Doctors told ‘justify chemical restraint scripts in aged care’

Doctors will have to ask the government permission to prescribe a drug used as a chemical restraint for over three months.

“This is the moment, the line in the sand, together, where we change the way that Australians deal with ageing in what is, by definition, an ageing society”: Greg Hunt

Doctors will have to ask the government permission to prescribe a patient the antipsychotic drug risperidone for more than three months, as Health Minister Greg Hunt promises to take stronger action to stop the over-reliance on chemical restraint in aged care.

Mr Hunt’s office confirmed stronger safeguards around prescribing the medication, which is commonly used as a chemical restraint to treat disturbances in dementia, is due to take effect in January following a recommendation from the Pharmaceutical Benefits Advisory Committee.

Under the new rules, doctors will have to explain to Services Australia why they believe it is clinically necessary for a patient to have risperidone for more than 12 weeks.

If the extended prescription is approved, the government will be able to more easily track which patients are on the medication.

The Morrison government is under increasing pressure to take immediate action after the aged care royal commission’s draft report identified chemical restraint, extra home care packages and getting young people out of nursing homes as areas that required urgent reform.

The royal commission found just 10 per cent of antipsychotics and minor tranquillisers used on residents was justified and Mr Hunt said the Morrison government was “working to make sure that we have the right response” on chemical restraint.

Asked if the government would introduce behavioural plans for aged care residents before drugs were administered and a register detailing how often chemical restraints were used and why, as well as ensure informed consent was required, Mr Hunt told the ABC’s Insiders program: “Our approach is to look at the elements outlined in the royal commission and to adopt them.

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“We think that that is an important and necessary step. The understanding and the role of families, the ability to make sure that we have checks and balances are critical.”

A substantial funding package to address the estimated 120,000 Australians waiting for home care packages is due to be unveiled in next month’s mid-year budget update, with advocates saying at least an extra $1.7 billion was required to fix the backlog.

Mr Hunt and his state counterparts also pledged on Friday to improve medication management for those in aged care, with a report being commissioned to help inform new best practice models and national standards.

The royal commission suggested the next Community Pharmacy Agreement, which will come into effect on 1 July and is due to be signed by the end of this year, should play a role in addressing dependence on chemical restraint.

The royal commissioners noted the government’s aged care clinical advisory panel estimated only about 10 per cent of antipsychotics medications and benzodiazepines used in residential aged care “was clearly justified in the treatment of mental illness and some rare, acute psychotic, manifestations of dementia”.

Mr Hunt said the royal commission had uncovered a culture in Australia towards older people that “went beyond anything” he had expected, which was confronting for everyone.

“We have to deal with that as a country but as a government we have to take primary responsibility. It’s been multiple governments over decades,” he said.

“The country as a whole, and indeed one of the saddest finings was the number of people who have no visitors. On all of these things, what’s the big change here? The big change is to deal with what the commission refers to as an ageist society and respect. And respect is both government and communal.

“This is the moment, the line in the sand, together, where we change the way that Australians deal with ageing in what is, by definition, an ageing society.”

The government introduced a number of changes this year to minimise the use of physical and chemical restraint, including a requirement that providers meet certain conditions before a restraint is used and further conditions while a person is restrained.

Informed consent is required for both physical and chemical restraints.

The royal commission’s interim report found despite a plethora of guidelines there was “insufficient limitations on the use of restrictive practices, especially in residential aged care”.

Anthony Albanese launched Labor’s “aged care act now” campaign in northern Tasmania on Sunday, saying even the money that has been allocated for the sector hasn’t been spent.

There is about $600 million allocated for home care that has not been used.

“You’ve had this interim report. There is no excuse for Greg Hunt to have gone on the Insiders program this morning and to not have an answer, but to say that they would wait weeks for a response,” the Opposition Leader said.

His ageing and seniors spokeswoman Julie Collins added: “In one year alone, 16,000 older Australians died while waiting for their home care package. For every week that the government delays action, 300 older Australians die without their home care package. And for every week the government delays action, over 200 older Australians are going into residential care when they wanted to stay at home and they cannot get their home care package.”

Mr Albanese nominated increased funding to deliver more home care packages as a solution but did not specify how the government should urgently deal with getting young people out of aged care facilities and cracking down on chemical restraint.