New rules for using restraints in aged care

Residential aged care providers need to ensure assessment by an approved person and document alternative alternative options tried before physical or chemical restraint can be used from 1 July.

Residential aged care providers need to ensure assessment by an approved person and document alternative alternative options tried before physical or chemical restraint can be used from 1 July, the government has announced.

Minister for Senior Australians and Aged Care Ken Wyatt announced the new rules for providers to use restraints last Friday and has since amended the Quality of Care Principles 2014 to reflect the incoming specific requirements.

He said the government has worked with a group of key stakeholders to inform a regulatory approach to minimise the inappropriate use of restraints, treating chemical and physical restraints as separate issues.

“Restraint must only be used as a last resort,” Mr Wyatt said.

Under the new regulations residential aged care providers will need to satisfy several conditions, Mr Wyatt said.

They include the requirement for an assessment by approved health practitioner before physical restraints are used and an assessment by the medical practitioner or nurse practitioner who prescribed the medication before the use of chemical restraint.

“The aged care home must also have the informed consent of the consumer or their representative before using physical restraint, unless restraint is necessary in an emergency.

“In all cases of restraint, the home will also be required to document the alternative options to restraint that have been used. Any use of restraint must also be regularly monitored,” Mr Wyatt said.

Mr Wyatt foreshadowed the strengthening of regulations for the use of physical and chemical restraints in residential aged care on the eve the first public hearing of the Royal Commission into Aged Care Quality and Safety following media reports showing images of residents with dementia being strapped to chairs.

The new arrangements reflect elements of the Decision-Making Tool: Supporting a Restraint Free Environment in Residential Aged Care (revised in 2012).

These new regulations support the government’s broader reform agenda to ensure aged care is delivered to a high-quality at all times and in all places, he said.

Also coming into force on 1 July 2019 are the new Aged Care Quality Standards.

Mr Wyatt said providers delivering clinical care will be required to have a clinical governance framework in place that minimises the use of all forms of restraint.

“We have equipped managers and staff in aged care facilities with tools and guidelines to achieve safe, high-quality care and practice safe management of medicines,” he said.

Providers also need to collect and report information on the use of physical restraints, as well as pressure injuries and unplanned weight loss, as part of the quality indicators program, which becomes compulsory for residential aged care providers from 1 July.

Aged Care Quality and Safety Commissioner Janet Anderson said last month it was expected that the first release of quality indicator data would be published online by the end of the year (read more here).

Mr Wyatt said he expected to sign the regulatory changes regarding restraints into law this week.

This story was updated on 3 April to reflect new information.

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8 thoughts on “New rules for using restraints in aged care

  1. This has resulted in a major increase in residents being injured, causing injury and property damage simply because facilities are now too scared to try everything else then looking at the least restrictive restraint. Management in majority of facilities even go as far as saying restraints are outlawed instead of saying “let’s look at every avenue and only then, if all options are exhausted, will we explore restraint options with the resident/representative and MO”.

    I agree 100% restraints should never be the go to option but when people are falling out of bed onto crash mats on a regular basis, it’s gets a bit much for any aged care worker to see the bruises that are piling up. Crash mats are great for feather weights, not so good for larger people. That also adds on to staff muscular and spinal injuries when transferring from floor onto bed with a full mechanical lifter. The theory of sensors to let us know if they have fallen out of bed only lets us know when, it does not prevent it and unless you plan on standing beside the bed 24/7, regular checks only work at that moment, it does not mean they won’t roll out between them.

    We have become such a “scared of our own shadow” industry, and society for that matter, that we are allowing people to harm themselves and calling it their right. I’m pretty sure not one person on this earth has injured themselves accidentally is thinking ‘THANK GOD, THOUGHT THAT WOULD NEVER HAPPEN THIS WEEK!’.

