Challenges of Ageing

Introduction to Restricted Practices in Residential Aged Care

The term restrictive practices explains the physical and pharmacological interventions given to non-competent persons. In context with the residential aged care restrictive practices, reflects the activities that control the behavior with the intension of minimizing the associated risk to the residents (Royal Commission,2019). Restrictive practices accounts the restricted use of overuse of psychotropic and other medication that can impact the health of the residents in Australia (Royal Commission,2019). However, these practices can bring forth various fundamental concerns that can impact the dignity and liberty of the residents. It means in case the restriction have been imposed without their consent, can infringe the legal rights associated with the elderly residents. The essay will reflect light on the use of restrictive care practices and the impact of these activities with the legal rights associated with the aged care residents.

Legal Rights

Restrictive practices in residential aged care is provided to manage their challenging activities which is a rising human right issue in Australia. Common types of restrictive practices include detention(indefinitely locking the resident in the room), physical restraint in which the person is restricted to move needlessly, mechanical restraint( tying the person with chair) (The Public Advocate,2017).The other chemical mode of restriction involves the use of sedative to calm the aggressive or violent person. These restrictions can result in negative impact on the mental and emotional behavior of the receiver moreover, the use of these practices can affect the legal rights of the receiver, creating a breach of law and human rights. These practices without their legal consent or any excuse is considered unlawful and older abuse. Australian government along with states and territories has designed a legal framework which protects the legal and ethical dimensions of the aged care residents (The Public Advocate,2017). The common law imposed was related to informed consent and there should be a legal consequences for providing care without any legal consent in competent persons. However, a separate law was designed, which states, in case the person is not mentally fit to take decisions, the substitute can be authorized to persons with impaired capability under the Guardianship Act 1987 (Tuckett et al.,2015).

Various states in Australia have designed policies and guidelines which safeguard the persons rights to decide either to take treatment for mental care or not with respect to the restricted practices in old care residents, as guided by the state and territory mental health legislation. In March, 2014, National Framework designed a quality assurance team that safeguards the legal rights of the residents under the National Disability Insurance Scheme (NDIS) (Royal Commission,2019). The scheme would provide an approach to the application of restrictive practices related to disability services. Eventually from 1 July, 2019, NSID become active in the Australian Capital Territory and Northern Territory and from 1 July, 2019 in the Western Australia (Royal Commission,2019). However, it has been observed that these legal framework for restrictive practices in aged care residents will not provide proper legal framework. The human right treaty in Australia will benefit all the residents by protecting their human rights equally. The International Covenant on Civil and Political Rights protects the rights of the residents to entertain with the highest achievable standards of the physical and mental health (The Public Advocate,2017). The Convention against Torture and Other Cruel, Inhuman or Degrading Treatment (CAT) also protects the human rights equally in Australia related to the restrictive practices in aged acre residents involving people with disabilities either physical or mental (The Public Advocate,2017). 

Physical Harm

Restraint in the medical term, associated with the actions performed to control the aggressive behavior. Three major restraints are involved in the restrictive practices and include physical restraint( holding the person on ground), mechanical restraint which involve use of ropes, jackets, and chemical restraint( sedative drugs) (Kim et al.,2014). The physical restrictions can be also be imposed by the use of device or the removal of the mobility aids or by using physical powers for using disabled behaviors (Kim et al.,2014). These restrictions are usually adopted to protect the person with mental disabilities to prevent from self harm or to others. But in case the practices are imparted without their legal consent can impact their legal and basic human rights, leading to physical harm. These practices in some cases when imposed without receiver consent can prove fatal by causing serious physical consequences which can increase the morbidity rate or can accelerate the dying process. The restrictive practices can trigger the emotional values and beliefs of the receiver (Tuckett et al.,2015). The physical restraints also cause skin injuries, bruising, under nutrition, various health complications, and consequently the older age people depends on others for everyday activity and this dependency turn them into a vulnerable group also, older persons are more prone injuries and mortalities

The restrictive interventions involving the use of ropes can cause serious problems like chocking or suffocation. The definition of physical restraint has been conceptualized and experts have found it a challenging process whether the harm or restrain is provided to the receiver for provoking their basic rights or restrictions can prevent from the associate physical harm to self or others (Tuckett et al.,2015). For example if a person is suffering from dementia or memory loss with the tendency to harm himself and has been locked in the room for safety, in this condition the physical restrain is for welfare rather than a physical harm. Although, these restrictions are imposed to prevent from serious injuries associated with the aggressive behavior. The physical restraint is often justified for improving life quality and reducing falls among older residents. Royal Commission of Inquiry into Aged Care Quality and Safety evaluated that overuse of these restrictions owing to lack skills and knowledge regarding these activities may impact the wellbeing and safety of the persons (Kim et al.,2014). The Australian government has restricted the use of various physical interventions and must be applied with a legal consent and all the restrains should be imparted only for therauptic purposes.

