Minimising restrictive practices

There are 5 types of restrictive practices under the legislation.

For examples of each type, read our Restrictive practices scenario resource.

Chemical

Chemical restraint is a practice or intervention involving medication for the primary purpose of influencing behaviour.

Environmental

Environmental restraint involves a provider restricting free access to all parts of a resident's environment (including items and activities) to influence behaviour.

Mechanical

Mechanical restraint is when a device is used to:

• prevent
• restrict, or
• subdue movement to influence behaviour.

Examples may include bed rails, low beds, princess chairs, and clothing restricting movement.

Physical

Physical restraint is using force to prevent, restrict or subdue movements of a resident's body.

Seclusion

Seclusion is using solitary confinement to influence behaviour in a room or physical space. Voluntary exit is prevented, or it's implied that a resident cannot leave the room or physical space at any hour of the day or night.

Restrictive practices can only be used as a last resort to prevent harm to a resident.

There are some instances where a resident may require a restrictive practice to be used. However, the provider needs to support individualised care that seeks to reduce or end the need for a restrictive practice.

Before a provider can use restrictive practices, they must:

• have an approved health practitioner assess and discuss alternative strategies with the resident
• discuss and obtain valid informed consent for the use of a restrictive practice from the resident or their restrictive practices substitute decision-maker
• have a discussion with the resident about the restrictive practice. This involves the development of a plan, such as a Behaviour Support Plan (BSP). Doing this helps providers understand the resident's circumstances, preferences and needs.

Giving informed consent

Sometimes, a resident can't give informed consent for a restrictive practice. In that case, there are options under state or territory laws to decide on a substitute decision-maker. Under legislation, this appointed person(s) is called a restrictive practices substitute decision-maker.

For more information on state-specific laws, visit:

• ACT Civil and Administrative Tribunal
• NSW Civil and Administrative Tribunal
• NT Office of the Public Guardian
• QLD Civil and Administrative Tribunal
• TAS Civil and Administrative Tribunal
• VIC Civil and Administrative Tribunal
• WA Office of the Public Advocate.

Visit the Department of Health and Aged Care website for Frequently asked questions about consent for restrictive practices.

A BSP is required when:

• a resident undergoes changed behaviour (defined below) or
• a restrictive practice is used.

Dementia Support Australia defines changed behaviour as any behaviour which causes:

• stress
• worry
• risk of, or
• actual harm to the person, carers, family members or those around them.

The provider must develop a BSP if behaviour support or a restrictive practice is required. This plan should focus on the resident's health and wellbeing and prevent the need for restrictive practices.

A BSP must be included in the resident's Care and Services Plan to understand their individualised needs and preferences.

A provider must include the resident and any other person nominated by the resident in the development of a BSP.

BSPs help protect residents' rights, safety and wellbeing. They include information about:

• a resident's background, behaviours that may require support and preferences
• steps to understand your individual care needs and tailored support strategies to meet those needs
• restrictive practices if used as part of the resident's care, and
• informed consent from the resident or their substitute decision-maker for restrictive practices.

To learn more about BSPs and their requirements:

• read the Quality of Care Principles 2014
• visit the Dementia Support Australia website.

Report concerns

If you have concerns about your care or the care of someone you know, you can raise them with your provider.

You can contact us if you:

• don't feel comfortable talking to your provider or
• your provider wasn't helpful.

You can also make a complaint.

• The Older Persons Advocacy Group (OPAN) gives older people free, independent, confidential support and information.
• Watch a video on human rights in aged care on the OPAN website.
• Our resource library has guides, factsheets, posters and videos about aged care services, rights, quality standards and more.
• Our restrictive practices resources cover what restrictive practices are and when they can be used.
• Dementia Australia has information on planning ahead and decision-making.

Medication in aged care

• We partnered with OPAN to produce the Medication: it's your choice resources. It explains the role you can play in deciding what medications you take.
• Our Consent for medication in aged care fact sheet covers the importance of consent if you're being prescribed or taking medication.

Watch our Reducing the use of sedatives in aged care video for more information on the responsible use of sedatives in aged care.