Aged care dignity of risk in the spotlight after couple go missing

A couple’s 32-hour disappearance from a Melbourne aged care home has raised important questions for the sector.

Respite care residents Colin, 89, and Claudette, 83, left Ryman Healthcare’s Nellie Melba Retirement Village in Wheelers Hill, 22km southeast of Melbourne’s CBD, at 11.15am on Saturday (11 July).

Married for 65 years, the couple had moved into the home just a few days earlier.

Their disappearance sparked immediate concern. Colin had recently been diagnosed with Alzheimer’s Disease, while Claudette was living with vascular dementia and experienced frequent seizures. Both required daily medication.

Following an extensive search, the couple were found at nearby Brandon Park Shopping Centre on Sunday evening (12 July), bringing the 32-hour ordeal to an end.

The best way to protect residents?

The incident raises important questions for aged care providers about balancing their duty to keep residents safe with residents’ right to make their own choices, even where those choices involve risk – a principle known as the dignity of risk.

Finding the balance between protecting residents and allowing them ‘dignity of risk’ can be “tricky”, says Lee-Fay Low, Professor in Ageing and Health at University of Sydney (pictured below).

Operators have to determine the person’s capacity to decide, and their capacity to go out alone and come back safely. This judgement is not straightforward, and made more complex by the fact capacity can vary from day to day.

If a person is judged as having capacity to go out safely and come back, “they should be able to go out alone,” Low said.

Safeguards can be put in place to provide a layer of protection. For example, the person might be required to have their mobile phone with them, or have a tracker in their bag in case they get lost, or have their address on a card they could show a taxi driver.

The community can also play a role. For example, people in the local community can get to know the person, where they live, and when they should return.

Low said police can also play a role in mitigation, and should receive dementia training.

To prevent residents from wanting to leave in the first place, Low suggests aged care operators provide dementia training, ensure staff have good handovers, make sure staff really get to know residents, good environmental design, and provide activities that engage residents.

Some operators assume incapacity

In Low’s experience, operators take significantly difference approaches to determining capacity, but tend towards protection over dignity of risk.

“Some providers work on a case-by-case basis and I’ve heard of residents going for a walk up the street by themselves as part of their routine,” she said.

“Other providers seem to assume incapacity: residents can’t leave by themselves, even if they don’t have cognitive impairment/dementia, and some negotiation is needed by family for permissions the person to be able to leave the facility unaccompanied.”

Facilities with blanket rules for residents in Memory Support Units that don’t allow them to leave unaccompanied “goes against the dignity of risk”, Low said.

It’s not easy for operators. Judging capacity is difficult and allowing residents dignity of risk takes additional time and resources.