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Decision making tool: Responding to issues of restraint in Aged Care

This document has been developed to assist staff and management in residential aged care facilities to make informed decisions in relation to the use or non use of restraint, in responding to behaviours of concern

This document is available for download in PDF format.

PDF printable version of the Decision Making Tool (PDF 437 KB)

If you are having problems downloading the PDF file please send an email to: acc@health.gov.au for a copy to be sent to you.

Purpose statement

'If we spent as much time on trying to understand behaviour as we spend trying to manage or control it, we might discover that what lies behind it is a genuine attempt to communicate.' Goldsmith, M (1996) Slow down and listen to their voices. Journal of Dementia Care, 4 (4) 24-25

This document, Decision-making tool: Responding to issues of restraint in Aged Care, has been developed to assist staff and management in residential aged care facilities to make informed decisions in relation to the use or non use of restraint, in responding to behaviours of concern.

The tool covers the following elements:

• aspects of decision making in addressing an urgent and immediate at risk episode;
• requirements for considering longer term restraint; and
• responsibilities of management.

The document is not a guideline. It is an information tool provided to homes in order that suitable and considered policies can be developed around the issues of restraint.

Each staff member and management in a home is a valuable part of the team responsible for the delivery of safe and effective quality care to residents. Management must ensure that policies and procedures are developed in conjunction with the requirements of the Aged Care Act 1997, as well as the requirements of the Aged Care Standards and Accreditation Agency, state and territory legislative processes and professional and ethical requirements. There are many and varied legislative processes in each state and territory and it is vital that managers make themselves informed and aware of such legislation when developing policies and procedures. Legislation for each state and territory has no been included because of the size and amount of the legislation and the constant changes and updates.

Restraint is the act of removing another person's freedom. It is sometimes considered in a number of situations including:

• resident requests to prevent falling
• family requests to prevent resident falling
• care staff concern to prevent resident falling
• care staff concern to manage resident's behaviour

Whether this act is in the resident's best interests in any of the above situations must be determined for an individual resident in a specific situation.

This tool is designed to assist that process of decision making, bearing in mind that ANY form of restraint is only used as a last resort.

If it is decided, after careful consideration of all options, that restraint is to be used in the resident's best interests, then it is still restraint, and precautions must be rigorously observed in the care of the resident who is restrained. Usually these decision are made in the interests of the resident's safety, however, the expected benefits need to be weighed against the potential harm of any form of restraint.

The tool is provided in an easy to read format in five sections with two appendices. It includes maps and easy to photocopy pages which can be easily adapted for homes to provide in-house training with the assistance of the enclosed posters. The document also contains a segment to hand to relatives and consumers to open discussion about restraint. This part of the tool can be personalised with the details of the home and contact information of the staff member who deals with the restraint policy.

To be able to meet the needs of all residents, it is important for staff of any aged care facility to ensure that any of their actions are based on the best available evidence.

Information in Sections 1–3 are designed to assist aged care staff when making a decision about whether or not to apply the use of restraint.

The application of restraint, for ANY reason, is an imposition on an individual's rights and dignity and, in some cases, may subject the person to an increased risk of physical harm. The decision to use restraint in any of its forms, and for any reason, should therefore not be taken lightly and only be used as a measure of last resort.

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