New legislation introduced to minimise the use of restraints
From 1 July 2019, amendments to the Quality of Care Principles 2014 placed explicit obligations on residential aged care providers to minimise the use of chemical and physical restraints in residential care settings. The amended Principles require services to exhaust all alternative strategies and ensure restraints are used only as a last resort, and are regularly monitored and reviewed.
The regulatory changes require providers to satisfy a number of conditions before restraint can be used, including assessment by an approved health practitioner (for physical restraint) and assessment by a medical practitioner or nurse practitioner who has prescribed the medication (for chemical restraint).
Strengthened restraint regulations
The Quality of Care Amendment (Reviewing Restraints Principles) Principles 2019 further strengthens the regulation of chemical restraints in residential aged care settings.
The legislation now:
- makes it clear restraints must always be used as a last resort;
- refers to state and territory legislation which regulates the responsibility for prescribers to gain informed consent for chemical restraint; and
- requires a review of the first 12 months of the operation of the restraint regulations to ensure they are minimising the use of inappropriate restraint in aged care facilities.
Assessment of compliance with the new requirements
The use of restraints 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 restraint. The Quality Standards also require organisational wide governance systems for regulatory compliance, which includes compliance with the Principles on minimising the use of restraint.
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 restraints under the Aged Care Quality Standards.
Information about the National Aged Care Mandatory Quality Indicator Program and data collection and reporting requirements can be found on the Department of Health website.
The Guidance and Resources for providers to support the Quality Standards has been updated to reflect the new legislation and includes the following best practice resources for providers:
- Decision-making tool: supporting a restraint-free environment in community aged care
- Decision-making tool: supporting a restraint-free environment in residential aged care
- Guiding Principles for Medication Management in Residential Aged Care Facilities
The Commission has developed a Self-Assessment Tool for Recording Consumers Receiving Psychotropic Medications to support their process of continuous improvement in relation to the standard of care and services.
The Commission has also released Scenarios involving Physical and/or Chemical Restraint and a Regulatory Bulletin to help providers understand issues and their responsibilities around minimising the use of physical and chemical restraint.
These resources make it clear that the use of physical at the request of the consumer or for the consumer’s safety, are still considered restraint. This does not mean these restraints cannot be used. Rather, the practices of assessment, informed consent, care planning, monitoring and evaluation outlined in the Principles need to be undertaken, to ensure risks to consumers’ safety, health and well-being are minimised and consumers are treated with dignity and respect.