Restrictive Practices & Chemical Restraint in Aged Care (2026)

If you've been told your mum or dad is being given a sedative "to settle them", or you've noticed bed rails, a locked door, or a lap belt, you're right to ask questions. These are restrictive practices, and Australian law now treats them very seriously.

The Royal Commission into Aged Care Quality and Safety (2018-2021) found that restraint had at times been used in ways that were, in its words, inhumane, abusive and unjustified - particularly the prolonged use of powerful psychotropic (mind-altering) medication on people living with dementia, often without proper permission. Its final report, Care, Dignity and Respect, called for urgent reform.

In response, the law was tightened in stages, and on 1 November 2025 a brand-new framework began: the Aged Care Act 2024 and the Aged Care Rules 2025, alongside strengthened Aged Care Quality Standards. These are more detailed and measurable than the old rules. This guide explains, in plain English, what is and isn't allowed in 2026, what consent you're entitled to be asked for, and exactly what to say if something doesn't feel right. This is general information, not legal or medical advice - for help about your specific situation, use the free phone lines listed throughout.

A restrictive practice is any practice or intervention that has the effect of restricting a person's rights or freedom of movement. Under the legislation there are five types, with definitions aligned to those used under the NDIS:

• Chemical restraint: medication or a chemical substance used for the primary purpose of influencing a person's behaviour. The most common form is psychotropic medication (drugs affecting the mind, emotions and behaviour) - mainly antidepressants, anxiolytics/hypnotics (often benzodiazepines), and antipsychotics. Crucially, it does NOT include medication prescribed to treat a diagnosed mental disorder, a physical illness or condition, or for end-of-life care. Those have a genuine medical purpose; restraint is when medication is used to manage behaviour.

• Mechanical restraint: a device used to prevent, restrict or subdue movement to influence behaviour - for example bed rails, lap belts, harnesses, certain restrictive clothing, or a wheelchair with brakes applied so the person can't move themselves. Devices for genuine therapeutic reasons (a cast for a broken bone, a wheelchair for someone who needs mobility support) are not restraint.

• Physical restraint: using physical force to prevent, restrict or subdue body movement to influence behaviour - for example pinning someone down or holding them to force a shower or medication. It does not include a reflexive, caring action like catching someone who is falling or guiding them from danger.

• Environmental restraint: restricting free access to parts of the person's environment, items or activities to influence behaviour - locking away a walking frame, restricting access to the garden, or limiting an activity. (It doesn't cover off-limits areas like kitchens or medication rooms.)

• Seclusion: solitary confinement in a room or space, at any hour, to influence behaviour, where the person can't freely leave.

This is the single most important principle, and it's the law. A restrictive practice must only be used as a last resort to prevent harm to the older person or others - and only after the provider has considered how it affects that person. If used at all, it must be in the least restrictive form and for the shortest possible time.

"Last resort" is not a slogan. Before using any restrictive practice, the provider must trial and document alternative strategies first. For behaviours of concern (especially in dementia), the first question should always be why the behaviour is happening - the person may have an unmet need such as pain, fear, boredom, infection, or a noisy environment. Dementia Australia notes antipsychotics help only around one in five people with dementia for short-term severe agitation, and carry real risks including falls, stroke and increased mortality - so non-drug approaches must be tried first.

Providers now also face stronger accountability: the framework includes restrictive practices compliance notices and the potential for civil penalties where providers don't meet their obligations. Under the strengthened Quality Standards (from 1 November 2025), clinical care - including restrictive practices and behaviour support - sits under a dedicated Standard 5.

Informed consent is required before a restrictive practice is used. Consent comes from the older person if they have capacity, or otherwise from their substitute decision-maker. "Informed" means a genuine conversation - not just a signature.

That conversation must cover: the behaviour or condition being managed; the options and alternatives (including not treating); the risks and benefits of each; the side effects and potential harms; what monitoring will happen; and how the effect will be reviewed. The person consenting must have enough information and time to ask questions and reach their own independent decision.

What is NOT valid: blanket or indefinite consent. The Quality Commission is explicit that forms giving blanket or open-ended consent for medications or restrictive practices are insufficient and contrary to law and the Quality Standards. A signed form is invalid if no proper conversation took place, or if the person signing lacks the capacity or authority to decide. Consent doesn't have to be written - it can be given in person, in writing, or by phone to the prescriber - but it must follow a real informing process and be documented with a date.

Consent can also be refused or withdrawn at any time. A substitute decision-maker can refuse to consent to a restrictive practice and can revoke consent at any stage. In a genuine emergency a practice may be used to prevent imminent harm, but the provider must then communicate that to the substitute decision-maker and document it.

If the older person can't give informed consent themselves, a Restrictive Practices Substitute Decision-Maker (RPSDM) must consent on their behalf. An RPSDM can consent to (or refuse) a restrictive practice, and to the prescribing of medication where chemical restraint is proposed.

Where a state or territory has a legal way to appoint an RPSDM (for example via a guardianship tribunal), that pathway is used. Where there's a gap - or a significant delay by a tribunal - providers follow the Commonwealth RPSDM hierarchy set out in section 6-20 of the Aged Care Rules 2025, in this order: a restrictive practices nominee chosen in advance by the person; then a partner with a close continuing relationship; then a relative or friend who was the person's unpaid carer immediately before they entered care; then a relative or friend who was not the carer; then a medical treatment authority appointed under state/territory law. Each must have agreed in writing and have capacity to consent.

This Commonwealth hierarchy is a transitional safety net: its application has been extended to 1 December 2026, to give all states and territories time to put appropriate consent and guardianship laws in place. If you expect to make these decisions for a parent, ask the provider now who is recorded as the RPSDM, and consider formal arrangements (such as an enduring guardian) so there's no doubt. For free help understanding your role, OPAN runs a substitute decision-makers toolkit and advocacy line.

You are allowed to ask, and you should. Practical questions to put to the facility or prescriber:

• "Is this a restrictive practice?" If a new medication is being used to settle behaviour, ask directly whether it's chemical restraint and what its primary purpose is.

• "What did you try first?" Ask which non-drug alternatives were trialled and documented, and why they didn't work.

• "Can I see the behaviour support plan?" Every person who has a restrictive practice considered or used must have one, including evidence of consent. You're entitled to be involved.

• "Who consented, and to exactly what?" Confirm whether you (or the recorded RPSDM) were asked, what risks and side effects were explained, and the review date.

• "How and when will this be reviewed and reduced?" Restraint must be for the shortest time - ask when it will be stepped down.

If you're worried, raise it with the provider first - but you don't have to. Inappropriate use of a restrictive practice is a reportable incident: providers must report Priority 1 incidents (serious harm, or grounds to involve police) to the Commission within 24 hours, and Priority 2 incidents within 30 days. You can also complain directly and for free - anonymously if you wish - to the Aged Care Quality and Safety Commission on 1800 951 822, even if you haven't spoken to the provider first.

Free, independent support is there for you: My Aged Care 1800 200 422 for general help and complaints; OPAN's older persons advocacy line 1800 700 600 (Mon-Fri 8am-8pm, Sat 10am-4pm) for a free advocate on your side; and for any financial or fee questions, Services Australia's free Financial Information Service on 132 300. This guide is general information only and isn't personal medical, legal or financial advice - these services can help with your specific circumstances.