The discussion around care for older Australians rightly places respect and dignity at the forefront. Central to this standard of care is a clear understanding and appropriate application of restrictive practices—actions that limit a person’s rights or freedom of movement. While sometimes necessary as a last resort to prevent serious harm, their misuse constitutes a significant breach of trust and a serious incident under the Serious Incident Response Scheme (SIRS).

This article will guide aged care workers, families, and recipients through what defines a restrictive practice, the strict requirements for its proper application, and why its inappropriate use is now a mandated reportable incident.

What are Restrictive Practices?

In residential aged care, a restrictive practice is any action taken that restricts the rights or freedom of movement of a care recipient. The aim is to move away from practices that treat residents merely as bodies to be managed, and towards care that respects their autonomy and individual needs.

The current framework identifies five distinct types of restrictive practices:

1. Chemical Restraint: This involves the use of medication or a drug primarily to influence a person’s behavior or restrict their movement, where the drug is not a standard treatment or dosage for a diagnosed medical condition. For instance, giving a sedative solely to manage "challenging" behavior without a therapeutic justification falls under this category.
2. Physical Restraint: This includes any manual method or physical or mechanical device, material, or equipment that reduces the ability of a person to move their arms, legs, body, or head freely. Examples can include certain bed rails, restraint chairs, or belts/straps used to keep a person in a specific location against their will or without proper authorization.
3. Environmental Restraint: This refers to restricting a person’s access to certain parts of their environment. This could involve locking doors or placing barriers to confine a resident to a specific area of the facility, limiting their movement within the grounds.
4. Mechanical Restraint: (Often grouped with Physical restraint, but sometimes listed separately in older guidance) This specifically involves devices applied to the body to restrict movement.
5. Seclusion: This is the confinement of a person alone in a room or area from which they cannot leave. Though rare in aged care, it is the most extreme form of restrictive practice.

It is absolutely important to note what is not considered a restraint. For example, orthopedically prescribed devices, surgical dressings, protective helmets, or physically holding a person briefly for routine physical examinations or to prevent a fall, are usually excluded, provided they are used for therapeutic purposes or protection from injury, and not primarily to limit freedom of movement for behavior management.

The Standard for Proper Use: Last Resort, Least Restrictive

The legal and ethical standard across Australian aged care services is unequivocal: restrictive practices must only be used as a last resort. This means all other less restrictive alternatives must have been trialed and documented before considering a restrictive practice.

When a restrictive practice is deemed necessary, the following mandatory requirements apply:

• Preventing Harm: The practice must be necessary only to prevent harm to the consumer or other persons.
• Proportionality: The practice must be proportionate to the risk of harm.
• Least Restrictive Form: It must be the least restrictive form possible to manage the risk.
• Shortest Period: It must be used for the shortest time needed.
• Consent and Authorization: Crucially, proper consent and authorization (often through a behavior support plan and a substitute decision-maker) must be in place before the practice begins.

The focus must always be on understanding why the person is displaying the behavior and addressing the underlying causes (such as pain, boredom, discomfort, or unmet needs) rather than simply suppressing the behavior using restraint.

Inappropriate Use: A Serious Reportable Incident

The introduction of the Serious Incident Response Scheme (SIRS) significantly tightened the accountability of aged care providers regarding restrictive practices. SIRS requires providers to manage and report certain incidents to the Aged Care Quality and Safety Commission.

Under SIRS, the inappropriate use of restrictive practices is a reportable incident. This means that if a provider uses a restrictive practice without appropriate authorization, or without meeting the "last resort, least restrictive" criteria, it must be reported to the Commission as a serious incident.

Examples of inappropriate use that trigger SIRS reporting include:

• Using a restrictive practice without the required prior authorization or consent from the person or their substitute decision-maker.
• Applying a restrictive practice in a non-emergency situation without a documented behavior support plan.
• Administering a drug to affect a person’s behavior (chemical restraint) where it is not for a diagnosed condition and is not authorized.

This requirement underscores the government’s commitment to patient safety and autonomy. The act of restraining a person without authorization is treated with the same seriousness as other forms of neglect or abuse, signaling that dignity and freedom are fundamental rights for all aged care recipients.

The Role of Staff and Behavior Support Plans

Staff training and awareness are paramount. Care staff must be fully versed in distinguishing appropriate therapeutic support from unauthorized restraint. Training should focus heavily on understanding and responding to behaviors of concern using non-restrictive techniques.

For any person displaying behaviors where restrictive practices might become necessary as a genuine last resort, a Behavior Support Plan (BSP) is mandatory. The BSP is developed by a qualified practitioner and details the person’s communication methods, the triggers for the behavior, and specific non-restrictive strategies to support the person. Only after a BSP is in place, and authorization obtained, can a restrictive practice be considered, and only then for the shortest period possible. The BSP ensures that any necessary restriction is therapeutic and respectful, not punitive or for staff convenience.

The Path Forward: Culture Change

Reducing and eliminating the inappropriate use of restrictive practices requires a fundamental shift in the culture of care. It moves away from managing risks through restriction and toward individualized, relationship-centered care that respects personal history and preferences.

When facilities prioritize understanding the individual—what makes them comfortable, what causes distress, and how they communicate their needs—the need for restrictive interventions dramatically diminishes. This involves:

1. Individualized Care: Tailoring activities and routines to the resident, reducing confusion and anxiety.
2. Environmental Adaptations: Making the environment safe and stimulating, reducing environmental triggers for distress.
3. Regular Reassessment: Frequently reviewing the necessity of any existing restrictions and aiming for their removal.

Compliance with SIRS is not just about reporting incidents; it is about recognizing the grave seriousness of misusing power over a vulnerable person and taking proactive steps to ensure their freedom and safety are protected daily. The goal for every provider should be zero inappropriate use of restrictive practices, ensuring older Australians receive care that supports their independence and maintains their dignity until the end of life.