What is the facility's policy on the use of chemical or physical restraints?
Restraint must never be routine or used for convenience. In residential care, it requires strict assessment, consent, documentation and review. In Support at Home, providers must also protect the person’s rights and must not use informal restraint in place of skilled, properly staffed and clinically supported care.
Key points
- Restrictive practices are a last resort.
- The least restrictive option and shortest duration must be used.
- Consent, documentation and review are essential.
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01Guide sectionWhat is the provider’s policy on chemical or physical restraints?
Aged care providers should aim to prevent and minimise restraint. Chemical or physical restraint must never be used simply because a person is difficult to support, short-staffed, restless or living with dementia.
A restrictive practice is an action that limits a person’s rights or freedom of movement. The recognised types include:
chemical restraint
physical restraint
mechanical restraint
environmental restraint
seclusion.
Restrictive practices should only be considered as a last resort, in the least restrictive form and for the shortest possible time, where necessary to prevent harm.
02Guide sectionWhat is chemical restraint?
Chemical restraint is the use of medication primarily to influence or control a person’s behaviour rather than to treat a diagnosed medical or mental health condition.
Examples may include giving sedating, antipsychotic or anti-anxiety medication mainly to stop someone:
walking around
calling out
resisting personal care
attempting to leave
expressing agitation or distress.
Medication prescribed appropriately to treat pain, psychosis, anxiety, depression, epilepsy or another diagnosed condition is not automatically chemical restraint.
The key question is:
Is the medication being used to treat a clinical condition, or mainly to control behaviour?
03Guide sectionWhat is physical restraint?
Physical restraint involves another person using physical force to prevent or restrict movement.
Examples can include:
holding a person down
preventing them from standing or walking
physically forcing personal care
blocking them from leaving a chair, room or area.
Devices such as belts, restrictive chairs or equipment that prevent movement may instead be classified as mechanical restraint.
04Guide sectionWhat rules apply in residential aged care?
Residential aged care homes have specific legal obligations when a resident requires, or may require, a restrictive practice.
The home should:
assess what is causing the behaviour or distress
try appropriate alternatives first
determine whether restraint is genuinely necessary to prevent harm
obtain valid informed consent from the resident or the legally recognised restrictive-practices decision-maker
document the arrangement
monitor its use and effects
review it regularly
stop using it as soon as it is no longer necessary.
A behaviour support plan is required where restrictive practices may be needed. It should record the person’s needs, triggers, alternative strategies, consent, monitoring and review arrangements.
Consent is not a blank or permanent approval. The particular practice, reason, risks and alternatives should be explained, and the arrangement should be reviewed when the person’s circumstances change.
05Guide sectionWhat alternatives should be tried first?
Before considering restraint, the provider should investigate possible causes such as:
pain
infection or delirium
medication side effects
hunger or thirst
constipation
fear or confusion
poor communication
excessive noise
unfamiliar workers
disrupted routines
lack of activity
unmet cultural, emotional or social needs.
Alternative strategies might include:
treating pain or illness
changing the timing or approach to personal care
using familiar workers
improving communication
reducing environmental noise
providing safe walking areas
offering meaningful activities
adapting routines
involving family or dementia specialists
reviewing medication with the doctor or pharmacist.
The purpose should be to understand the person’s distress-not merely suppress it.
06Guide sectionWhat applies under Support at Home?
Support at Home workers and providers must also respect the person’s rights, safety, autonomy and freedom from inappropriate restraint.
A home care worker should not:
hold a person down to complete personal care
block exits for convenience
lock someone inside the home without proper legal and safety consideration
administer sedating medication outside the authorised medication plan
give extra medication to make the person easier to manage
use beds, chairs or equipment primarily to prevent movement
ask family members to approve informal restraint without proper assessment.
Support at Home does not have the same residential behaviour-support-plan framework for every participant. However, the registered provider remains responsible for safe, rights-based care, including care supplied by contractors or subcontractors.
Where advanced dementia or behaviours create a serious risk, the provider should arrange:
an individualised care and risk plan
clinical review
medication review where relevant
dementia-specific strategies
worker training and supervision
consistent workers where possible
advice from Dementia Support Australia or other specialists
escalation to the GP, hospital or emergency services when required.
Restraint should not become an informal substitute for adequate staffing, worker competence or clinical support.
07Guide sectionWhat should I ask a residential home or Support at Home provider?
Ask:
What is your written restrictive-practices policy?
How do you define chemical and physical restraint?
How often have restrictive practices been used in this service?
What alternatives must workers try first?
Who authorises the practice?
How is informed consent obtained and documented?
How often is the arrangement reviewed?
How are medication-based restraints identified and monitored?
Who reviews antipsychotic or sedating medication?
How are family members notified?
What dementia and de-escalation training do workers receive?
What happens if a contractor believes restraint is needed?
How do I raise a concern or withdraw consent?
Can I see the relevant care or behaviour support plan?
A strong provider should be able to explain the process clearly and provide its policy in writing.
08Guide sectionWarning signs
Be cautious if a provider says:
“We sedate residents when they become difficult.”
“The doctor prescribed it, so it cannot be restraint.”
“The family agreed once, so we do not need to review it.”
“We lock the doors because residents wander.”
“There are not enough staff to supervise them safely.”
“Contractors make their own decisions.”
“This is standard for advanced dementia.”
These answers suggest the provider may be using restriction for convenience rather than as a lawful last resort.
09Guide sectionWhat if I am concerned about restraint?
Ask the provider for:
the reason the practice is being used
the medication indication and prescribing records
evidence that alternatives were attempted
the consent record
the behaviour or care plan
monitoring and review notes
the date of the next review.
You can request a medication review by the treating doctor and pharmacist.
Serious or unresolved concerns can be raised with the Aged Care Quality and Safety Commission on 1800 951 822. OPAN can provide independent advocacy on 1800 700 600.
10Guide sectionWhat should I do next?
Ask whether any restrictive practice is proposed, why it is considered necessary, what alternatives were tried, who consented and when it will be reviewed. Raise concerns with the Commission if answers are unclear.
11Guide sectionHelpful Local Home Help resources
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