One day after this and other sites posted about Joseph Ibrahim’s calls to investigate the causes of what a coroner’s report called premature deaths in aged care two other articles have surfaced regarding the same issue.
Falls in residential aged care facilities
In an article in the Medical Journal of Australia Dr. Stephen Judd, chief executive of Hammond care- an aged care provider, discusses potential consequences if nursing home regulation were to be tighten in an attempt to lessen premature deaths from falls.
“If staff think they are going to get rapped over the knuckles if Mary falls over when she goes outside, they’ll lock the door so she can’t get out,” he said.
“All life is about risk; we have to encourage people to enjoy life, not just keep themselves hermetically sealed in a life of boredom,” he said. “Rather than trying to eliminate risks, we must manage risks intelligently.”
Interestingly I wonder if Dr. Judd is aware that most nursing homes do have locks on exterior doors to prevent residents with dementia from travelling outside? From my experience in aged care many, if not most falls, occur in the resident’s bedroom when the patient is found close to their bed. While I have not statistics evidencing this fact, I am sure Dr. Ibrahim’s report would reveal this.
Additionally, I also find it interesting that Dr. Judd stated that ‘staff’ would be responsible for denying freedom for fear of retaliation. Staff of nursing homes answer to the corporate bodies of said homes, so wouldn’t the fear they would be reacting to not come from the disciplinary action from corporate executives should preventable deaths not reduce? The article also reiterates the principles that I discussed in my previous post regarding the role of residential aged care. There exists a conflict between patient safety and freedom of choice. If a resident is unsteady on their feet and a falls risk but fiercely independent and wants to walk around a facility, does that facility have a right to restrain the resident to reduce falls?
Suicide prevention in residential aged care
Yesterday an article in the Australian Ageing Agenda by Darragh O’Keeffe discusses the federal government’s stalemate on a decision of how to allow residents of Residential Aged Care Facilities (RACFs) to access the Better Access to Mental Health scheme (BAMH). The BAMH scheme, according to the federal Department of Health’s website
” Medicare rebates are available to patients for selected mental health services provided by general practitioners (GPs), psychiatrists, psychologists (clinical and registered) and eligible social workers and occupational therapists.”
However, according to Dr Margot McCarthy, deputy secretary of ageing and aged care, there is still discussion around how the scheme would be made available to residents in care facilities.
If an elderly member of the community was having depressive thoughts surely the GP would jump at the chance of engaging in this service to allow more treatment options for their patients. The same should be true for residents living in aged care facilities. The Medicare funding does change when a person goes into RACF care, however that should not change the available services to them. I hope that in the near future the Department of Health and Department of ageing and aged care can come to an agreement and make this valuable service available for residents in RACF homes, thereby moving towards reducing preventable deaths related to mental health conditions.
What does this mean for nursing staff and residents?
While the powers-at-be continue to struggle with how to research and tackle the issue of ‘premature deaths’ nursing staff in aged care facilities will continue to be in the firing line. Without clear-cut guidelines their actions and assessments will put the responsibility for minimizing the risks sits squarely on them. For residents and families the falls, suicides and choking will continue until the federal government and corporate aged care executives agree on a standard measure along with established preventative measures to minimize, and hopefully, eliminate the term premature deaths in aged care from existence.