What is the facility's policy on the use of chemical or physical restraints?

What 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.

What 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?

What 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.

What 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.

What 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.

What 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.

What 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.

Warning 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.

What 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.

What 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.

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