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When things go wrong: Elder Abuse / Residential Care Issues

What is elder abuse?

Elder abuse is any physical, sexual, verbal, psychological, or financial abuse perpetrated against an older adult. Elder abuse is most often commited by caretakers, whether they be family members or nursing home staffers. Many victims do not report violations because they are scared or ashamed.


Residential facilities for the aged are the responsibility of the Department of Health and Aged Care. The relevant act is the Aged Care Act 1997 (Cth), in conjunction with the Quality of Care Principles 1997. The principles set out the standards which the aged facility must follow and creates a statutory duty.

A breach of the statutory duty causing a personal injury may itself give rise to a separate cause of action and/or be evidence of negligence at common law.

Residential care issues: Use of restraints

A restraint is a mechanism used to control a person’s behaviour.

Examples of physical restraints include lap belts, table tops, meal trays, bed rails and backwards leaning chairs or ‘stroke chairs’ that are difficult to get out of and possibly bed alarm devices. Covert restraint practices may occur, e.g. tucking bed clothes in too tight, wedging cupboards against beds, locking doors.

Research indicates that residents who are physically restrained can actually suffer increased risks of falling, increased confusion and suffer injuries in an attempt to escape the restraint and death. In some instances, reducing the use of restraints may actually decrease the risk of falling.

The inappropriate use of psychotropic medication may be considered chemical restraint. Such drugs can be toxic to the elderly and cause side effects which may be temporary or permanent. Side effects can include Parkinsonism, postural hypotension, sedation, falls resulting in fractures and increased agitation, anxiety and confusion.

The focus of caring for people with behavioural issues should be on responding to the person’s behaviour rather than attempting to control it.

Alternative approaches to restraints

All facilities should have clear policies and procedures on the use of restraints. Investigation of causes of agitation, wandering or other behaviour warranting consideration of restraints should be undertaken. Reversible causes, such as delirium, should be treated. Restraints should not be used at all for people who can walk safely and who wander or cause disturbance to other residents. The disturbance of other patients and residents through wandering behaviour warrants urgent exploration of other strategies including behavioural and environmental alternatives to restraint use such as:

  • strategies to increase observation/surveillance
  • provision of companionship
  • provision of physical and diversionary activity
  • meeting the person’s physical needs (according to individual routines as much as possible rather than facility routines)
  • use of very low beds
  • decreasing environmental noise and activity
  • exploring previous routines, likes and dislikes and attempting to incorporate these into the care plan.

Ensure appropriate, adequate and ongoing staff education about alternatives to restraint use as this can reduce the perceived need to use restraints.


Where psychotropic medication has been prescribed and administered or physical restraint used without consent:

  • The Aged Care Complaints Investigation Scheme replaces the Complaints Resolution Scheme established under the Aged Care Act 1997. Free-call 1800 550 552 (Dept of Health and Aging).
  • Possible causes of action – assault, battery and false imprisonment, breach of contract and negligence.


Quality care or human rights abuse? Physical restraint of people with dementia in residential aged care “…The question to be asked is: is the widespread but barely acknowledged use of physical restraint (along with other forms of elder abuse such as neglect and financial abuse) of vulnerable older people, particularly in the residential aged care context, simply due to ageism – albeit mixed with a good measure of sexism, since most of its victims are elderly women?…”

Best Practice Model for Use of Psychotropic Medication in Residential Aged Care Facilities and Guidelines on the Management of Challenging Behaviour in Residential Aged Care Facilities in New South Wales [NSW Health Department – 2000] Abstract: “…The NSW Ministerial Taskforce on Psychotropic Medication Use in Nursing Homes (1997) recommended the development of guidelines for the use of both physical and chemical restraint in the management of challenging behaviour in residential aged care facilities in New South Wales. Building on these recommendations, this document provides a model for better practices in the management of challenging behaviours in residential aged care facilities. It also aims to provide all staff and general practitioners working in residential aged care facilities principles of practice and strategies to optimise the provision of restraint free care in the least restrictive environment for residents who are difficult to manage…”

Care is a cruel character when words fail the world’s frail [The Australian – Opinion – Emma Tom] Elder Abuse – For Signs of Neglect & Abuse: 12 Point Check List see: www.agedcarecrisis.com

Elder Abuse – For Signs of Neglect & Abuse: 12 Point Check List see: www.agedcarecrisis.com

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