  2. My Father lives in a aged care facility, at least 3-5 times a week l get a call saying he has had a fall, generally falling out of bed, but sometimes he crashes to the floor in the bathroom, ( in his dementure he forgets that he can’t walk very well and he gets out of bed- because there is nothing stopping him from doing so). He is left brused, in pain and confused, often missing long strips of skin, and, more often than not requiring medical attention.They say restraining them is abuse–THIS IS ABUSE! How does a bed rail constituency restraint/abuse, it keeps them safe. If you saw your toddler walking towards the end of a jetty, and someone went to hold them back, would you put out your arm to stop them, and say “no, leave them, it’s not right to restrain them”! !.my Father has had well over 200 falls, and do you know how upset and angry l feel because l can do nothing to stop it? I can’t help the man who stopped me from falling when l was young, and l just have to sit by and here about the details of how he ‘has a bruse on his face and he’s missing a bit of skin on his left arm, he’s a bit confused at the moment, but were keeping an eye on him in case of concussion! I bet he’s confused!, confused as to why he’s always getting hurt, and why l’m not doing something to stop it !
    And as far as mat alarms are concerned, GOD SAVE US FROM FOOLS, how the hell does that get classified as restraint? (Unless you roll them up in it and tie the cord around their neck!). Such a brilliant idea, let them fall out of bed, then let them lay there for hours because nobody is await that something has happened. BRILLIANT!, who was the dumb ass who thought that was a clever system?
    I was informed today that my Father was found cralling on all fours into other patients rooms, please, give him back his dignity, he needs gentle restraint, and to say that the staff should be responsible for manually keeping them in a safe position at all times, is down right ridiculous! have you ever watched how flat out busy they are with the work they already do? ? Mr Wyatt, if you believe that is a feasible propersition, then, l’m sorry, you just aren’t living in the real world!.
    I would even say a gentle sash around his waist, not tight, loose enough that he could turn over, sit up reach for something on his bed side cabnet, but would stop him being injured by restricting him from getting out of bed on his own, would be far kinder than the constant falls and knocks that he suffers! ! ! !Please wake up and think about what l’ve said Mr Wyatt ( and any other politician that is responsible for this calamity), this obvious example of ‘peoples rights’ gone mad has to be put right, before something horrendous happens, like a nursing home catching fire because the patients are running free with nothing to restrain them, and a lot of them suffering with dementure makes it so feasible a possibility! ? !
    Thank you for taking the time to read this message, l hope it does some good.

  3. I think that there should be some sensibility in looking at restraints and policies in relation to this.
    Aged Care Facilities should not look at the management of each individual resident as a black and white To Restrain or not to Restrain point of view but to question WHY?
    WHY do residents display behaviours? Is there an unmet need – food, drink, warmth, toileting? Are they in pain? Are they lost and needing redirection?
    The laws are in place to stop staff from reaching for the easy option and using restraint before trying other options . Unfortunately it is sad to say that prior to this, if a resident with dementia had behavioural issues or wandered, it was too easy to either restrict their movements or sedate them to aid staff in being able to manage them. The shift now is to make staff think about WHY they are doing this and to justify their actions. They need to prove that they have tried everything else. Restraint is not to be used as a first line option. It does have a place when all else fails.
    The point is that previously, some residents were being restrained when they needed to go to the toilet and were getting agitated.
    They were being restrained when they were in pain…or hungry…or thirsty.
    They were being restrained when they weren’t given adequate information and did not understand what was going on.
    Staff are busy but the switch in mindset needs to happen. By questioning why we do things, we learn and hopefully plan ahead to manage care. This in turn makes the workload so much less.
    So while there is absolutely a place for restraint to ensure safety, it should NEVER be the first option and should only be utilised when all other strategies are ineffective.

  4. I think the whole world has gone mad!

    My sister is bed bound, cannot walk anymore and they use a mechanical lifter to move her to the bathroom for a shower.

    Apparently she fell out of bed at 1 am in the morning. I asked if they had bedrails on her bed and to keep them up. The response from the nurse was ‘ these are restraints!’

    I was gobsmacked.

    I am an ex registered nurse, so not unfamiliar with caring for people.

    Bed rails are a mechanism to help stop people falling out of bed. That is the reason they were invented.

