Education is key to restrain on restraints – ACJ report shows work to reduce the misuse of restraints still needed

Across provider leadership, clinical heads and front-line staff, organisations continue to tackle the complexity of restraints in the aged care setting. A practice at the intersection of safety, ethics and care, navigating the use of the practice continues to require consistent education and training, to empower not only front-line staff in its application but residents and loved-ones. Honouring the safety of all, from residents, their senior neighbours and front-line staff who are providing care, being familiar with the legislation to guide is not a wish-list but a requirement. Aged Care Justice has released its two-year education project, detailing the activities and outcomes over this time. The report reiterates and contributes afresh resources to aid seniors, loved-ones and providers, to clearly identify and help reduce the misuse of restrictive practices. For provider leadership, the resources can be utilised to support the high caliber of training needed in facility operation.

Reducing misuse

Stemming from the Royal Commission and its finding of “widespread” use of restrictive practices that needed “immediate attention”, legislative reform both nationally and state has been enacted. In Victoria, the ACJ’s project was undertaken to strengthen understanding of restrictive practice laws, particularly who is able to consent to their use at all, and facilitate options to pursue legal support.

It is through the education of the laws now underpinning the use of restrictive practices that all parties, whether seniors, loved-ones and importantly, new front-line staff, that the unnecessary use of restrictive practices may be able to be reduced, benefiting all.

Sue Williamson, ACJ’s Chair and Dentons Partner shares, “This project has allowed us to equip communities and professionals with the knowledge to navigate one of the most complex and sensitive areas of aged care.”

“With new laws now in place, understanding consent and provider obligations is not optional — it’s essential. We urge everyone involved in aged care to learn, question, and act to uphold the dignity and rights of older Australians.”

Resources

So far the ACJ team has researched, verified and created 16 fact sheets and five explainer videos, accessible in both public and professional capacity. The entirety of the five categories of restrictive practices – chemical, physical, mechanical, environmental restraint and seclusion are each identified and explained in practice and in keeping with legal requirements of use.

Both providers and loved-ones are encouraged to utilise the accessibility improved resources, with reader-accessible versions created for screen readers, as well as physical copies that have been distributed throughout Victoria. A summary fact-sheet has also been translated into Greek, Italian and Traditional Chinese.

Solicitor and ACJ CEO, Anna Willis says, “Community engagement revealed confusion on what is a restrictive practice and debate about when they should be used and who should provide consent to their use.”

“We are pleased we could assist many family members with better understanding of these practices, and improve the quality and safety of care.”

Employee time and training

The ACJ report lays out clear points that are critical for front-line staff and provider leadership to be across in understanding and practice.

From explanations of the federal and state legislation overseeing the legal framework for restrictive practice use, to a clear definition of restrictive practices, the report may well be used by providers to facilitate the deeper education of staff to avoid future misuse.

Through providing time to comprehensively go through the report, provider leadership may substantively support the quality of training, and subsequent practice, of care by front-line staff that wish in earnest to provide quality.

The report also details the levels of consent under the law, and the definition of informed consent which is the “key safeguard” under the law when it comes to the use of restraints. In the difficulty of making a decision to use a restrictive practice, front-line staff may be strengthened in their confident to make the right choice by understanding the rules of decision-making capacity, the ranking of restrictive practices substitute decision making (Victoria) and importantly, to understand the overarching provider obligations under the new Aged Care Act 2024.

Supporting staff to be empowered to know the legislation and understand the rules, so they may fluidly and in confidence enact care to meet not only legislation but the protection and dignity of human rights, can lead to strengthened culture and provider operations overall.

The ACJ notes that there has been significant appreciation for professional aged care sector staff. They share that calls for a building up of staff in numbers and training is strong, that supporting front-line staff to handle restrictive practices is highly warranted.

Outcomes

To support the navigating of the complexity of restrictive restraints was key for ACJ in this project, as well as the access of resources to pursue accountability and justice. The ACJ notes that it received a wide range of complaints showcasing the current reality for many. 

Chemical restraint was found to have been used without consent, restraints were used for an extended period of time without loved-one knowledge, requests to desist in the use of restraints were ignored despite proof of adverse consequences, seclusion without consent was utilised without consent resulting in distressed behaviour, these were all managed by ACJ and its partners.

High-performing providers have already been using the resources the ACJ have made available to prevent the aforementioned situations from occurring. However, ACJ notes that much progress must still be made to bring the misuse of restrictive practices around the country as close to zero as possible.

The report shares comments from Professor Ibrahim, a consulting physician in geriatric medicine who believes, “[legislation alone] is ‘normalising’ restrictive practices and condoning suboptimal approaches to care in an effort to avoid investing the additional resources needed to manage the issue”.

Industry leading providers and medical staff echo the need for change. The desire to support nurses and front-line staff to manage behaviour challenges in RAC, without needing restraints, remains an area where support and funding reform may yet see much innovation and improvement.

Legal nurse consultant, Melanie Scott affirms this, “a conscious shift towards a more empathic and humanistic approach is gradually gaining momentum”.

Victoria leading improvement

The ACJ shares in their report that Victoria recorded a 29% decline in reportable incidents of misuse of restrictive practice between 2022-2023 and 2023-2024. Nationally whoever, this figure is not reflected, with only a 7% reduction found. These figures highlight the disjointed improvement across Australia and the need for heightened education in some states.

The Aged Care Quality and Safety Commission notes in their latest sector performance report that the “use of physical restraint continued to rise and has now grown 2.1% in the last 2 quarters to 19.8%”, indicating a need to understand the rise and opportunities to negate and reverse the trend.

Willis shares, “There is more work to do… As a legal organisation, ACJ will keep working to turn legal knowledge and support into real change for older Australians”.

Continued reform and learning

The ACJ has provided invaluable resources for seniors, loved ones, aged care staff, and provider leadership to navigate the complexity of restraint use.

While the use of restraints continues to be complex discussion, the ACJ sharing that there remains a heated debate between those who oppose all restraints and those that emphasise a duty of care, many writing in, “it’s not black and white”, there is opportunity for education to safeguard care in practice at all times.

The complexity of the restraints discussion does not limit the ability for change now. A good and appropriate goal is the reduction of the misuse of restraints to its lowest levels across the entirety of Australia. For seniors confused about their rights, for loved-ones worried about treatment and facilitating increased training for front-line staff unsure of what to do, the ACJ’s report and resources can be a step to educational empowerment and care elevation.