Education facilitates safety – empowering LGBTQIA+ residents and front-line staff in restrictive practices in Victoria

The use of restrictive practices has been and will remain a complicated element of senior care. For all involved, from provider leadership, front-line staff and residents, the need for continued education and access to helpful resources is key. Aged Care Justice (ACJ) has released a new fact sheet, Restrictive Practices in Aged Care and the LGBTQIA+ Community, to support members of the LGBTQIA+ community to know their legal rights and protections in receiving care services in Victoria. As well, the guide is set up to help provide a resource for providers and front-line staff in this area of care that needs particular awareness, sensitivity and follow-through in the routine.

Education to support care

The resource outlines the current laws governing the use of restrictive practices in aged care in Victoria, and the obligations of aged care providers to ensure care meets dignity and equality standards.

Anna Willis, ACJ CEO and Solicitor speaks to the fact sheet as a tool to empower LGBTQIA+ seniors to be able to advocate for themselves and find support in navigating potential situations where their rights may be at risk.

She says, “This fact sheet gives them clear, practical information about their rights and how to challenge unlawful or unsafe practices. Everyone deserves to age in an environment that is inclusive, affirming, and free from harm.”

“This [resource] is an important resource for building awareness of the legal protections that exist for some of the most vulnerable members of our community.”

Type of restrictive practices

Under current care models and the law, there are five restrictive practices that are permitted under limited circumstances.

• Chemical restraint
• Physical restraint
• Mechanical restraint
• Environmental restraint
• Seclusion

Obligational requirements prior to use

Under the legislation, there are strict conditions that must be met prior to the use of a restrictive practice in aged care. It is critical that residents, front-line staff and leadership are routinely ensuring they understand the full scope of these measures.

Restrictive practices can only be used:

• As a last resort to prevent harm to the resident themselves, or another person, after due consideration on the reasonable impact on the resident of the practice.
• To the reasonable extent it is necessary, and in keeping with the level of risk of harm to the resident or another. It must also be done in the least restrictive form possible, and for the shortest duration of time necessary.
• The practice must comply with the resident’s behaviour support plan, the aged care quality standards and be aligned to the charter of aged care rights
• Following consideration of other options, and their possible use, as documented in the resident’s behaviour support plan
• Following informed consent to its use from the resident or authorized substitute decision maker, except in the occasion of an emergency

Who can decide?

Within the residential aged care setting, a provider must seek and receive consent from the resident for the use of a restrictive practice, or substitute decision maker (RPSDM) if the resident does not currently have decision making capacity.

Under the law, a resident or RPSDM can grant or refuse to provide this consent.

In the state of Victoria, after the resident themselves, there is now a clear rank of persons who can be RPSDMs.

1. Restrictive Practices Nominee (RP Nominee) – nominated only by the resident when it is clear they have decision making capacity
2. Temporary RPSDM – If no RP Nominee is nominated, a temporary authorized person can be appointed by: “(1) spouse or partner; (2) primary carer; (3) oldest to youngest child; (4) oldest to youngest parent; (5) oldest to youngest sibling.”
3. VCAT Appointment of an RPSDM – If options (1) and (2) and unavailable, a person with “an ongoing personal or professional relationship with the Resident can apply to the Victorian and Civil Administrative Tribunal to be appointed RPSDM.”
4. VCAT as RPSDM – As last measure, if no RP Nominee, temporary RPSDM, or appointed RPSDM, then, “VCAT may decide on the use of a restrictive practice, subject to any conditions VCAT considers appropriate, and by considering any preferences of the Resident.”

The strict measures in place are an indicator of the complexity and high level of consent, assessment and accountability that is crucial to the use of restrictive practices.

For both LGBTQIA+ seniors in care, and the front-line staff and providers responsible for their care, consistent comprehension of the laws and measures in place prior to restrictive practices is a critical foundation to providing safe, sustainable and rights-based care.