In residential aged care settings, restrictive practices can include bed rails when used to restrict a person’s movement, restricting a person’s access to an outside space or the use of medication to influence behaviours, such as aggression.
In 2021, a number of legislative changes to the use of restrictive practices in residential aged care settings were introduced.
The changes recognise the significant impact that restrictive practices have on a person’s rights and freedoms and are ultimately designed to minimise their use.
The revised legislation:
- defines restrictive practice
- requires service providers to have thorough processes in place for the use of restrictive practices, including consent, monitoring and documentation
- ensures that restrictive practices are only used as a last resort after best practice behaviour supports have been tried.
Importantly, it is now a requirement for aged care providers to have a behaviour support plan in place for people that need them.
Behaviour support plans bring together important information about a person’s background, preferences and behaviour. They document positive strategies for people with disability that respond to the person’s needs, to reduce the occurrence of behaviours of concern and minimise the need for the use of restrictive practices.
Key considerations for guardians
Service providers must seek consent before implementing restrictive practices, even if the practice has been recommended by a specialist or behaviour support practitioner.
If the person themselves can’t provide consent, you as their legal guardian can either give or withhold consent to the use of the restrictive practice only if you have been given the restrictive practices function in the person’s guardianship order.
This includes decisions about the use of chemical restraint. Decisions about chemical restraint – medication used for the purpose of controlling behaviour – are not considered a medical treatment or intervention used to promote the person’s health. For this reason, guardians cannot consent to chemical restraint with the medical/dental consent function.
If restrictive practices are proposed or already being used, and you do not have the restrictive practices function, you will need to apply for this extra authority.
It is important that any proposals relating to the use of restrictive practices are received in writing and that you consider the views of the person as well as the recommendations of their health professionals.
Before making a decision about the use of restrictive practices, some questions you might ask service providers, or take note of in a behaviour support plan are:
- How serious is the behaviour and does it pose a threat to the person or to others?
- What are the recommendations from the behaviour support plan or specialist assessment?
- How will the restrictive practice benefit the person and is it the least restrictive option?
What else is being done to manage the behaviour of concern, for example, can extra staff be provided to assist the person? - What alternative behaviour support strategies have been considered and tried?
- What might be the consequences of the practice and how will the comfort, safety and dignity of the person be ensured?
- In what context will the practice be used and for how long (i.e., how many hours per day, how many hours per week)? How will it be monitored and reviewed?
- Is the proposed restrictive practice proportionate to the behaviour, i.e., not more excessive than what it needs to be?
- If it is a medication (chemical restraint), what are the side effects and how will this medication interact with the person’s other medications?
- What is the service provider’s or aged care facility’s policy around the use and monitoring of restrictive practices?
It is important to understand that restrictive practices impinge greatly on the freedom of movement and rights of the person. A thorough process that considers the views of the person you represent, professionals and the principles of the Guardianship Act 1987 (NSW) will help ensure the best decision is made.
