Royal Commission – June Update
This much is clear: the constant theme that emerged from the witnesses in this hearing was the need to respect the enduring humanity of the people in care, no matter how far their cognitive function might have declined and no matter how challenging it might seem to be to care for them. – My P. Gray, Counsel Assisting
During the Month of May, the Royal Commission’s hearing was held in Sydney. The hearing was held to inquire into:
- the perspective and experience of people in residential aged care and people living with dementia, and their family and carers
- quality and safety in residential aged care, particularly for people living with dementia
- the use of restrictive practices in residential aged care
- the extent to which the current aged care system meets the needs of people in residential aged care
- good practice care for people living with dementia, particularly in the context of residential aged care
Although the focus of this hearing was on Residential Care, there are several important points raised about the care and rights of people living with dementia who are receiving aged care services.
During this hearing, 46 witnesses provided evidence to the Commission over eight days. Representatives included:
- Consumers and those with direct experiences in the aged care system
- Aged care professionals
- General Practitioners
- Frontline staff
- Dementia care professionals
- Researchers and academics
- Primary and Allied healthcare professionals
- Policy experts
On the final day of the Sydney Hearing, Mr Peter Gray, Counsel Assisting, summarised five lasting impressions from the evidence including:
- Attitudes encountered in residential care and the need for respect and de-stigmatisation
Mr Gray described evidence about the impacts of the residential care environment on choice, dignity and independence and the lack of culturally specific care for people living with dementia. Mr Gray stated that the disregard for older people’s autonomy and privacy in residential care was “deeply disturbing”.
- Clinical consensus supports person-centred and relationship-based care
The commission heard recounted witness statements that providers have the responsibility of creating, sustaining and monitoring a milieu of care which is interdisciplinary, person-centred and evidence based. Relative to this, Mr Gray stated that “People living with dementia are no different from us. All the clinical evidence points to the need for individualised care that respects the choices and preferences of the care recipient”.
- The expert consensus that dementia care is not meeting the standards expected
Mr Gray suggested that leadership in residential care is lacking person-centred philosophy and emphasised the need for comprehensive care needs assessment, care planning and ongoing review. Resultantly, Mr Gray stated that a lack of understanding of dementia in the sector is “likely to lead to substandard care”.
- Restrictive practices
Evidence was recounted to the commission regarding the use of physical and chemical restrictive practices by providers in response to perceived challenging behaviours of residents with dementia. Mr Gray stated that “both types of restraint are inherently dangerous and have the ability to end, or at least contribute to the end of life of a resident”. Gray also reminded the commission that expert witnesses stated that restrictive practices should only be used in an emergency, when there is significant imminent risk of serious harm to other residents.
- Organisational leadership and support for the workforce
Finally, Mr Gray described how the evidence presented during the hearing suggests that the solution lies with providers by ensuring their staff have the skills and support to provide high quality care. Gray urged providers to evaluate recruitment processes and training so that all staff are aware of manual handling procedure, maintaining dignity, identifying triggers for behaviours and de-escalation techniques for people living with dementia.
Mr Gray concluded by stating that there is a clear need to foster organisational leadership and culture of care which places the interests and dignity of the residents first.
Full transcript and witness list for Adelaide Hearing 2
The next hearing will take place from 17-19 June in Broome and then 24-28 June in Perth and will focus on aged care for Indigenous Australians, person-centred care and the delivery of aged care in remote locations.