‘Vulnerable Monsters’: Constructions of Dementia in the Australian Royal Commission into Aged Care

Abstract

This paper argues that while regulatory frameworks in aged care authorise restraints to protect vulnerable persons living with dementia from harm, they also serve as normalising practices to control challenging monstrous Others. This argument emerges out of an observed unease in aged care discourse where older people living with dementia are described as ‘vulnerable’, while dementia behaviours are described as ‘challenging’. Using narrative analysis on a case study from the Final Report of the Australian Royal Commission into Aged Care Quality and Safety (RCAC), this paper investigates how the RCAC (re)produced constructions of persons with dementia as ‘vulnerable monsters’. Drawing upon monstrous theory about ‘unruly and leaky’ bodies, extracts from the case study reveal how the RCAC repeated and reinforced monstrous constructions of dementia. Dementia behaviours, particularly ‘wandering’, were constructed through a dehumanising crisis frame that produced ‘challenging’ bodies and legitimised ‘last resort’ normalising practices, such as physical and chemical restraints. In failing to resist monstrous constructions of dementia behaviours, the RCAC accepted and authorised a regime of scaled responses leading to restrictive practices for control of challenging bodies in aged care. Although dementia care and restrictive practices received substantial attention in the RCAC, this paper reveals a missed opportunity for deeper review of institutionalised use of restraints that has relevance for ongoing reform of Australian aged care following conclusion of the RCAC.

Reparations for people living with dementia: Recognition, accountability, change, now!

“…Harm experienced by people living with dementia can be trivialised, pathologised and ignored by reason of dehumanisation of people living with dementia and stigma associated with dementia, or concealed through the institutional, closed nature of LTC institutions. Some harmsuch as restrictive practices and segregationis legally, medically and socially authorised and is viewed as therapeutically necessary and beneficial (Chelberg, 2023;Spivakovsky and Steele, 2022). People living with dementia in LTC institutions, as well as care partners and family members advocating on their behalf, encounter ineffective and traumatising complaint, prosecutorial and court processes when they seek justice in response to harm.…”

“…It is grounded in stigma towards dementia and ableism and ageism towards people living with dementia . For example, some scholars have drawn attention to the construction of people living with dementia as 'wandering monsters' and 'zombies' which in turn legitimates their subjection to exclusion, violation and death (Behuniak, 2011;Chelberg, 2023).…”