal Commission into Aged Care was established in October 2018 in response to concerns about abuses in aged care publicized in an ABC investigative television program, Four Corners.

The Royal Commission heard from 641 witnesses, including residents, staff, families, and experts, held almost 100 days of hearings, accepted more than 10,500 public submissions, and produced 38 reports and research papers, including an October 2020 special report on Covid-19.

The eight volume final report makes 148 recommendations including a new Aged Care Act that enshrines the rights of older people, strengthening the oversight and accountability of aged care providers, and setting out minimum staffing times for qualified staff in aged care facilities, including at least one registered nurse on site at all times.

Revelations in late February of alleged deadly neglect in a Perth nursing home indicate that these abuses continue and that accountability mechanisms remain insufficient and weak.  

Among the commission’s findings were serious concerns regarding aged care facilities giving older people drugs to control their behavior even though the drugs are not required to treat medical symptoms – a practice known as chemical restraint. The commission stated that “The overuse of restrictive practices in aged care is a major quality and safety issue. Restrictive practices impact the liberty and dignity of people receiving aged care. Urgent reforms are necessary to protect older people from unnecessary, and potentially harmful, physical and chemical restraints.”

However, the commission missed an important opportunity to call for a complete ban on this abusive practice, Human Rights Watch said. An end to the abusive practice of chemical restraint will only happen if aged care providers that wrongly administer medication as a restraint are held accountable and if the government bans the practice.

In a 2019 report, Human Rights Watch documented the use of chemical restraint in several aged care homes in Queensland, Victoria, and New South Wales. In certain circumstances, chemical restraint amounted to inhuman and degrading treatment. Human Rights Watch has criticized Australia’s existing regulation on restraints as insufficient and has called for the government to ban the practice.  

In August 2020, The Australian reported that several residents in some aged care facilities in Melbourne who had tested positive for Covid-19 were refused hospital admission and were instead heavily sedated with morphine, the anti-psychotic risperidone, or other medications to prevent them from “wandering” and infecting other residents. The government said that it was investigating the allegations.

The Aged Care Quality and Safety Commission, in response to a December 2020 inquiry from Human Rights Watch, said that it does not proactively monitor for chemical restraint, meaning that the only information it has received about this practice is through complaints. It reported that “from 29 November 2019 to 16 October 2020, the Commission received 53 complaint issues in relation to chemical restraint in residential aged care.” It also stated that “from 1 July 2021, medication management will be introduced as a new quality indicator” in regulating aged care.  

The use of chemical restraints is closely linked to staffing and training. The Royal Commission urged the Australian government to ensure there are sufficient numbers of appropriately skilled staff available to attend to the needs of all people receiving aged care. It called for a daily minimum staff time for registered nurses, enrolled nurses, and personal care workers for each resident.  

Inadequate staff and training can make it difficult to take an individualized, comprehensive approach to supporting people with dementia with symptoms of agitation or aggression, which can drive chemical restraint. Non-pharmacological intervention can include exercise, music, building relationships, and reducing boredom and loneliness. The Royal Commission recommended that aged care staff should undertake regular training on dementia support.

The commission also said that the government should do more to support older people’s autonomy and choice by providing greater access to support services at home, known as home care packages, and to clear the waiting list for this assistance. A January 2021 report by the Productivity Commission found that there continue to be long waiting lists to receive support at home, with an average waiting time of 28 months for those requiring the highest level of support. In December 2020, the government announced funding for an additional 10,000 home care packages for older people, among other aged care reform initiatives.

“If implemented, the Royal Commission’s recommendations could catalyze a much-needed transformation of how Australians experience their later years,” Pearson said. “Older people should be able to receive support and services that respect their dignity, autonomy, and human rights whether at home or in an aged care facility.”