Alternative Strategies to Restrictive Practices in Aged Care

Restrictive practices in aged care settings are linked to a variety of adverse care outcomes ranging from injury to falls or even death (RCACQS 2019).

Since the findings of the Royal Commission into Aged Care Quality and Safety, Australia's aged care sector has undergone significant legislative reform, culminating in the Aged Care Act 2024 and the accompanying Aged Care Rules 2025, which commenced on 1 November 2025. This new legislation places the rights of older people at the centre of aged care and introduces stronger, enforceable obligations for providers to minimise restrictive practices (DoHDA 2025b; ACQSC 2025a).

Meeting these obligations requires a shift toward proactive, person-centred care. This article explores a range of alternative strategies, from de-escalation techniques to preventive approaches, for managing changes in behaviour and falls.

A Rights-Based Framework for Aged Care

The Aged Care Act represents the most significant reform to Australia's aged care system in decades. It replaces the former Aged Care Act 1997 and introduces a rights-based framework that places the rights and dignity of older people at the centre of every care decision (Australian Government 2024; DoHDA 2025b).

Central to the new Act is the Statement of Rights, which outlines what older people can expect when accessing funded aged care services. Under this framework, providers have a duty to ensure their care practices are compatible with the Statement of Rights (ACQSC 2025b). This means that any use of restrictive practices and the failure to explore alternatives must be considered through a human rights lens.

The Statement of Rights reinforces the right of older people to:

• Make decisions about their own lives and care
• Be treated with dignity and respect
• Receive safe and quality care
• Raise concerns without fear of reprisal
• Communicate in their preferred language or method of communication
• Have their identity, culture and diversity respected and supported.

(Australian Government 2024)

For aged care workers, this framework means that minimising restrictive practices is not simply best practice; it is a legislative obligation that is actively monitored and enforced by the Aged Care Quality and Safety Commission (ACQSC).

Restrictive Practices Under the Strengthened Aged Care Quality Standards

Standard 3: Care and Services - Outcome 3.2: Delivery of care and services (Action 3.2.7) under the Strengthened Aged Care Quality Standards advises that the use of restrictive practices is minimised as much as possible and that when restrictive practices are used, they are:

• Only used as a last resort
• Used in the least restrictive form and for the shortest length of time possible
• Used with the older person's informed consent
• Monitored and regularly assessed.

(DoHDA 2025a)

Note: Under the Aged Care Act, registered providers are legally required to trial and document alternative strategies before using any restrictive practice. This documentation requirement applies to all restrictive practices, including the prescribing of psychotropic medications as chemical restraint (DoHDA 2025b).

Barriers to Preventing Restrictive Practices

Understanding why restrictive practices continue to be used is an important step in reducing them. A number of barriers have been identified that can make it difficult for aged care staff and organisations to move away from these practices.

The Royal Commission identified several potential barriers, including:

• Safety concerns
• Legal concerns
• Fear of care recipient injury
• Staff and resource limitations
• Organisational culture
• Inadequate staff knowledge about the implications of restrictive practices
• Inadequate staff knowledge about alternatives to restrictive practices
• The beliefs and expectations of staff, family and older people
• Paternalistic views towards older people
• Communication barriers
• Complex care needs
• Inadequate collaboration between healthcare professionals and aged care workers.

(RCACQS 2019)

Alternative Strategies to Restrictive Practices

Preventing the need for restrictive practices begins with delivering person-centred, empathetic care that prioritises the comfort, safety and wellbeing of each older person (VIC DoH 2022).

General Tips

In general, aged care services should:

• Recognise behavioural changes when they occur and identify older people who may be at risk of requiring restrictive practices
• Conduct a comprehensive assessment of each care recipient and develop an individualised plan if any risk factors are identified. The assessment should include:
  • Cognitive assessment
  • Medical history
  • Responsive behaviours
  • The person's routines, preferences and values
  • Pain assessment
  • Communication ability
  • Delirium
  • Medications
  • Mental state
  • Falls risk
  • Psychosocial needs
  • Physical environment
• Refer the individual to other services (e.g. general practitioner, physiotherapist) if deemed necessary
• Assess behaviour interventions and falls prevention strategies on an ongoing basis
• Involve the individual and their supporters in the process of developing and implementing strategies
• Ensure staff are adequately trained in the ethics of restrictive practices and possible alternatives
• Recognise situations that may cause care recipients to become distressed, anxious or aggressive
• Ensure all alternative strategies trialled are documented in the older person's clinical record, in accordance with the Aged Care Act and the Aged Care Rules.

(VIC DoH 2022)

Preventing Falls

To help reduce the risk of falls without resorting to restrictive practices, you can:

• Use equipment such as non-slip mats
• Ensure the service environment is secure, well-lit and safe for walking
• Address underlying health issues such as mental health conditions, sensory loss, poor balance or unstable blood pressure, and ensure medication is reviewed regularly
• Ensure the individual's bed height is appropriate for their needs, and the brakes are applied
• Keep mobility aids close by
• Ensure seating meets the individual's needs
• Implement an alarm system to notify staff of potential dangers
• Ensure indoor areas are free of clutter
• Reduce glare in corridor areas
• Use non-slip or carpet flooring
• Implement signage and visual aids to aid orientation
• Ensure outdoor areas are safe and protected
• Provide sensory aids, if required.

(My Aged Care 2022; VIC DoH 2022)

Managing Changed Behaviours

Note: Changed behaviours are sometimes called 'behaviours of concern' or 'challenging behaviours'. However, the term 'changed behaviours' is preferred as it avoids negatively stigmatising people who display behaviours that indicate a need for support (DSA 2021).

