Experts are warning that Australia’s aged care sector is in danger of normalising restrictive practices, despite laws that were meant to eliminate them and safeguard residents’ human rights. A new report from advocacy group Aged Care Justice has revealed that the use of physical restraints continues to rise, prompting fears that restraint is becoming a default part of care rather than a last resort.
According to the report, physical restraint use has risen by 2.1 per cent in the past two quarters, now affecting nearly one in five aged care residents (19.8 per cent). The finding has alarmed experts who say the sector is failing to implement the intent of recent reforms and is instead embedding restrictive practices into routine care.
Professor Joseph Ibrahim, a leading aged care safety and quality expert from Monash University, said that despite legislative change, the system is drifting towards acceptance of practices that undermine older people’s autonomy.
“Legislation is not solving the root cause,” Professor Ibrahim said. “It is ‘normalising’ restrictive practices and condoning suboptimal approaches to care.”
Restrictive practices in aged care refer to any action or intervention that limits a person’s freedom of movement or decision-making. These include physical restraints such as bed rails, lap belts and chair tables, as well as chemical restraints, where sedatives or antipsychotic medications are used to manage behaviour. While they are legally permitted under strict conditions, they are only meant to be used in extreme circumstances and for the shortest time necessary.
Yet advocates say the reality in many aged care homes looks very different. Staff shortages, insufficient behavioural training, and a culture of risk aversion have contributed to the routine use of restraints as a way to manage residents, rather than to protect them.
The Aged Care Justice report argues that this represents a profound ethical failure in how Australia cares for older people. It notes that while legislation such as the Aged Care Quality Standards and the 2021 amendments to the Aged Care Act sought to limit the use of restraints, the lack of meaningful enforcement and education has allowed restrictive practices to persist under the guise of compliance.
Professor Ibrahim said the system’s focus on documentation and regulatory compliance has missed the point of person-centred care. “We are not addressing the fundamental issue, which is how to provide person-centred care without taking away people’s freedom,” he said. “We are ticking boxes rather than changing culture.”
Dr John Chesterman, Victoria’s Public Advocate, echoed these concerns and cautioned that governments and providers must ensure regulation does not inadvertently legitimise restraint.
“We need to regulate — not regularise — restrictive practices,” Dr Chesterman said.
He added that while rules are necessary to prevent abuse, they can also create a false sense of legitimacy if not paired with clear accountability and education. “The danger is that by defining restraint in legislation, we start to see it as part of the normal toolkit of care rather than something exceptional.”
The Aged Care Justice report calls for stronger independent oversight, better transparency in reporting, and mandatory training for all staff in de-escalation and alternative behavioural approaches. It also recommends involving residents and families in care planning to ensure consent and understanding whenever restraint is considered.
Advocates say that while some facilities are adopting innovative approaches — such as environmental design, sensory interventions, and personalised engagement programs- these efforts are inconsistent and often underfunded. Without systemic reform, they warn, restraint will continue to be used as a substitute for adequate staffing and skilled care.
The debate over restrictive practices strikes at the heart of Australia’s aged care reform journey: whether the system values autonomy and dignity as much as safety and control. For many experts, the current trajectory suggests that the balance has tipped in the wrong direction.
Professor Ibrahim said the increase in restraint use should serve as a wake-up call. “If we truly believe in dignity and respect for older people, we must stop pretending that restraint is care,” he said. “It is a failure of the system, not a solution.”
The Aged Care Justice report concludes that meaningful change will only come when providers and policymakers address the underlying causes of restraint use — including understaffing, inadequate clinical support, and a lack of person-centred training. Until then, the report warns, restraint will remain a symptom of a system struggling to balance compassion with control.
As Australia continues to reform its aged care system, experts are urging leaders to remember that protecting rights means more than passing laws. It requires culture change, empathy, and the courage to see restraint for what it is: a last resort, not a routine response.
Can staff in the nursing homes refer angry relatives of residents whom have had a fall and sustained injury and those residents who are the victims from other residents due to behaviours to Aged Care Justice representatives?
Because this is the reality.
Despite every intervention possible these incidents happen.
Increasing staff numbers and education is a choice which we all support however tell me where are those staff?
There is a shortage and many facilities are running on agency and transient staff members, those who are still ‘green’ when it comes to experience and experience is the key (not numbers and academia) that is required.
You are damned if you do and damned if you don’t and it is reports such as these that highlight the deficits and slap in the face those facilities and staff who are person centred and are using restraint as the last option and in short intervals.
Did Aged Care Justice obtain the data from residential facilities where residents were on existing psychotropic medications due to pre existing illnesses?
That throws the numbers out and we know it is not clinically recommended to cease the medication, review and adjust- but not cease.
Will Aged Care Justice be obtaining data of restraint used in the home setting or is that okay?
‘Yes’ quite a few questions and until they are answered then we will not truly have a balanced report.
Aged care providers in the current climate try and avoid restraint at all costs, we certainly do. The use of restraints requires documentation, monitoring and agreement from all parties involved. The reality is that to avoid using restraints there will be residents that aged care providers will not accept because they know that they will need to be restrained. I believe that the majority of the people in public hospitals waiting for an aged care bed, are probably men with cognitive deficits, who are likely to either need restraint in aged care or who are likely to be involved in physical incidents with other residents. Dementia specific units often have far more women than men and so tend to be far more physically frail and vulnerable. So, aged care providers, to reduce the need to manage and report the use of restraints, and to also minimise the possibilities of Reportable Incidents will choose not to admit a large number of potential residents. This is exacerbated by the fact that those very people whilst waiting for an aged care bed are often subject to chemical restraint in public hospitals where the same rules do not apply. Until bureaucracy familiarises itself with the realities of the real world the issue will not go away. And is it better to live in a public hospital for 6 months and be restrained or to live in an aged care facility and be restrained? I would choose the latter.