A woman with dementia was sexually assaulted after wandering into another resident's room in an aged care facility, an inquiry has heard.
Registered nurse Elizabeth, whose surname cannot be published, said people with dementia may exhibit difficult behaviour but can also be vulnerable if they are unable to communicate and express themselves.
"They can be exposed to some quite unpleasant behaviours. They can be quite at risk," she told the aged care royal commission on Wednesday.
Elizabeth gave the example of a woman who had complete dementia and was wandering around a facility.
"She was wandering into a person's room who didn't have dementia, who was then sexually assaulting her.
"It was only because there was a person there who didn't have dementia and who was completely intact and was able to alert us to what was going on.
"You get that sort of vulnerability and they can't tell you that that's happened."
Assistant-in-nursing Susan Walton said it can be very difficult when people with dementia are mixed with residents who do not have the disease, as occurred in the main units of the NSW aged care facility where she works.
"The people with problem behaviours that get frightened, wander or are violent are with other people that aren't as bad," Ms Walton said.
The royal commission's Sydney hearing has also examined the use of physical and chemical restraints in residential aged care.
Expert Dr Juanita Westbury said the use of antipsychotic medication varied markedly between aged care facilities, from six per cent to 45 per cent of residents taking an antipsychotic every day.
"It really speaks to what I call a prescribing culture in the home where some homes are very quick to rush to the medication for management whereas other homes are much more prudent."
Most of the nursing staff Dr Westbury interviewed supported the use of the drugs and felt it was necessary to provide comfort and calm residents.
"A quote was 'surely it's better to have someone calm and cozy than to have them agitated and upset'."
The senior lecturer at the University of Tasmania's Wicking Dementia Research and Education Centre said most of the doctors she interviewed emphasised they were only using small doses of the drugs that would not have a high risk of side effects.
Elizabeth said chemical restraint was used in residential aged care because there was not enough staff.
"Rather than giving proper care you just sedate people so they're not annoying you. It's not acceptable," she said.
Australian Associated Press