Support for people with dementia in aged care homes during COVID-19 lockdowns

Aged care residential services have been warned use of chemical and physical restraints is particularly dangerous for people living with dementia experiencing COVID-19 respiratory illness and urged to explore alternatives.

Dementia Support Australia, a national service funded by the Australian Government to support people living with dementia and their families, has issued advice to all residential care services on how best to support residents living with dementia during COVID-19 lockdowns.

DSA has released a Helpsheet, Restrictive practices: understanding and managing behaviours in a time of pandemic, circulated to all residential aged care services to assist them with advice on how to manage the present COVID-19 environment.

It is estimated more than half of residents in residential aged care services in Australia have a diagnosis of dementia.

DSA Director Associate Professor Colm Cunningham said ongoing COVID-19 restrictions and resulting isolation had created a stressful environment for residents living with dementia and this may lead to an increase in behaviours and psychological symptoms.

As well, A/Prof Cunningham said some providers may face the complex issue of how to assist a person with dementia to self-isolate in the event of infection.

“The need to keep everyone safe and supported is challenging for residential care services during the COVID-19 restrictions,” Professor Cunningham said. “But we never recommend chemical restraint for people with dementia, especially in the current situation.

“COVID-19 is primarily a respiratory disease, and the use of medications that might cause respiratory depression or render a person immobile, are likely to lead to an adverse outcome for that resident.”

A/Prof Cunningham said physical restraints to enforce immobility when applied to a person with a potential serious respiratory infection may also lead to adverse outcomes.

“Physical restraint is always a last resort and even in the case of infection and the need for isolation there are a range of options to consider first," he said.

If residents infected with COVID-19 are unable to voluntarily isolate themselves, the DSA recommends one-on-one care where possible. Where not, DSA may be able to arrange funding for additional support to assist the resident.

The Helpsheet warns normal infection procedure controls should be followed when caring for a person living with dementia with a suspected active COVID-19 infection.

“In this situation, certain types of behaviour such as aggression and ‘wandering’ may post greater risks for the resident, other residents, staff and visitors,” it reads. “The first question that should be asked is ‘does this particular behaviour place anyone at increased risk of infection’. If the answer is ‘no’ then there is no reason, in terms of managing infection risk, to restrain a person in any way."

The Helpsheet advises that residents - facing restricted visitors, cancelled excursions and a reduction in other activity opportunities - may seek to gain access to outdoors more regularly. Residential care home managers should provide opportunities to access outdoor areas at specific times during the lockdown period.

All DSA services continue to be available during the pandemic. DSA has consultants in 34 offices across Australia available to offer support, advice and intervention 24 hours a day, to any aged service service experiencing difficulties, on 1800 699 799 or visit dementia.com.au

DSA, a partnership involving HammondCare, provides services including the Dementia Behaviour Management Advisory Service and the Severe Behaviour Response Teams to provide advice and short-term case management interventions for people with Behaviours and Psychological Symptoms of Dementia.