Minimising the use of restrictive practices

On this page you will find information for consumers and their representatives about how the use of restrictive practices is monitored and regulated in residential aged care.

Amendments to the Aged Care Act 1997 that took effect on 1 July 2021 regulate restrictive practices arrangements for approved providers and strengthen safeguards for consumers.

Residential aged care providers have a responsibility to protect the safety, wellbeing and rights of consumers by reducing and eliminating the inappropriate use of restrictive practices, ensuring they are only used as a last resort.

These requirements are set out in the Quality of Care Principles 2014.

If you are an aged care provider, please visit the Minimising the use of restrictive practices providers page.

What are restrictive practices?

Restrictive practices refer to any practice or intervention that restricts the rights or freedom of movement of a consumer.

Restrictive practices must only be used as a last resort.

If required, they must only be used in the least restrictive form, and for the shortest period of time, to prevent harm to a consumer or other people, and only after careful consideration about how it may affect the consumer. In emergency situations some exceptions apply.

There are 5 types of restrictive practices under the legislation:

Chemical restraint

Chemical restraint is a practice or intervention that involves the use of medication or a chemical substance for the primary purpose of influencing a consumer's behaviour.

It does not include the use of medication prescribed for the treatment of the consumer for a diagnosed mental disorder, a physical illness or a physical condition, or end of life care.

The Aged Care Quality and Safety Commission, Australian Commission on Safety and Quality in Health Care and the NDIS Quality and Safeguards Commission released a joint statement committing to national collaborative action on inappropriate use of psychotropics to manage and control behaviours of older people and people with a disability.

Environmental restraint

Environmental restraint is a practice or intervention that involves restricting a consumer's free access to all parts of their environment (including items and activities) for the primary purpose of influencing their behaviour.

Mechanical restraint

Mechanical restraint is a practice or intervention that involves the use of a device to prevent, restrict or subdue a consumer's movement for the primary purpose of influencing their behaviour.

Examples of mechanical restraint include bed rails, tray tables, belts, harnesses, restrictive clothing, the use of straps to restrain any part of the body, splints or gloves.

Mechanical restraint does not include the use of a device for therapeutic or non‑behavioural purposes, such as splints/casts for broken bones, or wheelchairs for people unable to walk long distances.

Physical restraint

Physical restraint is a practice or intervention that involves the use of physical force to prevent, restrict or subdue movement of a consumer's body, or part of a consumer's body, for the primary purpose of influencing their behaviour.

This does not include the use of a hands‑on technique in a reflexive way to guide or redirect the care recipient away from potential harm or injury if it is consistent with what could reasonably be considered the exercise of care towards the consumer.

Seclusion

Seclusion is a practice or intervention that involves the solitary confinement of a consumer in a room or a physical space at any hour of the day or night for the primary purpose of influencing their behaviour, where voluntary exit is prevented or not facilitated, or it is implied that voluntary exit is not permitted.

These definitions of restrictive practices under the Aged Care Act 1997 and the Quality of Care Principles are aligned with those applied under the National Disability Insurance Scheme.

New consent arrangements for restrictive practices

Commencing on 1 December 2022, amendments to the Quality of Care Principles 2014 provide greater clarity on who can provide informed consent for the use of a restrictive practice where an aged care consumer lacks the capacity to consent on their own behalf and there is no explicit legal avenue under state and territory laws for this consent to be provide by a substitute decision maker.

The Principles set out a hierarchy of consent to identify the appropriate individual or body to provide consent. The hierarchy can only be used when a mechanism under State and Territory law to appoint a restrictive practices substitute decision-maker is not available, or a substitute decision maker has not already been appointed.

The consent hierarchy is an interim measure to allow time for State and Territory governments to make amendments to their consent and guardianship laws, and are not intended to be ongoing.

The Commission will continue to develop resources to support consumer to understand the requirements regarding appropriate consent.

Additional information can be viewed on the Department of Health and Aged Care webpage on minimising the use of restrictive practices and in its fact sheet on consent.

Strengthened regulations for restrictive practices

Aged care consumers deserve the right to safe and quality care and to live without abuse or neglect.

On 1 July 2021, the Aged Care Act 1997 and the Quality of Care Principles 2014 were updated to clarify and strengthen the requirements for providers in relation to the use of restrictive practices.

The revised legislation:

defines restrictive practices
details the requirements that providers must meet for the use of restrictive practices, including strengthening those in relation to consent, documentation, and monitoring
introduces restrictive practices compliance notices and the potential for civil penalties if providers do not meet the requirements, and
emphasises person-centred care and reinforces the rights of aged care consumers, by ensuring that restrictive practices are only used as a last resort to prevent harm after best practice behaviour supports have been considered, applied and documented.

