Vulnerable elderly restrained in chairs all day: documents

Rest home carers do a valiant job but many are overworked, says Grey Power.

Rest home residents have been strapped to chairs all day with minimal movement or repositioning, documents show.

The Herald can also reveal Justice Minister Andrew Little is set to sign off on a major shake-up of the monitoring of locked aged-care and disability facilities – a move Grey Power says could help avoid rare "horror stories".

It follows warnings from the Human Rights Commission about the large number of older Kiwis in facilities where "lived experience is being locked within a building with no exit".

TELL US ABOUT YOUR FAMILY'S REST HOME EXPERIENCES

Physical restraint restricts a patient's voluntary movement, including through belts and railing. Because of a high risk of trauma and injury it must only be used if a resident is at serious risk to themselves or others.

A Herald review of rest home audit reports published since 2016 has found 27 homes have had "moderate" or "high" risk shortcomings related to restraint.

In one of the worst, a resident was restrained to a chair and instructions to move them twice each morning and afternoon shift weren't carried out. Auditors saw the resident in the same sitting position for more than four hours, and records showed the lap belt was on for up to six hours at a time.

"The amount of time staff spent mobilising the resident had been an ongoing issue for the family for five months," the September 2016 audit report of Bethlehem Views stated.

Arvida Group bought the facility shortly after the audit, and a spokesman said management and policy had been overhauled. A restraint minimisation policy included GP and family consent.

Issues picked up in audit reports for other homes include a lack of documentation or family notification, and restraint being applied despite the resident not being at risk.

Systemic issues at one home included a resident strapped with a lap belt all day with just one "walk", and another who slipped in her chair, meaning a lap belt was at chest height. KiwiAnnia Care, owner at the time of the 2015 audit, is now in receivership.

Places of detention including psychiatric units and jails are subject to independent monitoring under the Optional Protocol to the Convention against Torture (Opcat) framework, with the Office of the Ombudsman among those tasked with checking facilities.

Justice Minister Andrew Little looks set to change the way some aged-care facilities are monitored. Photo / Stephen Parker

The Human Rights Commission has recommended the framework be widened to include locked aged-care facilities and disability residences, citing incidents when older people were unable to move from chairs for many hours.

"Staffing levels don't allow for staff to take residents outdoors on request, and people with moderate or severe dementia will struggle to remember scheduled walking times. Their lived experience will be of being locked within a building with no exit," the 2016 report stated.

Janet Anderson-Bidois, the HRC's chief legal adviser, said an independent review of seclusion and restraint in facilities currently monitored under Opcat found a disturbing misuse and over-reliance in some areas.

"It's likely similar issues arise in secure facilities where older adults are required to live. Large numbers of older New Zealanders are being held against their will and it's essential we ensure this level of care is appropriate."

Justice Minister Andrew Little – in Geneva to address the United Nations Human Rights Council – said aged-care providers which restrain residents fell within the scope of Opcat.

"I am presently considering designating an appropriate Government agency to provide oversight of aged-care institutions which restrain residents … it is appropriate there be effective oversight as provided for under Opcat. I expect a decision will be finalised shortly."

Grey Power national President Tom O'Connor welcomed that news. His organisation heard anecdotal reports of the occasional "horror story" relating to restraint, and increasing monitoring could help address that.

"I don't think anybody is deliberately cruel or unkind to elderly people in dementia care. But under the pressure of work – and these people do a valiant job and many are overworked – some things can be overlooked.

"And most elderly people are uncomplaining, and some of them reach the stage where they can't complain."

Simon Wallace, chief executive of the NZ Aged Care Association, said the sector was working towards being restraint-free, and de-escalation methods were being encouraged in dementia care.

"Providing staff understand the restraint process and implement the guidelines as recommended, residents will remain safe."