Restrictive practices in aged care – a last resort

Restrictive practices in residential aged care

A restrictive practice is any action that restricts the rights or freedom of movement of an older person.

There are 5 types of restrictive practices:

1. chemical restraint
2. environmental restraint
3. mechanical restraint
4. physical restraint
5. seclusion.

Restrictive practices impact a person’s human rights.

A restrictive practice must only be used as a last resort to prevent harm to the older person or others.

Eliminating the inappropriate use of restrictive practices

There are safeguards and monitoring frameworks in place to eliminate the inappropriate use of restrictive practices in residential aged care.

This includes:

• supporting providers in understanding best practice behaviour support and caring for people living with cognitive impairment such as dementia
• strict legislative requirements for restrictive practices including using best practice alternative strategies first
• safe and quality use of medicines and increased governance and oversight on the use of psychotropic medicines
• reporting the inappropriate use of restrictive practices through the Serious Incident Response Scheme (SIRS)
• reporting the use of restrictive practices (excluding chemical restraint) through the National Aged Care Quality Indicator Program (QI Program)
• making sure any use of a restrictive practice complies with the Aged Care Quality Standards and Aged Care Code of Conduct.

Provider responsibilities

Providers must respect and protect the rights of older people in line with the Statement of Rights when they deliver aged care services.

To support the rights of older people there are strict legislative requirements that apply to providers of residential aged care services when considering or using a restrictive practice.

Providers using a restrictive practice must:

• only use it as a last resort to prevent harm to an older person or others and after considering how the use impacts the older person
• use and document best practice alternative strategies before considering a restrictive practice
• use it in the least restrictive form and for the shortest time needed
• ensure the older person or the restrictive practices substitute decision-maker gives informed consent for the use of the practice
• only use it in line with the rights of older people outlined in the Statement of Rights
• monitor and regularly review its use.

Providers must also have a Behaviour Support Plan (BSP) in place and implement the BSP as part of the older person’s Care and Services Plan.

Informed consent for restrictive practices substitute decision-makers

Providers must obtain informed consent for the use of a restrictive practice.

This consent model supports a person-centred approach for older people. Informed consent needs to be given by the:

• older person, or
• the older person’s restrictive practices substitute decision-maker, if the older person lacks capacity to give consent.

A restrictive practices substitute decision-maker is a person or body that can give informed consent to the restrictive practice.

The process for appointing or recognising a restrictive practices substitute decision-maker differs across states and territories. This is because of different guardianship and consent laws which are administered by state and territory governments. Consent must follow the laws of the state or territory in which the older person is receiving aged care.

The Aged Care Rules 2025 include a hierarchy on restrictive practices substitute decision-maker. The hierarchy can be used when the older person cannot consent themselves and:

• there is no legal avenue under the state or territory law to appoint a restrictive practices substitute decision-maker, or
• an application to a tribunal has been made to appoint a restrictive practices substitute decision-maker but there is a delay in the tribunal deciding the application.

For more information see:

• Restrictive practices Substitute decision-maker decision tree
• Role of a restrictive practice substitute decision-maker
• Aged Care Quality and Safety Commission – Restrictive Practices.

Medical practitioners and nurse practitioners

Medical practitioners and nurse practitioners are an important part of the aged care sector and a key part of the residential aged care team.

It is important that providers work with general practitioners and nurse practitioners to ensure older people receive safe and quality care that meets their needs. This means that providers should:

• work in partnership with general practitioners and nurse practitioners to keep them informed about the older person’s needs and changes to their care
• collaborate with medical practitioners and nurse practitioners to ensure the older person’s needs are met and they are aware when the older person’s needs, goals or preferences change.

When a medical practitioner or nurse practitioner (prescriber) prescribes a medicine and obtains informed consent to the prescribing of the medicine, providers must have systems and processes to:

• ensure information about the effects and use of the chemical restraint is provided to the prescriber
• keep the prescriber informed about the older person’s needs and any changes to their care or condition.

Information and resources

• The Aged Care Quality and Safety Commission is the aged care regulator and leads guidance for providers on minimising restrictive practices in aged care. The Commission educates and supports providers on behaviour support and restrictive practices and monitors compliance and investigates complaints. For more information visit Minimising restrictive practices
• Dementia Support Australia (DSA) provides support for people living with dementia, who are experiencing changes in behaviour that impact their care or carer. Services include the Dementia Behaviour Management Advisory Service (DBMAS) and Severe Behaviour Response Teams (SBRT).
• Dementia Training Australia provides free online dementia training, practical resources and training packages. Dementia Training Australia also provides face-to-face training to providers and the sector. These resources help staff understand the causes of behaviour change and ways to avoid or reduce them.
• The Department of Health, Disability and Ageing has developed Guiding principles for medication management in residential aged care facilities.
• The Older Persons Advocacy Network provides advocacy services and has resources to support older person’s rights including Medication: It’s your choice. It’s your right.

Contacts