What does this mean for consumers?

Consumers who live in residential aged care are entitled to enjoy the same freedoms as the general community, including not having restrictions on their rights or freedom of movement.

There are some instances where the risk to a consumer or other person cannot be minimised through other strategies, and is of such seriousness, that a restrictive practice may need to be used.

However, any action will only be used in the least restrictive form, and for the shortest period of time possible.

Strengthening legislation

Aged care legislation has been updated to clarify and strengthen provider responsibilities when restrictive practices are considered or used.

Under the amended legislation:

Quality of Care Principles prescribe a number of conditions that must be met before and during the use of any restrictive practice and provide for the emergency use of restrictive practices
providers are required to document the alternatives to restrictive practices that have been considered and used, and why they have not been successful
before a restrictive practice may be used, an appropriate assessment must be carried out and documented which details the need for the restrictive practice
where a restrictive practice is used, informed consent must be obtained from the consumer or their restrictive practices substitute decision maker
where any restrictive practices are used, the consumer must be regularly monitored for signs of distress or harm, side effects and adverse events, changes in wellbeing, as well as independent functions or ability to undertake activities of daily living
the need for, use of, and effectiveness of the restrictive practice must be regularly monitored, reviewed and documented with a view to removing it as soon as possible or practicable
since 1 September 2021, every consumer who exhibits behaviours of concern or changed behaviours, or who has restrictive practices considered, applied or used as part of their care, must have a behaviour support plan in place.

Behaviour support plans

It is now a requirement for all residential aged care providers to have Behaviour Support Plans (BSP) in place for consumers that need them.

BSPs protects the rights, safety and wellbeing of senior Australians and are at the centre of care planning and delivery.

The BSPs form part of the existing Care and Services Plan and are required for any consumer:

that needs behaviour support
where the use of a restrictive practice has been assessed as necessary, and
where a restrictive practice is being used.

Why are BSPs important?

The requirements for BSPs were introduced on 1 September 2021 to reduce and eliminate the inappropriate use of restrictive practices, ensuring they are only used as a last resort. These requirements are set out in the Quality of Care Principles 2014.

The plans bring together important information about a person's background, preferences and behaviour. They also help providers to identify when changes are required in order to meet the needs of individuals in aged care settings.

What to include

A BSP must also include evidence of informed consent from the consumer or their authorised substitute decision maker if restrictive practices are used.

It is important that a BSP:

includes best practice support strategies
is responsive to the consumer's needs
seeks to reduce or end the need for restrictive practices
supports individualised care
addresses the underlying causes of concern
provides safeguards, and
optimises the consumer's health and wellbeing.

Want to know more about BSPs?

Dementia Support Australia was funded under the Department of Health to develop and provide a wide range of resources on BSPs and restrictive practices to help consumers understand and providers deliver best practice care. For more information visit the Dementia Support Australia website.

Monitoring compliance

The Commission's priority is ensuring that risks to consumers' safety, health and wellbeing through the use of restrictive practices are eliminated or minimised, and that consumers are always treated with dignity and respect.

The Commission gathers and assesses information on the use of restrictive practices through our complaints handling processes, the Serious Incident Response Scheme, and our quality assessment and monitoring activities. We always apply a proportionate response to any non-compliance.

For more information on compliance, please visit the restrictive practices providers page

Support for consumers

A provider is also legally required to help consumers understand their rights under the Charter of Aged Care Rights.

The Commission is continually developing materials and resources to improve support for consumers and their families, or carers, to make it easier for them to understand the appropriate use of restrictive practices and what is being done to prevent inappropriate use.

Visit our dedicated consumer resources page

Make a complaint about care or services

Feedback and complaints are important in helping the Commission protect the safety and rights of consumers.

By identifying issues, it will enable us to improve the quality of care and services delivered by providers which benefits consumers.

If you feel comfortable, you can raise your concern with staff or managers at the aged care service first as it is often the best way to have your concerns resolved.

All aged care providers are required to have a complaints system in place. If this doesn't work or you don't feel comfortable, the Commission can support you to resolve your concern with the provider.

The Commission provides a free service for anyone to raise a concern or make a complaint about the quality of care or services provided to people receiving Australian Government funded aged care.

To find out more visit Making a complaint or call 1800 951 822.

Access the Older Persons Advocacy Network (OPAN)

OPAN supports senior Australians and their representatives to effectively access and interact with Australian Government funded aged care services including having their rights protected.

To contact OPAN call 1800 700 600 or visit opan.org.au

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Friday, 16 December 2022 - 6:16pm