Aged care royal commission: Antipsychotic medications overused in care

After two years and 99 days of public hearings, the Royal Commission into Aged Care Quality and Safety has wrapped up, with the commissioners to submit their final report in February.

The devastating pandemic revealed more problems in the system after 688 aged care residents died as a result of the virus, Commissioner Lynelle Briggs said on Friday.

“The age care system was indeed broken and in need of significant repair and realignment around older people themselves,” Ms Briggs said.

But she said she was confident the commission would “change the landscape of aged care.”

“Treating our older people well is purely and simply the right thing to do. Everyone knows that and it’s about time we did it,” the commissioner said.

A new act was necessary to ensure the federal, state and territory governments could come together to deliver high quality care, she said.

Counsel assisting the commissioners suggested 124 recommendations including mandating staffing ratios, laws based on human rights principles for older people and an independent process for aged care quality standards.

However, Commissioner Tony Pagone QC said it was important the system was overhauled and aged care was reformed.

“What we don’t want this commission to do is to bring about changes but for things to remain the same.”

Other proposals revealed on Friday included changes to the overprescription of antipsychotics, young people with disabilities in aged care and improving telehealth services.

ANTIPSYCHOTIC MEDICATION OVERUSE

Not enough had been done to tackle the overuse of antipsychotic drugs in the aged care system, the royal commission heard.

“In the future, the system should never again be involved in this apparent resort to antipsychotics in place of proper care of people showing so-called challenging behaviour,” counsel assisting Peter Gray QC said.

There needed to be “concrete action” to tackle the overuse of the drugs in these settings and “great caution” should be taken if prescribed, the lawyer said.

Only a psychiatrist or geriatrician should be able to prescribe antipsychotic medication initially before a GP can provide repeats is one of the 124 recommendations to be considered ahead of the final report in February.

“Generally great caution needs to be exercised in the prescription of psychotropics of this kind for people who may be living with cognitive decline and may not be adequately cared for and managed and therefore exhibiting what are sometimes called challenging behaviours,” Mr Gray said.

Changes including altering prescription criteria for a commonly used antipsychotic, and additional education about the medications in aged care and training were announced by the Australian government following the interim report in October 2019.

But Mr Gray said these did not go far enough.

“They don’t go far enough for a problem that’s persisted now for decades,” he said.

YOUNG PEOPLE IN AGED CAR E

Thousands of young people under the age of 65 were living in residential aged care homes across Australia despite how inappropriate it was, the commission was told.

There were 4860 people as of June 30 this year, counsel assisting the commission Peter Rozen QC said on Friday.

One of them was Lisa Corcoran, a 43-year-old woman who previously told the commission in a statement her number one goal was “to get the f**k out of the nursing home”.

Her moving statement resonated with everyone in the room and showed the passion of people who found themselves in aged care homes, Mr Rozen said.

“For decades the Australian government has accepted younger people should not have to live in residential aged care, but younger people have still continued to find themselves living in residential aged care,” he said.

Previous initiatives had not delivered in any enduring way, and Mr Rozen urged the federal government to keep a promise to move these people out of the facilities by 2025.

“The government have delivered some encouraging early signs but … there have been false dawns before,” he said.

TELEHEALTH SHOULD CONTINUE

Telehealth services were not used enough in the aged care sector and it needed to come out of the “dark ages” to help older Australians, the commission was told.

“Telehealth will continue to be a benefit beyond the response to the pandemic,” Mr Gray said.

These online services could help avoid “potential harm and distress” travel could cause for frail and elderly people, the lawyer said.

This was particularly important for those in regional and rural areas who also have difficulty accessing speciality services.

Digital technology needed to be adapted for better record keeping and the sector had to move out of the “dark ages”, he added.

SEXUAL ASSAULTS

It was revealed on Thursday there were almost 50 sexual assaults in residential care every week.

“Commissioners, this is a national shame,” Mr Rozen said.

Almost two in three residential care services reported an assault allegation in 2018–19, he said.

“It is entirely unacceptable that people in residential aged care face a substantially higher risk of assault than people living in the community.”

There were 588 submissions mentioning sexual abuse tendered to the royal commission.

In total, more than 10,000 submissions were received from residents, their families, staff, providers and government agencies across Australia.

The commission has also heard from 641 witnesses, including 113 with direct experiences.

Other proposed changes for the system include an independent authority to determine prices in aged care and a commission to be responsible for regulation.

Originally published as Australia’s aged care ‘broken’