Restrictive practices are ethical, legal and clinical violations of fundamental human rights that may lead to poor care outcomes (VIC DoH 2018).
As much as possible, aged care services should aim to create and maintain a restrictive practice-free environment. This is the recommended standard of care and will prevent residents from suffering unnecessary harm and trauma (VIC DoH 2016).
As of 1 July 2021, the Aged Care Act 1997 has been updated with new amendments aiming to further regulate and strengthen restrictive practice requirements for residential aged care providers (DoH 2021a).
Note: Updated legislation now uses the term ‘restrictive practices’ instead of the previously-used ‘restraint’.
Confining a resident in a room or physical space by themselves (at any hour of the day or night) and preventing them from leaving voluntarily, or implying that they cannot leave voluntarily. Examples include:
Locking a resident in a room
Imposing a ‘time out’.
Using medications or chemical substances to influence a resident’s behaviour. This does not include medications that have been prescribed by a medical practitioner to treat a mental or physical condition.
Using devices such as lap belts, bed rails and restrictive clothing to restrict a resident’s movement for the purpose of influencing their behaviour. This does not include devices used for therapeutic or non-behavioural purposes, e.g. a wheelchair.
Using physical force to prevent, restrict or subdue the movement of a resident’s body for the purpose of influencing their behaviour. Examples include:
Physically holding a resident in a certain position
Pinning a resident down
Physically moving a resident to prevent them from moving in the direction they wish to go.
Restricting a resident’s free access to environments, items or activities. Examples include:
Putting wanted or needed items out of reach
Restricting access to certain activities.
For more clarification on what is and isn’t considered a restrictive practice, view the following resource from the Aged Care Quality and Safety Commission:
Restrictive practices must only be used as a last resort to protect the resident, yourself or others from harm. They must be used in the least-restrictive form possible, and only after considering the likely impact on the resident (ACQSC 2021a).
(VIC DoH 2016; Melbourne Social Equity Institute 2014; QLD DoH 2016)
Emergency Use of Restrictive Practices
In rare cases, a serious and unexpected situation may arise where a restrictive practice is needed in order to protect a resident or another person from immediate harm (ACQSC 2021a).
In these emergencies, restrictive practices may be used and with exemption from certain requirements such as consent. However, the resident’s restrictive practices substitute decision-maker must be informed as soon as possible once the restrictive practice has commenced (ACQSC 2021a).
The following must also be documented in the resident’s care and services plan:
The behaviour that required the emergency use of a restrictive practice
Any alternatives to restrictive practices that were considered or used
The reasons why the restrictive practice was necessary
The care that will be provided to the resident in order to address this behaviour
A record that the resident’s restrictive practices substitute decision-maker was informed about the use of the restrictive practice
Any relevant assessments, information and decisions
Any additional advice or support that is needed.
Why are Restrictive Practices Harmful?
Restrictive practices may exacerbate a resident’s trauma or inflict physical or emotional harm, posing a profound risk to their safety and wellbeing and even increasing their risk of death. Furthermore, these interventions are not known to alter the resident’s behaviour in the long-term (PSEP 2017; VIC DoH 2018).
Remember that restrictive practices are not therapeutic interventions and should never be treated as such (Melbourne Social Equity Institute 2014).
The following table illustrates just some of the potential harms of restrictive practices:
Preventable injury or death
Feelings of distress, powerlessness, humiliation, abandonment or rejection
Sedation, gait disturbance or increased falls risk
Urinary tract infection or incontinence
Cognitive impairment or confusion
Constipation, potentially leading to fecal impaction or bowel obstruction
Extrapyramidal (movement-related) side effects
Respiratory complications, stroke, arrhythmia or death
Suffocation or choking
Reduced ability to perform daily living activities
Fear, shame, loss of dignity, agitation, depression or decreased cognitive performance
Reduced rights and freedoms, including for others who are receiving care (e.g. a locked door affects all care recipients, not just the resident who the door has been locked for)
(RCACQS 2019; NDIS 2020)
Restrictive practices are interventions that should only be used as a last resort.
Remember that these practices are highly distressing for the resident and may cause or exacerbate trauma. As someone caring for these residents, your goal should be to minimise and hopefully prevent restrictive practices as much as possible.
Always refer to your state or territory’s legislation, as well as your organisation’s policies and procedures.