Providing a Respectful and Welcoming Service Environment

While reducing the need for restrictive practices involves exploring alternative options in challenging situations and learning to effectively de-escalate conflict, prevention should begin at a grassroots level. In other words, you should consciously ensure your interactions, communication and engagement with older people actively address their needs and make them feel comfortable. This, in turn, will aim to reduce the incidence of changed behaviours in the first place.

The following are some practical suggestions for caring for older people in a way that will help reduce changed behaviours:

• Ensure you provide trauma-informed care
• Always provide person-centred care
• Be polite and respectful, and practice effective and empathetic communication
• Meet the individual's immediate needs
• Provide the individual with access to a range of meaningful activities they can choose from
• Align the individual's routine with what they are used to (e.g. shower and sleeping patterns)
• Respect the individual's communication needs
• Avoid invading the individual's personal space
• Inform the individual in advance before providing care
• Consider the individual's values and preferences
• Support the individual to make choices or suggest alternatives
• Surround the individual with familiar objects from home
• Encourage visitors and appropriate interactions with staff
• Ensure continuity of staff, if possible
• Offer relaxing activities (e.g. therapeutic touch or massage)
• Decrease sensory overload
• Individualise the person's routine.

(VIC DoH 2015; VIC DoH 2022; Roberton & Daffern 2022)

Responding to Changed Behaviours

Note: For specific guidance on responding to behavioural and psychological symptoms of dementia using the ABC Approach to Behaviour Management, see Behaviour Management and BPSD.

It's important to remember that changed behaviours generally have underlying causes. These may include:

• Pain, discomfort or illness
• Interruption to routine
• Fatigue
• Medication changes, side effects or interactions
• Changes to the living environment
• Life events
• Wanting to communicate something
• Boredom or loneliness
• Delirium
• Constipation
• Dehydration
• Hunger or low blood sugar
• Mental illness (e.g. depression or anxiety)
• Hallucinations or delusions
• Restlessness
• Sensory impairment.

(Carer Gateway 2015; VIC DoH 2022; Dementia Australia 2025)

When faced with changed behaviours, consider why they are occurring and how the individual's unmet needs can be addressed.

Knowing the person's typical behaviour will help you to recognise changes (VIC DoH 2019).

It may be useful to keep a log of changed behaviours in order to identify a specific pattern or trigger. If a trigger is identified, try to avoid or reduce the individual's exposure to this particular situation (Aged Care Guide 2022).

Any strategies that have previously been successful in managing this behaviour should also be recorded (VIC DoH 2019).

Non-pharmacological Interventions

If the changed behaviours are having minimal impact on safety, wellbeing and quality of life, consider individualised, meaningful interventions such as:

• Life review and individual's story work
• Modifying the person's physical environment
• Social inclusion, such as one-to-one interaction or meaningful hobbies
• Validation therapy
• Sensory therapies (e.g. aromatherapy, massage, animal-assisted therapy)
• Reminiscence therapy
• Simulated presence therapy
• Physical exercise
• Assistive technology
• Psychological therapy.

(VIC DoH 2019)

De-escalation Strategies

If changed behaviours escalate, it is important to assess the risk they pose to the individual, yourself, and others. Consider:

• The type, degree and immediacy of risk
• The nature, frequency and severity of the individual's behaviour and the context in which this behaviour is occurring
• The severity of distress being experienced by the individual, as well as by other people.

(VIC DoH 2019)

If the individual becomes agitated or aggressive, the following de-escalation strategies may help to calm them down and prevent the situation from intensifying further:

• Speak to the individual in a quiet area with minimal stimulation, while ensuring the safety of yourself and others. If there are safety concerns, respectfully and carefully divert the individual or divert others from the area.
• Remove any potentially dangerous items from the environment.
• Call for extra assistance if needed.
• Observe the individual's body language and try to understand what they may be feeling.
• Approach the individual calmly, empathetically and respectfully.
• When speaking to the individual, remain calm, introduce yourself, use their preferred name and provide verbal reassurance, e.g. 'You are in a safe place, and we are here to help.'
• Use non-threatening behaviour and body language.
• Ask the individual what the problem is. Ensure you allow them adequate time to respond and to have their concerns heard.
• Validate the individual's concerns and acknowledge their feelings (e.g. 'I can see you're upset.')
• Avoid arguing or trying to reason with the individual.
• Apologise if the individual is upset about something that has happened (if reasonable).
• Assess whether environmental stressors, such as noise, temperature or light, might contribute to the behaviour, and remove or alter the environment if possible.
• Consider the following:
  • Does the individual need more information or an explanation?
  • If you are asking the individual to do something, can it be done later?
  • Is the individual able to make connections between their actions and the consequences?
  • The individual is allowed to feel angry - is it possible for them to vent in private?
• Address any unmet needs.
• Redirect the individual to a meaningful activity that they enjoy.
• If it is safe to do so, leave the individual and return later.

(VIC DoH 2022; DSA 2021; Queensland Health 2023)

Conclusion

If the situation continues to escalate and there is a risk of harm to the individual, yourself or others, you may need to consider a restrictive practice. However, keep in mind that this should be a last resort and must be used only where alternative strategies have been trialled and documented. Where a restrictive practice is used, informed consent must be obtained from the older person or their restrictive practices substitute decision-maker (except in an emergency), and the incident must be reported in line with Serious Incident Response Scheme (SIRS) obligations (DoHDA 2025b; End of Life Law for Clinicians 2025).