On this page you will find information on the steps that have been taken to eliminate or minimise the inappropriate use of restrictive practices in aged care settings to improve the quality of care and rights for consumers across Australia.
New consent arrangements for restrictive practices
The Australian Government has amended the Quality of Care Principles 2014 to provide greater clarity on informed consent for the use of restrictive practices where consumers lack the capacity to consent on their own behalf and there is no explicit legal avenue under state/territory laws for a restrictive practices substitute decision-maker to be appointed.
Commencing on 1 December 2022, the Quality of Care Amendment (Restrictive Practices) Principles 2022 set out a temporary hierarchy of persons or authorised bodies who can give informed consent where restrictive practices are necessary and a consumer is unable to provide consent or where a restrictive practices substitute decision-maker has not already been appointed. The changes will give certainty to consent arrangements in states and territories that do not have arrangements permitting another person to provide consent for restrictive practices use on a consumer’s behalf.
This will ensure restrictive practices are only used with appropriate consent to protect the health, rights and dignity of older Australians in residential aged care.
There are five levels of the hierarchy – these are:
- relative or friend who was a carer
- relative or friend who was not a carer
- medical treatment authority, who will best support care recipients who cannot consent themselves.
Strengthened regulations to minimise restrictive practices
From 1 July 2021, approved providers have had updated and specific responsibilities under the Aged Care Act 1997 and the Quality of Care Principles 2014 relating to the use of any restrictive practice in residential aged care or short-term restorative care in a residential care setting.
The Quality of Care Principles require providers to satisfy a number of conditions before and during the use of any restrictive practice:
- providers are required to document the alternatives to restrictive practices that have been considered and used, and why they have not been successful.
- 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 use of the restrictive practice must be regularly reviewed by the provider with a view to removing it as soon as possible or practicable.
- providers are required to develop and implement a behaviour support plan for every consumer who exhibits behaviours of concern, or changed behaviours, or who has restrictive practices considered, applied or used as part of their care.
Providers are required to have a clinical governance framework in place to minimise the use of restrictive practices. The Commission expects that where a restrictive practice is used, such a framework will ensure that informed consent for the restrictive practice has been obtained from the consumer or their restrictive practices substitute decision maker.
Behaviour support plans
Restrictive practices must only be used as a last resort and in the least restrictive form for the shortest period of time to prevent harm to the consumer or another person. Furthermore it must only be applied after careful consideration of the likely impact on the consumer.
All residential aged care providers are required to have Behaviour support plans (BSP) in place for consumers that need them.
BSPs protect the rights, safety and wellbeing of senior Australians, putting them at the centre of care planning and service 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 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 BSP brings together important information about a person’s background, preferences and behaviour. It also helps 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 or considered.
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.
Delivering BSPs that better support consumers
The behaviour support plan must clearly set out information about the consumer so the provider can understand the individual’s background and changed behaviours.
It includes, but is not limited to, the following:
- any assessments that have been carried out with respect to those behaviours
- known triggers which may precede those behaviours
- alternative strategies (whether successful or unsuccessful) that have been applied in managing those behaviours, and
- any restrictive practices that have been applied after trying alternative strategies.
Want to know more about BSPs?
Dementia Support Australia was funded by the Department of Health to develop and provide a wide range of resources on BSPs and restrictive practices to help providers deliver best practice care.
For more information visit the Dementia Support Australia website.
Ensuring providers comply with the requirements
The Commission’s number one priority protecting the safety, health and wellbeing of consumers by reducing and eliminating the inappropriate use of restrictive practices so they are treated with dignity and respect.
The Commission gathers and assesses information on the use of restrictive practices through our complaints handling processes and the Serious Incident Response Scheme.
The use of restrictive practices is also assessed under a number of the Aged Care Quality Standards (Quality Standards).
The Quality Standards require that clinical care is best practice and supported by a clinical governance framework that minimises the use of restrictive practices.
The Quality Standards clearly outline that providers must have organisation-wide governance systems for regulatory compliance. This includes compliance with the Quality of Care Principles for behaviour support planning and restrictive practices.
The Commission always applies a proportionate response to any non-compliance.
Restrictive practices and other legal obligations
The requirements for restrictive practices sit alongside, and complement, other obligations that aged care providers must meet.
All providers must comply with the Aged Care Quality Standards, which outline the standards of care a person can expect as an aged care consumer.
A provider is also legally required to help consumers understand their rights under the Charter of Aged Care Rights.
Under the Serious Incident Response Scheme, the use of a restrictive practice that is inconsistent with the requirements set out in the Quality of Care Principles must be notified to the Commission.
Together, these requirements reinforce the importance of reducing and eliminating the inappropriate use of restrictive practices.
National Aged Care Mandatory Quality Indicator Program
Please note: reporting physical restraint under the National Aged Care Mandatory Quality Indicator Program is a separate and different process to the Commission’s assessment of restrictive practices under the Quality Standards.
Information about the National Aged Care Mandatory Quality Indicator Program is available on the Department of Health and Aged Care website.
Where to find more information
The Commission is focused on supporting providers by developing a range of resources that help them understand the appropriate use of restrictive practices and how to minimise their use.
The Commission will continue to review, update and develop resources and education tools for providers regarding use of restrictive practices, behaviour support plans and appropriate consent.
Guidance is available online to assist providers understand the requirements for minimising the use of restrictive practices.
It includes information on:
- behaviour support and care planning
- consent and decision making
- medication safety
- minimising restrictive practices.
- Self-assessment tool