Restrictive practices and chemical restraint in aged care

What counts as a restrictive practice

A restrictive practice is any practice or intervention that restricts an older person's rights or freedom of movement. The law names five types.

When is medication chemical restraint?

Medication prescribed and documented to treat a diagnosed health condition, such as a diagnosed psychosis, is treatment. Medication used mainly to manage behaviour is chemical restraint. The Department is clear on the case families meet most: medication prescribed for the behavioural and psychological symptoms of dementia is chemical restraint, so every rule in this guide applies to it.

A practice still counts when the family asked for it. In the government's quality reporting, a bed rail or locked door that the resident or their family requested is recorded as a restrictive practice like any other.

Source: Aged Care Quality and Safety Commission: minimising restrictive practices

The rules a home must follow

A registered provider of residential aged care can only use a restrictive practice if:

• it is a last resort to prevent harm to the resident or people around them, after considering how it affects the resident
• it is used in the least restrictive form and for the shortest time possible
• an approved health practitioner (a medical practitioner, nurse practitioner or registered nurse) has assessed it as necessary and documented that
• best practice alternative strategies have been used and documented first, as far as possible
• a behaviour support plan is in place and being followed
• the resident, or their restrictive practices substitute decision-maker, has given informed consent.

The provider must also monitor and regularly review any restrictive practice. Following these rules is a condition of the provider's registration under the Aged Care Act 2024.

Extra rules for chemical restraint

Before a medicine is used as chemical restraint, the provider must be satisfied that the doctor or nurse practitioner who prescribed it obtained informed consent to prescribing it. If the provider cannot be satisfied of that, the chemical restraint cannot be used. Providers must also keep the prescriber informed about the resident's needs and any changes.

Care at home

These specific consent and behaviour support rules apply to residential aged care. Every registered provider, including home care providers, must still report the inappropriate use of a restrictive practice to the Aged Care Quality and Safety Commission under the Serious Incident Response Scheme.

Source: Department of Health, Disability and Ageing: restrictive practices in aged care, a last resort

Consent: what it must look like

For consent to be valid it must be informed, voluntary, current and specific, and given by someone with the capacity to understand and communicate the decision. Before anyone agrees, the home should explain:

• the proposed restrictive practice, including whether it involves medication
• why it is being proposed
• the alternatives, including not using it at all
• the risks and benefits of the practice and of each alternative.

The person deciding should have time to read, ask questions and reach their own decision without pressure.

No blanket consent

Consent must be given for each type of restrictive practice and the circumstances in which it will be used. Overarching or advance consent cannot be given, and the Department says seeking or accepting blanket consent for all types of restrictive practice is contrary to the Aged Care Act 2024, the Quality Standards and the Statement of Rights. A form signed at admission that agrees to "restraint if required" is not valid consent.

Consent is time-limited, and you can say no

• The home must tell you how long it intends to use the practice. Using it beyond that time, or in other circumstances, needs fresh consent.
• Consent can be withdrawn at any time.
• It must be reviewed regularly, and whenever circumstances change: a change in mood or behaviour, a decline in health, a hospital stay, a fall or an incident.
• The person consenting can refuse. The provider and the health practitioner must respect that, and the practice cannot be used. The home cannot go further down the list to find someone who will agree.
• The person consenting can ask for a second opinion on any treatment, including medication.

Emergencies

In a genuine emergency (a serious, unforeseen situation that needs immediate action) a restrictive practice may be used without prior consent. This should be rare. As soon as practicable, the home must tell the substitute decision-maker what was used and why, and record it in the behaviour support plan.

Source: Department of Health, Disability and Ageing: consent for restrictive practices, frequently asked questions

Who consents if your parent cannot

Older people should be supported to decide for themselves wherever possible. If your parent has capacity, the decision is theirs. If they cannot consent, the decision passes to a restrictive practices substitute decision-maker (often shortened to RPSDM), identified under the law of the state or territory where they live in care. The role is narrow: it covers consent to restrictive practices only, not where the person lives or their money.

In Victoria

The Aged Care Restrictive Practices Substitute Decision-maker Act 2024 (Vic) sets out four tiers:

1. A nominee. A person with capacity can nominate an adult, in writing and in advance (before or after moving into care), with an appropriate witness who can take an affidavit. The nominee must agree. Someone employed by, or acting for, the resident's aged care provider cannot be the nominee.
2. A temporary decision-maker. If there is no nominee, the home identifies the first adult on this list who has a close and continuing relationship with the resident and is reasonably available, willing and able: spouse or domestic partner, primary carer, oldest adult child (then the next oldest), older parent, oldest sibling. The appointment ends once that decision is made.
3. A person appointed by VCAT.
4. VCAT itself, as the decision-maker of last resort.

Disagreements between family members over who decides can go to VCAT if they cannot be settled informally.

Elsewhere in Australia

Each state and territory has its own process, through its tribunal, public advocate or public guardian: NSW, Queensland, South Australia, Western Australia, Tasmania, the ACT and the Northern Territory.

