Addressing Restrictive Practice in the In – Home Care Environment: A Call for Awareness and Action

By Danni Meredith

Addressing Restrictive Practice in the In-home Care Environment: A Call for Awareness and Action 

Restrictive practices limit a person’s freedom, movement, or decision-making. In home care, these practices often arise unintentionally when informal carers such as family or friends try to keep an older person safe. Good intentions can still infringe on a person’s rights, which is why understanding the issue is so important. 

Understanding when restrictive practice can be lawfully applied, how to respond, and how to minimise the overall use of restrictive practice is essential to protecting older people and to provide better support to carers.  

There are five common forms of restrictive practice. 

• Mechanical restraints designed to block movement or the removal of mobility aids. 

• Chemical restraint via the misuse of medication to control behaviour. 

• Physical restraint whereby force is used to hold someone down. 

• Environmental restraint involves restricting access to parts of the home, such as locking fridges or doors. 

• Seclusion means to confine someone to a room or locking them inside their home. 

What are the warning signs or potential triggers? 

Informal caring is an incredibly demanding role which can often require a carer to be “on” call 24 / 7. Informal carers may be exhausted, unwell, and distressed at seeing their loved one deteriorate and unaware that their actions are restrictive. Responsive behaviours like agitation or restlessness need investigation and often signal unmet needs. Usually things like pain, thirst, and general discomfort can be easily managed without restriction. 

Positive actions to support informal carers 

Support workers can role model safer practices, gently explain why they are preferable, and discuss options for respite or other practical supports. Balance discussions with cultural and gender-based nuances to avoid shaming or stigmatising the informal carer. Warm referrals to specialist services and behaviour management planning can help carers address underlying causes rather than control behaviour.  

What the law says 

The Australian Law Reform Commission states, “The use of restrictive practice will, in some circumstances be elder abuse. Restrictive practice can deprive people of their liberty and dignity – basic legal and human rights. The practice might also sometimes amount to assault, false imprisonment, and other civil and criminal wrongs.”  

The new Aged Care Act and the Strengthened Quality Standards highlight that person-centred care includes the older person’s choice to include carers in the assessment, planning and decision-making for their care needs. Carer inclusive practice is part of the Statement of Rights, which acknowledges the importance of remaining connected with important people in their lives, recognition and support for the important role carers contribute as partners in care.  

In what circumstances can a restrictive practice be used? 

• When it is regulated and clearly documented for use in specific scenarios. Ie: using a wheelchair safety belt only when travelling. 

• With the consent of the older person or lawful authorisation.  

• As a last resort following and the trial of alternative strategies, is time limited and the least restrictive measure.  

• When all emergency scenarios and risks have been considered.  

• With an awareness that dual vulnerabilities can exist for elder abuse between an older person and an informal carer. 

Reporting, escalation, and workplace process 

• Firstly, adhere to your workplace policy and the Aged Care Quality and Safety Commission (ACQSC) guidance. 

• Use SIRS and escalate concerns to your supervisor or manager when the risk is immediate or unclear. 

• Gain the older person’s consent and respect their wishes whilst balancing safety and legal obligations. 

• Make thorough notes of your observations including all actions taken, and the rationale for any restrictive practice used.  

In essence, any restrictive practice must be legally justified, agreed to by the older person, used only for a limited time, and directed toward meeting underlying needs rather than simply managing behaviour. 

Carers NSW have released useful resources such as the Carer Inclusive Aged Care Practice Guide and the Responding to Restrictive Practices by family and friends facts sheet. To learn more, click here.  

The Department of Health, Disability and Ageing have produced resources including Types of Restrictive Practice and Consent for Restrictive Practices: Information for Aged Care Providers.