What are restrictive practices?
Restrictive practices are actions or interventions that limit a person’s rights or freedom of movement. [1, 2] Restrictive practices are often used to promote the safety of older people and those around them. [3, 4] Common reasons for using restrictive practices include:
- reduce the risk of falls or accidents in older people with impaired mobility or judgement
- protect residents, staff and visitors from harm
- prevent interference with essential medical treatment, and
- protect active wounds or surgical sites. [3, 4]
Types of restrictive practices include physical, chemical, mechanical and environmental restraint, as well as seclusion.
| Type of restraint | Definition and examples |
| Chemical restraint |
|
| Environmental restraint |
|
| Mechanical restraint |
|
| Physical restraint |
|
| Seclusion |
|
In residential or long‑term care settings, mechanical restraints in the form of bed rails and belts are commonly used. [3]
Informal restraints or ‘creative tricks’ are actions intended to influence or control a resident without formal restraint devices. They are used especially during busy times to ensure residents’ safety. Informal restraints are described as ‘grey‑zone restraints’ due to the absence of clear legislative regulation. Informal restraints may be regarded as a ‘milder’ form of restraint than formal measures, and therefore can be perceived to be preserving residents’ dignity to a certain extent. [6]
Examples include:
- distracting someone to manage behaviour
- telling ‘white lies’
- persuasion or pressure
- offers to influence compliance, and
- threats. [6]
Care practices or supportive actions such as gently guiding or assisting activities of daily living (ADLs), redirecting, or warning someone about potential harm or risk are not considered restraint. [1, 3]
Why does this matter for rights-based care?
Restrictive practices can breach the human rights of older people, including those with disability. [7] The Aged Care Act 2024 and Aged Care Rules 2025 require that they should only be used as a last resort and in the least restrictive way. [1, 3, 8] Reducing restrictive practices supports safer, higher‑quality, person‑centred care and aligns with the Strengthened Aged Care Quality Standards 1, 2, 3, 4, and 7. A person‑centred approach supports PLWD to exercise self‑determination, participate in decision‑making, and be treated with dignity and respect. [3, 14, 15]
Globally, around one‑third of residents in residential or long‑term care experience restrictive practices, with wide variation between facilities (6–85%). [3, 9]
People most likely to experience restraint include those with:
- cognitive or memory problems (especially severe dementia)
- disabilities
- history of falls or broken bones
- incontinence
- pressure sores
- repeated verbal or physical agitation, and
- serious mobility problems. [3, 4, 6, 10, 11]
People living with dementia (PLWD) are the most likely to experience restraint due to responsive behaviours, and communication difficulties. Responsive behaviours, also known as Behavioural and Psychological Symptoms of Dementia (BPSD) in clinical practice, are behavioural changes experienced by PLWD usually arising due to unverbalised unmet needs. Examples include aggression, agitation, wandering and repetitive vocalisations. [12] Pharmacologic and non-pharmacologic strategies are used to manage responsive behaviours. Pharmacologic strategies are often associated with chemical restraint due to the use of antipsychotic drugs. Non-pharmacologic strategies include physical, mechanical and environmental restraints. Surveillance technologies used to monitor PLWD residents are also regarded as a form of physical restraint.
Informed consent should be sought before any of these are given or used. The use of these strategies without consent is unethical and violates human rights. Supported decision making is needed for PLWD to make informed decisions and seek care that meets their needs, though the Act outlines restrictive practice-specific processes for substitute decision-making when a person lacks capacity to consent. [13] Supported and substitute decision-making are described in more detail in the RBC theme dementia, cognitive impairment, and capacity.
The Aged Care Act and Rules 2025 regulate and safeguard the use of restrictive practices in residential aged care facilities to protect the rights of older people and adhere to the quality standards. They outline the providers’ responsibilities, who can give informed consent, including a hierarchy of who can consent to the use of a restrictive practice, and medical practitioners’ responsibilities. [1] They help ensure restrictive practices are used safely, appropriately, and only when absolutely needed.
Restrictive practices can harm an older person’s autonomy, dignity, independence, physical health, and emotional wellbeing. They should be used only when absolutely necessary, for the shortest possible time, within ethical and legal requirements, and monitored and reviewed regularly. [6, 12] Alternative strategies such as environmental modifications or improving ways of communication should be trialled first and documented before using any type of restrictive practice. [1, 12]. The most promising and acceptable interventions to manage responsive behaviours, such as psychological interventions, case management, massage and touch, are described in detail here.
Want to learn more?
These resources explain restrictive practices:
- Overview of restrictive practices
- What are restrictive practices?
- Restrictive practice used in residential aged care
These resources recommend strategies to minimise restrictive practices and support accountable processes to address restrictive practices:
- Minimising restrictive practices
- Restrictive practices
- Restrictive practices in aged care – a last resort
What can be done?
Assess the need for restrictive practices and associated risks
Care teams:
- Conduct a comprehensive person‑centred assessment, including physical health, cognitive function, mobility and any underlying conditions.
- Prioritise autonomy, comfort, dignity and cultural values.
- Assess the immediacy of risk (for example, falls or behaviour that may cause harm).
- Explore all alternatives before considering restraint.
The evidence:
- A person‑centred assessment is essential for identifying the individual needs of older people, prioritising urgent concerns, and determining whether restrictive practices are necessary. The provision of person-centred care protects the safety of the older person while respecting their autonomy, dignity, and well-being. [3]
Use alternative and multicomponent interventions
Care teams:
- Trial alternative interventions such as environmental modifications, person‑centred care and psychological support to prevent restraint use.
- Use tools and strategies specifically designed for responsive behaviours in PLWD. A list of possible interventions to reduce responsive behaviours in PLWD is available here.
The evidence:
- Restraint removal or minimisation strategies can include early preventative actions and improving approaches towards care. [3]
Consult with family members, caregivers, and other clinicians in the multidisciplinary team before using any form of restrictive practice
Care teams:
- Involve family members, caregivers and multidisciplinary teams early in decision‑making.
- Discuss risks, benefits and alternatives based on the older person’s needs and preferences.
The evidence:
- Residents and families are rarely consulted about restrictive decisions. [16]
- Early engagement with the family members, caregivers, and other clinicians in the multidisciplinary team is essential in the decision-making process. This supports a holistic understanding of the older person’s needs and preferences, and allows careful consideration of the risks and benefits before any form of restraint is used. [3]
Educate staff on best practice restraint minimisation
Organisations:
- Train staff on restrictive practices, risks, alternatives and person‑centred approaches.
- Include restrictive practices training in onboarding and ongoing education.
The evidence:
- Education programmes targeting nursing staff attitudes and knowledge about physical restraint use, and alternatives to use, can be developed to reduce the moral conflict that staff may have about using physical restraint. [17]
Obtain informed consent
Care teams:
- Obtain informed consent from the resident or their authorised substitute decision‑maker.
- Refer to the informed consent for restrictive practices and interim arrangements for consent to restrictive practices pages for detailed guidance.
The evidence:
- For people with no capacity to provide informed consent, such as those with cognitive impairment or dementia, a discussion with a proxy, legal guardian, or representative (i.e. substitute decision-maker) should be initiated before attempting to obtain informed consent. [3]