She stays in her room all day: depression in aged care, and the number the home already reports

When she stops talking

She is not unwell, exactly. She just stops asking for anything. She stays in her room, the television on without being watched, answering you in single words. When you raise it, you are told she has "settled in", or that this is normal at her age.

Both answers are wrong. Depression is not a normal part of ageing. In residential aged care it is common, under-recognised and treatable — and common is not the same as inevitable, any more than it is with pain.

The number the home already has

Here is the Australian advantage, and almost no family uses it. Depression is one of the mandatory quality indicators that every residential aged care provider must collect and report each quarter. Homes assess residents using a validated screening tool and report the proportion showing symptoms of depression. Those indicators feed into public reporting and star ratings.

Which means two questions are entirely fair, and the home can answer both:

• "When was my mother last assessed for depression, with which tool, and what was the result?"
• "What proportion of your residents were reported with symptoms of depression last quarter, and how does that compare with the national average?"

If the answer to the first is "we'd have to check", that tells you the screening is a form being filled in rather than a clinical process. And if the home's rate is well above average, your mother's mood is not an isolated story.

Three things to rule out first

Withdrawal looks identical whatever is causing it, and the wrong order leads straight to the wrong prescription. Ask for these to be excluded:

1. Untreated pain. The leading cause of withdrawal and apathy in older people, and in someone with dementia it is not reported in words. Ask whether pain has been assessed with an observational tool, and when. Note that pain is also a mandatory quarterly indicator — ask for that result too.
2. Delirium. Withdrawal that came on over days rather than weeks, with fluctuating confusion, is delirium until proven otherwise: infection, dehydration, constipation, or a new medicine. That is a medical urgency, not a mood problem.
3. Hearing, sight and teeth. A hearing aid that is flat, broken or simply not put in isolates someone completely within weeks. So do lost glasses and dentures that no longer fit — a person who cannot manage a meal in the dining room retreats to her room.

The right treatment and the wrong one

If assessment confirms depression, treatment is an appropriate antidepressant plus non-drug support — activity, relationships, movement, routine. What is not a treatment for depression is an antipsychotic.

Check the medication chart and ask directly: "Has an antipsychotic been started, for what documented diagnosis, who prescribed it, and where is the behaviour support plan?" In Australian aged care, a psychotropic used to influence behaviour rather than to treat a diagnosed condition is a chemical restraint — a restrictive practice, subject to informed consent, last-resort requirements, documentation and review. Prescribing to make someone quiet is not care, and it is regulated as such. Antipsychotic use is also a reported quality indicator.

Ask as well for a pharmacist-conducted medication review, which is fundable and which you can request through the GP. Benzodiazepines, some blood pressure medicines and anticholinergics all flatten mood and alertness.

What else she is entitled to

Being in a residential home does not remove access to Medicare. Psychological services are available to aged care residents through a GP mental health treatment plan, and psychologists can see residents where they live. Ask the GP for a mental health assessment rather than a repeat prescription over the phone.

Ask also what the home's lifestyle or diversional therapy program actually delivered for her: which activities, on which dates. The Quality Standards are built around care that supports psychological and emotional wellbeing, not just clinical needs.

What you can do, and it counts more than you think

• Predictable visits beat long ones. Twenty minutes three times a week on the same days gives the week a shape; three hours on Sunday does not.
• Bring a task, not just conversation. Folding laundry, going through photographs with names on the back, podding peas. Someone with a role withdraws less.
• Get her out of the room while you are there, even just to the corridor or the garden. Light and movement act on sleep, and sleep acts on mood.
• Ask about the room itself. A room far from the common areas isolates. Requesting a move is reasonable — put it in writing.
• Check the hearing aid every visit. Battery, switched on, actually in the ear. It is the most effective and most neglected intervention there is.

If nothing happens

1. A written request to the facility manager and care manager for a care plan review, with a date.
2. The GP, for a mental health assessment, a medication review and a referral.
3. The provider's complaints process, in writing.
4. The Aged Care Quality and Safety Commission, which takes complaints directly. Psychological wellbeing is within the Standards, and chemical restraint is squarely within its remit.
5. The Older Persons Advocacy Network, free and independent, which will help you put it in writing.

When the problem is the home, not the person

There is a difference between a home where your mother is sad and one where everybody is in their room. If the lounge is empty at four in the afternoon, if a television plays to ten people who are not speaking, if the activities program is a poster rather than a log with names in it, the problem is not your mother's mood — and the quarterly indicators will usually agree with you.

If that is where you have landed and you do not have another round of phone calls in you, that is the part we do. Tell us the area, your parent's needs and what went wrong here, and you get a shortlist worth calling, for A$109. If you don't receive at least 3 homes matching the area and criteria you gave us, we refund you in full. Start here

This article is general information for families, not medical advice. Assessment and treatment decisions belong to the treating clinicians, and reporting requirements under the aged care system change over time. If you are worried about immediate risk to your parent, contact the GP without delay. Curalune does not allocate beds and does not guarantee availability.