Outrage over CSCI report on restraint in elderly care settings

The use of restraint in elderly care services is “unacceptable” and denies the human right to “dignity and choice”, finds a study by the Commission for Social Care Inspection.

The study, Rights, Risks and Restraints, looked at the experiences of elderly people – not at the prevalence of restraint methods – in residential care homes, nursing homes and individual’s homes.
 
The study described incidents where a resident was dragged by the hair and strapped to a chair; another was left in a soiled pad for three hours before being taken to the toilet; while other residents were put in a cocoon, a type of bed cover, to restrict movement in bed.

Other examples of inappropriate restraint methods included individuals being fastened or strapped to wheelchairs; blocked by tables, chairs or trays; locked in and out of rooms; confined to beds by furniture or bars; sedated with medication; or threatened and intimidated by care staff.

The incidents in the study were taken from CSCI inspection reports, reviews of concerns and complaints made to CSCI, and the Rights, Risks and Restraints survey.

Three-quarters of respondents to the survey of 253 older people and carers had been or knew of someone who had been restrained. 

CSCI recommended that policy and guidelines, based on sound evidence, should be developed to inform staff and carers on what constitutes restraint. It called for adequate training, support for care staff and further resources to ensure care is high quality.

However, the Registered Nursing Home Association (RNHA) and the National Care Association (NCA) slated CSCI for its critical report, published on Monday.

Frank Ursell, RNHA chief executive, said the report was “yet another unjustified character assassination of the care home sector’ by the national regulator”.

Ursell added: “On the one hand the regulator says that care home residents must be allowed to take risks. On the other hand, when risks are taken and something goes wrong, such as a very frail older person falling over and breaking a hip, or someone becoming very aggressive and assaulting other residents, the poor care home workers get the blame.”
 
In response to the report, NCA chairman Nadra Ahmed OBE, said its members were questioning CSCI’s motives for publishing a report that “lacked balance” and reviewing CSCI’s “credibility as responsible providers” to act in the best interests of the sector.

In contrast, the charities Action on Elder Abuse (AEA), Alzheimer’s Society, Counsel and Care, and Help the Aged, supported CSCI for bringing this issue out into the open.

Gary FitzGerald, AEA chief executive, said: “Restraint turns care into imprisonment and we should not accept it… Discussion documents are of course useful contributions to a greater understanding of the issue, but abuse demands immediate action and that appears missing.”

Neil Hunt, chief executive of the Alzheimer’s Society, stated: “It should provide a wake-up call that we can no longer leave people in the frontline of care to cope alone without adequate resources, proper inspection and regulation.”

And Stephen Burke, chief executive of Counsel and Care, added: “A delicate balance has to be made between an older person’s rights to take risks and make autonomous decisions, and their families’ and involved professionals’ responsibility to protect and keep them safe where possible.”

More information

Commission for Social Care Inspection

Registered Nursing Home Association

National Care Association

Counsel and Care

Alzheimer’s Society

Action on Elder Abuse

Help the Aged

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