Tuesday, August 16, 2011

Medication Caution ...

My first workshop for the Fall 2011 season was held this past Saturday for the Association of Advocates for Care Reform. This small but active non-profit group focuses on improving quality of care for older adults living in long term, residential care in BC.

Through advocacy and the development of family councils at residential care facilities, the ACRBC "helps provide a voice for residents and creates an inclusive, supportive environment for family and facility staff to work together".

While I was preparing for their workshop, ACRBC's, Kathleen Hamilton, sent me an article by freelance writer, Rob Vipond, from the June 2011 issue of Focus Magazine called, Crisis Behind Closed Doors. In this article, Vipond cites data obtained through a Freedom of Information request that shows that nearly half of all seniors in long term care in BC are being given antipsychotic medication. This is "... almost twice the average for the rest of Canada and among the highest rates found anywhere in the world. And even though Health Canada warns these drugs cause a doubling of death rates in the elderly, careworkers admit they're mainly being used as chemical restraints in the absence of adequate staffing and proper oversight."

Now, it is unlikely that this number of elders are actually psychotic. It is also unlikely that all healthcare workers choose to use medication, particularly inappropriate medication, to manage behavioural issues in the elderly. The problem, I suspect, lies not so much at the level of the residents or the careworkers but at the policy level, where care decisions are sometimes based on unrealistic fiscal restraint and myths about the care needs of the elderly.

The notion that older adults need less, rather than more, complex care is one that is offensive to anyone who has cared for older adults with multiple chronic conditions and yet, we frequently find large numbers of people cared for by a few care assistants supervised by an RN or LPN who has so many meds and treatments to deliver that he or she cannot be available to share more advanced knowledge and assessment skills with other staff.

And, when compassion fatigue and moral distress among staff members and family caregivers are added to the mix, residents face a very real danger of being treated at the level of behaviour management rather than as complex human beings who deserve to be seen, understood and treated as whole people whose behaviours ultimately make sense in terms of their life experience.

We know how to respond holistically and therapeutically to the often perplexing and frustrating behaviours of older adults in residential care but we need sufficient numbers of adequately prepared staff, uninjured by compassion fatigue and burnout, and with the time to discover and treat the roots of disturbed behaviour. Until that happens, I'm afraid we will be reading more and more articles like that of Rob Vipond.

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