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.
As a Trainer I heavily advocate for the alternatives to restraint with my students such as redirection or distraction and emphasize the client ‘s rights to movement to the point of ensuring they don’t tuck in bed clothes as it is restraint. I don’t know why more trainers don’t follow these basics so their students know what is right irrespective of staff problems
I too am a trainer within the sector and have worked in the sector from cert III to post graduate RN of 25 years. Some learners seem surprised when we discuss the different ways restraint and coercion occur in every day activities and interactions. The sector constantly complains about staff shortages but there are some fundamental issues causing this shortage. Until you train people correctly, there will always be a high level of staff burnout as workers try their best to cope without the skills and tools they need to be successful in their role. If you want to attract highly skilled RNs to the sector, you need to pay higher than R5 wages. Specialist knowledge shared during the work day would make a huge difference and education would happen in the role rather than a classroom. I agree, the sector is in trouble and no one really seems to want to drill down to rot cause. Everyone is recaching for bandaids.
Where are RNs Div 1 situated in majority of RACFs, not on the clinical floor.
It is PCAs and RN Div2 aka enrolled nurses who are doing the face to face interaction and activities.
The higher the qualification and experience of RNs the further they are from clinical practice and there is something fundamentally wrong with that practice.
I was a lousy DON as I was on the clinical floor more often than not and would engage in personal hygienes, wound management and other activities.
We have our own professional for our lower wages as nurses who worked in aged care were considered the ones who couldn’t make it in the acute sector- well that soon went topsy turvy as when acute care nurses came into aged care they didn’t have a clue.
Aged care nurses have to be highly skilled, know not only what is the ageing effects but also disease processes, medications and interactions and be astute detectives.
Then add on behaviour memory clinic practices, palliative and terminal care together with counselling skills.
Formal and informal education and training is mandatory – referred to as professional development and a trainer is only as good as their currency and experience.
How some are deemed trainers escapes me when you find out their only experience was on a work placement and they are training cert IV and Diploma level or have been out of the clinical area for more than 5 yrs.
Because of this rule in the aged care sector we have residents that cannot be showered for weeks on end. Some walk around smelling of urine for days because the staff cannot find ways to encourage hygiene practices. It is passed onto the next shift over and over again. You wouldn’t let a toddler walk around with a dirty nappy or smelly pants would you? I don’t know what the answer is to this but if their dementia is so bad that they refuse to be showered because it is their right to say no then I see this as neglect and abuse just as much. So how do you help someone who is incapable of making decisions for themselves? Or do we wait until they are so incapacitated and bedbound it is the only way to achieve any sort of hygiene cares?
Hit the nail on the head Prof Ibrahim “ticking boxes rather than changing culture”
So very sad to read this, how many other countries does this happen in?