    I cannot believe that anyone would consider these a restraint if the person is immobile and cannot walk. It’s just unbelievable.

    I’m absolutely certain that these issues are not what the royal commission is all about.

    Let’s all be sensible.

  5. I have recently been admitted to a nursing home and have been horrified at some of the ways residents are treated. This includes rudeness, yelling at residents and basically saying I don’t know what I’m talking about.
    I have worked in care situations for some 50 plus years and also brought up 4 children for many years on my own. I taught my children from an early age to be polite to others and be respectful at all times.
    I have now found myself in care due to recurrent strokes. I have queried the use of restraint on some of the very elderly. Not why are there but why aren’t they there!
    If the restraint is only at the top of the bed the rest is open. I asked what if the resident falls from the bottom part of the bed and I was told that is the rule “ nothing we can do or say”
    One resident in particular almost 99 years if she falls from her bed near the base she is likely to break almost every bone in her body. I was also informed I don’t understand the law.
    So after 50 plus years working both here and overseas in Child Care Young Defendants detention centres
    And also Age Care plus 30 plus years as a court Bailiff and running a paralegal business I am not entirely stupid if I resent being spoken to as if I was a half wit.
    This is the “norm” but as far as I am concerned treatment of the elderly has hit a new low by the government
    And the way in which we are treated as half wits! If my name comes up and my email is details are given to my Care facility I will I am sure have to move out

  6. I’m going to try settle some minds here as best as I can. I’ve worked in Aged Care since ’94 when restraints were just part of life then it got changed to restraints are a no no. However, they’ve never been made illegal no matter what any facility claims. They are a last resort. The problem with bed rails isn’t that frowned upon, its because they can cause just as much, if not more, damage to a person who tries to climb over them then rolling out of bed onto a soft fall mat. The greatest damage that can be cause from rolling out of a bed that’s been lowered to a floor or within 2-3 inches of it and “landing” onto a crash mat (just a phrase, they are soft fall mats, doesn’t mean people go crashing onto them) is a bruised ego. It is extremely rare for any actual injury to occur. Personally I do like rails but I have seen countless times the amount of damage they cause if used on the wrong person so having said that they are suitable for those who are at risk of rolling out of bed, not those who try to stand then fall.

    No restraint has been made illegal, as mentioned they are a last resort after trialing other interventions such as more activities during the day to assist with sleeping at night, better hydration, pain management, mobility assessments, soft music playing in their room if it helps them sleep etc. etc., then restraints are looked at and discussed in a conference with family/representatives and the persons doctor. All parties involved in the decision making then sign a restraint form. The form then removes any fault of injury away from the facility. That’s one of the biggest things in Aged Care, the amount of family members that will look for any reason to complain or even sue.

    Having said all that, family can request for a restraint to be used and again it is discussed with the doctor and signed off. It is nothing unusual for residents themselves to request some type of restraint for their own personal peace of mind and/or feeling secure.

    Don’t blame any other people be they politicians, facility staff including management or anything else, blame the fact that it is all about making sure our people are as safe as possible without injury.

    Also I don’t believe all the claims written in here about being in Aged Care or nursing, if you did, you’d know the reasons.

  7. Having put a resident’s bed along a wall to save space this was soon repositioned across the small room. Then I had to sign a form that makes no sense: signed ( no doctor involved) to put bed along the wall again, this time as a formal physical restraint, aim being to halve falls risk .

    This new law or directive is totally crazy. In 15 days, my partner has fallen out of bed on three occasions.
    I take a picture each day to send to his brother with an update as he is unable to travel. last night I zoomed into the picture taken 14th Feb 2023 and he has bruises.
    behind both eyes, he was found sitting on the floor on his crash mat. He is unable to walk, talk, or due to Alzheimer’s have a clue what an attention buzzer is for unless it is attached to his bed on the protection side rail. This is palliative care new rules. ? This is a wonderful care home, obeying rules. I have inspected many over the years.
    He would be unable to climb over a rail. Staff should be able to make informed decisions for each patient.

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