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Facility leadership

“I manage or govern a facility”

More than half of permanent residential aged care residents in Australia have dementia [1], which makes dementia care the core operating context rather than a specialist service alongside it. The quality of the visiting medical service is one of the larger variables a provider can actually influence.

Governance tools

Questions your clinical governance committee should be able to answer

If these numbers are not readily available, that is itself the finding. Each maps to an obligation under the strengthened Standards 55.

  • What proportion of residents are on a regular antipsychotic?. And how does that compare with six and twelve months ago? What is the trend, and who owns it?

  • For each of those, is there a documented indication and review date?. Not a diagnosis — an indication, with the alternatives tried recorded before initiation.

  • Is informed consent documented for every restrictive practice?. From the resident, or from a restrictive practices substitute decision-maker under the defined hierarchy 54.

  • Does every resident subject to one have a current behaviour support plan?. Current meaning reviewed, not merely present in the file.

  • What is the median duration of antipsychotic use?. Harms cluster in the first four weeks, but the compliance and quality problem is the prescriptions still running at two years 53.

  • How often are PRN psychotropics actually administered, and by whom?. PRN administration data is where restrictive practice reality diverges most from documented policy.

  • Are residents formally screened for delirium on any acute change?. And is pain assessed with an observational tool in residents who cannot self-report?

  • What proportion of deaths involved a hospital transfer in the last week of life?. A reasonable proxy for palliative capability and anticipatory prescribing.

What to ask a visiting medical service

The recurring complaints providers make are consistent and reasonable. These questions surface them before you contract rather than afterwards.

  • Will you attend, or prescribe by phone?. Telephone psychotropic orders without assessment are the single clearest marker of a service that will create compliance exposure for you.

  • How do you document restrictive practices?. Ask to see a de-identified example of the assessment, alternatives and consent record.

  • Do you conduct structured medication reviews, and how often?. At admission and at least annually is the reasonable standard. Ask how Residential Medication Management Reviews are used.

  • What is your after-hours arrangement?. Friday afternoon deterioration is where avoidable transfers are generated.

  • Will you record the dementia subtype?. A small question that reveals a great deal about clinical rigour.

  • Do you do advance care planning as routine?. And will you chart anticipatory medicines so residents can be managed in place?

  • Will you teach our staff?. Case-based education built around your actual residents is worth more than a generic module.

A word on what a medical service cannot fix

A good visiting service will reduce inappropriate psychotropic use, improve pain control, prevent avoidable delirium and hospital transfers, and support better end-of-life care. Those are real and measurable.

It cannot compensate for staffing that makes unhurried personal care impossible, an environment that generates agitation, or a workforce that has not been given time or training. A medical service suggesting otherwise is overstating what it can deliver.

Your reading pathway

The same library everyone else reads, sequenced for what you actually need from it and why.

  1. 1 Dementia care in your facility 9 min read Start here. How dementia care maps to each of the strengthened Standards, and what a dementia-capable medical service looks like.
  2. 2 Medicines in dementia 13 min read The restrictive practices framework and the quantified harms — the evidence base behind your psychotropic governance.
  3. 3 Changed behaviours 11 min read What the trial evidence supports, so training investment goes to approaches that work rather than whatever is being marketed.
  4. 4 Advanced dementia and end-of-life care 11 min read Palliative capability, avoidable transfers and anticipatory prescribing — where quality and cost pressures point the same way.
  5. 5 Understanding dementia 8 min read Useful background for board and family-council conversations.

Browse every topic instead →

Sources cited on this page

  1. 48 Watt JA, et al. Comparative efficacy of interventions for aggressive and agitated behaviors in dementia: a systematic review and network meta-analysis. Ann Intern Med. 2019;171:633–42.
  2. 53 Le HT, et al. Multiple adverse outcomes associated with risperidone in people with dementia: an individual participant data meta-analysis. CNS Drugs. 2026.
  3. 54 Australian Government Department of Health, Disability and Ageing. Restrictive practices in aged care — a last resort. View source
  4. 55 Aged Care Quality and Safety Commission. Strengthened Aged Care Quality Standards (commenced 1 November 2025). View source
  5. 67 Pieper MJC, et al. Effects of a stepwise multidisciplinary intervention for challenging behavior in advanced dementia (STA OP!): a cluster randomized controlled trial. J Am Geriatr Soc. 2016.

See every source cited across the dementia section →

Reading on behalf of someone else?

Living with dementia Family & carers Nurses & care workers GPs & clinicians

General information only, reflecting the interpretation of Umbrella Aged Care’s GPs of the published evidence as at September 2026. It is not individual medical advice, does not create a doctor–patient relationship, and must not be used to start, stop or change any treatment. Evidence and Australian regulatory and PBS arrangements change — always confirm current advice with the treating GP, pharmacist or specialist.

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