The Commonwealth fallback list

Where a state or territory has no legal way to appoint a substitute decision-maker, or a tribunal application is significantly delayed (months or years, not days or weeks), the Aged Care Rules 2025 set a fallback order: a nominee chosen by the person, then their partner, then a relative or friend who was their unpaid carer immediately before they entered care, then another relative or friend, then a medical treatment authority appointed under state law. Each must agree in writing and have capacity. If nobody fits, the home must apply to the tribunal, and until then it cannot use the restrictive practice.

Under section 163 of the Aged Care Act (as compiled at 1 July 2026), providers relying on consent from someone on this Commonwealth list are protected from civil and criminal liability only for restrictive practices used before 1 December 2026. This area may change, so check the current arrangements with the home.

If you expect to be the person asked, ask the home now who it has recorded as your parent's substitute decision-maker, so there is no confusion when a decision is needed.

Source: Department of Health, Disability and Ageing: role of a restrictive practices substitute decision-maker (July 2026)

The behaviour support plan

A behaviour support plan is required when a resident shows changed behaviour that needs support, or when a restrictive practice is considered or used. It forms part of the resident's care and services plan. It must include:

• information that helps staff understand and support the resident and their behaviour
• any assessments relevant to that behaviour
• when the changed behaviours happen, and their triggers or causes
• tailored alternative strategies, which come first
• details of any restrictive practice: how it will be used, for how long, how often, and the intended outcome
• how the practice will be monitored and evaluated.

The home must prepare, review and revise the plan with the resident (and their supporter, if they have one) or with their substitute decision-maker. The resident also has a right to records about their own care, so you can ask to see the plan.

For help with changed behaviours, Dementia Support Australia runs a 24-hour helpline on 1800 699 799 for family members and care staff. The National Dementia Helpline, run by Dementia Australia, is 1800 100 500.

Source: Aged Care Quality and Safety Commission: minimising restrictive practices (behaviour support plans)

Warning signs, and when misuse must be reported

The Commission lists these warning signs that a resident may have been subjected to the inappropriate use of a restrictive practice:

• red marks, bruising, tears or grazes on the skin that seem linked to a physical restraint
• tiredness, drowsiness or confusion
• an increase in frustration, anger or complaints
• refusing medication, or seeming afraid of it.

Any use of a restrictive practice that does not follow the rules is a reportable incident. The provider must first make sure the resident is safe, arrange medical or psychological help if needed, and tell the resident and family what it is doing to fix the problem (open disclosure). Then it must notify the Commission:

• within 24 hours, if there are reasonable grounds to involve the police, or the resident was hurt badly enough to need medical or psychological treatment (Priority 1)
• within 30 days, for all other cases (Priority 2).

If you notice a warning sign, write down what you saw and when, and raise it with the home straight away. You do not need proof to ask.

Source: Aged Care Quality and Safety Commission: inappropriate use of restrictive practices (Serious Incident Response Scheme)

How restrictive practices are measured

Every government-funded aged care home reports 14 quality indicators every three months under the National Aged Care Quality Indicator Program. Two relate to restraint:

• Restrictive practices. Staff review every resident's records over three days, on a collection date that changes each quarter and is meant to be unpredictable to care staff. The home reports the share of residents subject to any restrictive practice other than chemical restraint, and the share restricted only through a secure area. Each use must be recorded even when consent was given.
• Antipsychotic medicines (part of the medication management indicator). The home reviews seven days of medication charts and reports the share of residents who received an antipsychotic, and how many of them had a diagnosed psychosis.

The Australian Institute of Health and Welfare publishes this data each quarter at national, state and territory level. Individual homes' results feed into the Quality Measures part of the Star Ratings published by the Department of Health, Disability and Ageing, which include restrictive practices. See aged care Star Ratings explained.

Chemical restraint is not counted in the restrictive practices indicator itself, so on a tour ask directly about sedating medicines and how often their use is reviewed.

Source: Department of Health, Disability and Ageing: National Aged Care Quality Indicator Program Manual, Part A (September 2026)

What families can ask, and what to do

You are entitled to ask, and good homes expect it. Useful questions:

• Is this a restrictive practice? For a medicine: what is its main purpose, and is it treating a diagnosed condition?
• Who assessed it as necessary, and what alternatives were tried first?
• Can I see the behaviour support plan?
• Who is recorded as giving consent, to exactly what, and for how long?
• What seems to trigger the behaviour, and what does the plan do about the triggers?
• When will it be reviewed, and what is the plan to reduce or stop it?

If you are worried:

1. Raise it with the home, ideally in writing, and ask for answers to the questions above by a set date.
2. If you are the substitute decision-maker, you can refuse or withdraw consent, and ask for a second opinion.
3. Call OPAN on 1800 700 600 (Monday to Friday 8am to 8pm, Saturday 10am to 4pm). Its advocates cost nothing and can come to a meeting with the home, at your parent's direction.
4. Complain to the Aged Care Quality and Safety Commission online or on 1800 951 822. You do not have to raise it with the home first, and you can complain confidentially or anonymously.

In an emergency, or if you believe a crime such as an assault has happened, call 000. For the full complaint steps, see how to make an aged care complaint.

Source: Aged Care Quality and Safety Commission: minimising restrictive practices