Restrictive Practices in Aged Care: Compliance Guide

Restrictive practices — the use of force or constraint to limit a person's freedom of movement or behaviour — are an increasingly regulated area in aged care. The Aged Care Act 2024 takes a strong stance: restrictive practices should be used only as a last resort, when less restrictive alternatives have been exhausted, and only with appropriate governance and behaviour support planning.

Many providers underestimate the regulatory scrutiny around restrictive practices. The ACQSC identifies failures in this area frequently during assessments, and restrictive practice incidents are common SIRS reportable incidents. Understanding the types of practices, the regulatory requirements, and the documentation obligations is essential.

The Act recognises several categories of restrictive practices. Physical restraint is the use of force or physical constraint to prevent movement — for example, holding someone, preventing them from leaving, or using a physical restraint device.

Chemical restraint is the use of medication or psychotropic substances, not prescribed or administered for the person's immediate medical condition, but administered to control behaviour or movement. This is particularly concerning in aged care as it may mask underlying health issues or cause harm.

Environmental restraint is the restriction of access or movement through environmental controls — for example, locking doors, removing mobility aids, or preventing access to particular areas.

Mechanical restraint is the use of devices (seatbelts, bed rails, chairs with tables) to prevent movement. Note that some mechanical devices have legitimate therapeutic uses (e.g., a specialised seating system for posture support); the distinction is whether the purpose is restraint (limiting freedom) or therapeutic (supporting function).

Seclusion is the confinement of a person alone — typically in a locked room. This is rarely appropriate in aged care and requires exceptional justification.

The Act requires that restrictive practices be used only when less restrictive alternatives have been exhausted, that the use be documented and justified, that informed consent be obtained where possible, and that the practice be regularly reviewed.

Providers must have a behaviour support plan in place before using a restrictive practice. The plan should document: the behaviour of concern and its triggers, the risk or harm if not addressed, the less restrictive strategies that have been tried, why they were insufficient, the specific restrictive practice being used, the duration and frequency, who is authorised to implement it, and the review schedule.

Informed consent is a legal requirement. If the resident has capacity, they must agree to the practice. If they lack capacity, consent should be sought from their legally appointed representative (enduring power of attorney, guardian, or family if no formal representation exists). If consent cannot be obtained, the provider must document why and how the decision was made in the resident's best interest.

A behaviour support plan (BSP) is central to legitimate use of restrictive practices. The plan should be developed collaboratively with the resident (where possible), family, and staff who interact with the resident regularly. It should identify antecedents (what triggers the behaviour), the behaviour itself, and consequences (what happens after the behaviour).

The BSP should document positive behaviour support strategies: changes to the environment that reduce triggers, changes to staff interaction or communication, activities or engagement that prevent boredom or distress, and early intervention strategies to prevent escalation.

Only after documenting that positive strategies have been tried or are insufficient should the plan include restrictive practices. The plan should specify who can implement the practice (usually a nurse or trained staff member), in what circumstances, for how long, and when the practice will be reviewed.

Behaviour support plans should be reviewed regularly (at least quarterly, or earlier if the person's behaviour or circumstances change). Trends should be tracked — are the restrictive practices becoming more or less frequent? Are positive strategies becoming more effective?

Any inappropriate use of a restrictive practice is a reportable serious incident under SIRS. This includes: use without a behaviour support plan, use without proper authorisation, use that causes injury or harm, use beyond the duration specified in the plan, and use of chemical or mechanical restraint without clear therapeutic rationale.

Many restrictive practice incidents are Priority 2 incidents (reportable within 30 days), but those causing serious harm or involving allegations of inappropriate restraint use may be Priority 1 (24 hours).

Providers often delay reporting restrictive practice incidents because they perceive them as 'normal practice'. This is a regulatory failure. If a restrictive practice incident occurs outside the parameters of the behaviour support plan, it must be reported.

A centralised restrictive practices register should capture every instance of restrictive practice use. For each entry: the resident, the practice used, the date and time, duration, person who implemented it, reason/context, any authorisation obtained, outcome, and whether the practice was within the approved behaviour support plan.

This register serves multiple purposes: it provides an audit trail demonstrating compliance, it identifies trends (if a resident is frequently in chemical restraint, is the behaviour support plan working?), and it flags any uses that fall outside approved parameters — which should be reported as incidents.

During ACQSC assessment contacts, assessors will review the register and sample actual practices against documented plans. Discrepancies — uses not in the register, practices not in the BSP, unauthorised use — are compliance failures.

Effective aged care providers focus on preventing the need for restrictive practices. This requires ongoing investment in positive behaviour support: staff training in de-escalation and therapeutic communication, environmental design that reduces triggers, activity and engagement programs that meet residents' needs, and proactive health management to address underlying causes of behaviour change (pain, infection, cognitive decline, medication side effects).

When behaviour of concern emerges, the first response should be investigation and support, not restraint. Has the person's health status changed? Are they in pain? Is the environment overwhelming? Are they receiving appropriate activities? Addressing root causes often resolves behaviour without ever needing restraint.

The Restrictive Practices & Behaviour Support module in Statura Care maintains behaviour support plans with structured documentation of triggers, positive strategies, and approved restrictive practices. The Restrictive Practices register captures every use with authorisation tracking, plan compliance checks, and alerts when use falls outside approved parameters.

The module integrates with SIRS reporting to automatically flag suspected reportable incidents (uses outside the BSP, unauthorised practices), with staffing to track who is trained in behaviour support, and with clinical systems to link behaviour changes to health events. Trend reports show the effectiveness of positive strategies over time, enabling continuous improvement in behaviour support. Restrictive practices management is part of Statura Care's aged care compliance software — purpose-built for the Aged Care Act 2024.