Strengthened regulations regarding restrictive practices
Restrictive practices must only be used as a last resort and in the least restrictive form.
From 1 July 2021, approved providers have 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 and short-term restorative care in a residential care setting. Under the amended legislation:
- 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.
- 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.
- 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.
- from 1 September 2021, providers are required under the Quality of Care Principles to have a behaviour support plan in place 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.
Assessment of compliance with the requirements
The Commission’s focus continues to be on ensuring that risks to consumers’ safety, health and well-being through the use of restrictive practices are minimised, and consumers are treated with dignity and respect.
The use of restrictive practices may be assessed under a number of the Aged Care Quality Standards (Quality Standards), which came into effect on 1 July 2019. 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 also require organisational wide governance systems for regulatory compliance, which includes compliance with the Quality of Care Principles on minimising the use of restrictive practices.
From 1 September 2021, as part of its regulatory activities the Commission will monitor provider’s compliance with the requirements to have a behaviour support plan in place for every consumer which has restrictive practices used or applied to them, and that providers have policies and processes in place to support appropriate use of restrictive practices, including provision of consent, for consumers.
Please note, reporting physical restraint under the National Aged Care Mandatory Quality Indicator Program is a separate and distinct process to the Commission’s assessment of restrictive practices under the Quality Standards. Information about the National Aged Care Mandatory Quality Indicator Program can be found on the Department of Health website.
Supporting providers in minimising use of restrictive practices
The Commission continues to focus on supporting providers with advice regarding appropriate use of restrictive practices and minimising their use.
Guidance is available to assist providers regarding minimising use of restrictive practices. This includes information on:
- behaviour support and care planning
- consent and decision making
- medication safety
- minimising restrictive practices.
Self-assessment tool for recording consumers receiving psychotropic medications has been developed by the Commission for providers, to support their process of continuous improvement in relation to the standard of care and services.
- Letter from the Commissioner – Important changes relating to the use of restrictive practices (28 June 2021).
- Regulatory Bulletin – RB 2021-13 Regulation of restrictive practices and the role of the Senior Practitioner, Restrictive Practices.
- The Commission has released resources to support providers understanding of their requirements. Providers are encouraged to review the full suite within the Minimising the use of restraint resources.
- The Guidance and resources for providers has also been updated to include best practice resources.
- 'Minimising Restraint in Residential Aged Care Facilities’ storyboard user guide (DOCX, 1.07 MB).
- 'Minimising Restraint in Home Services' storyboard user guide (DOCX, 1.05 MB).
These resources make it clear that the use of restrictive practices at the request of the consumer or for the consumer’s safety is still considered restraint restrictive practice. This does not mean these restrictive practices cannot be used. Rather, restrictive practices are only to be used appropriately and within the current legal framework. The requirements of the Quality of Care Principles must be met and documented for each consumer.