Psychological Harm

Apart from the physical harm, emotional or psychological harm is often related to restrictive practices, where person lack to express their thoughts and views (Candice,2018). Various negative results have been identified with these interventions which impose unethical restrain and can be psychological traumatizing to receivers. The psychological impacts of these restrictions include loss of dignity, agitation, depression, lowered cognitive behavior, and other mental psychological illnesses (Candice,2018). The adverse physical harm are often related with fear and shame where receiver may feel emotionally deprived and can induce suicidal tendency in the receiver Steele et al.,2019). The nurses lacking skills for managing aggressive patients can impact these restrictive interventions by increasing the harm to receiver. Royal Commission studied that persons suffering from acute dementia when treated with medical interventions can impact their psychological balances which may result to death (Steele et al.,2019). The psychological harm is generally related with the emotional, spiritual diminutions affecting their beliefs and values.

The use of various medications to treat the person should always be considered the last option although, various mental therapies can be provided to treatment and include appropriate sensory stimulation, involving family members in therapies(Maker &McSherry,2019). Person can be engaged in various occupational therapies such as laundry or gardening, also therauptic touch or companionship can promote a sense of wellbeing and care in the residents of aged care. Team work can play an essential role by regular monitoring and evaluation of mental therapies. The Royal Australian and New Zealand College of Psychiatrists states that antipsychotic drugs should only be given after the psychotic signs are harmful for self or others (Steele et al.,2019). There is a gap in the restrictive practices that increase mental harm and can introduce the suicidal tendencies in the old aged persons. The Australian Institute for Suicide Research and Prevention’s Suicide reports revealed that the psychological harm is a consequential result of loneliness, lack of social support, social isolation, deprived from family love and care are increase the psychological risk to the residents (King et al.,2016). It can provoke the associated risk to themselves and others contributing to mental illness and suicidal risk. The caregivers are introduced with the importance of social support and social connections can be a major factor in suicide prevention and promote good health and wellbeing among the residents old aged care (Tuckett et al.,2015). Caregivers can initiate strategies to empower and support people to lead all the stages of life in the aged care sector.

Conclusions on Restricted Practices in Residential Aged Care

The effectiveness of restrictive practices and interventions will promote safety and wellbeing by reducing physical and psychological harm. These restrictions generate negative impact on the mental and emotional behavior of the receiver moreover . The application of these practices can impact the legal rights of the receiver creating a breach of law and human rights.. There are various psychological and physical risks associated with the medications provided during restrictive practices in persons lacking abilities to make decisions. The Australian government has developed various legislative frameworks to minimize the negative effects of restrictive practices. All the caregivers should adopt and follow the professional standards and guidelines before starting the restrain practices. The nursing professionals play an essential role in neutralizing the risk by regular monitoring and evaluation of the applied practices for wellbeing and safety. Education and knowledge sharing for the practical application of these practical activities will promote the positive application of restrictive practices in aged care.

References for Restricted Practices in Residential Aged Care

Candice, O. (2018). Fear and blame in mental health nurses’ accounts restrictive practices: Implications for the elimination of seclusion and restraint. International Journal of Mental Health Nursing, 41(2).1-10.

Kim, C., Lindy, W. &Ben, W. (2014) Rethinking restrictive practices: A comparative analysis. QUT Law Review, 14(2), 90-122.

King, J., Edwards, N., Correa-Velez, I., Darracott, R. & Fordyce, M. (2016), "Restrictive practices on refugees in Australia with intellectual disability and challenging behaviours: A family’s story". Advances in Mental Health and Intellectual Disabilities,10(4),222-232.

Maker, Y., McSherry, B. (2019). Regulating restraint use in mental health and aged care settings: Lessons from the Oakden scandal. Alternative Law Journal, 44(1),29-36.

Royal Commission. (2019). Restrictive practices in residential aged care. Retrieved from care#:~:text=Restrictive%20practices%20are%20commonly%20referred,others%2C%22%20the%20paper%20notes.

Royal Commission. (2019). Restrictive practices in residential aged care in Australia. Retrieved from

Sashidharan, S.P., & Saraceno, B. (2017). ‘Is psychiatry becoming more coercive?. BMJ, 41(2), 357, 366.

Steele, L., Swaffer, K.; Phillipson, L. (2019).Questioning segregation of people living with dementia in Australia: An International Human Rights Approach to Care Homes Laws 8(18).1-12.

The Public Advocate. (2017). Inquiry into the quality of care in residential aged care facilities in Australia. Retrieved from file:///C:/Users/Admin/Downloads/Sub060%20Office%20of%20the%20Public%20Advocate.pdf

Tuckett, A., Hughes, K., Gilmour, J., & Hegney, D.(2015). Caring in residential aged‐care. Qualitative findings from an e‐cohort sub‐study. Journal of Clinical Nursing. 18(18). 2604-2612.

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