Restrictive Practices at Home: A Behaviour Support Approach First

The Bed Rail in the Hallway

There is a bed stick sitting in a hallway somewhere in Australia right now.

It was prescribed, maybe six months ago, maybe two years ago. A thorough assessment was done at the time. Risks were documented and handed over to the family and care partner. The equipment was ordered and installed and the care partner advised ‘no further OT input required.’

The rail is still there. Nobody has reviewed it. The consumer's cognition has declined. They have started falling out of bed and need assistance to transfer. Her daughter, who holds an Enduring Power of Attorney (for financial matters) told the care partner, it was fine to keep it there. “It keeps her safe as it stops her from getting out of bed at night and falling”, and “we don’t have enough funding for ‘another OT review’.” The care partner put that in the notes.

Under the Aged Care Act 2024, that bed stick could now, almost certainly be considered a mechanical restraint. Was the consent properly authorised? There is no behaviour support plan. Where does the risk sit in terms of non-compliance and restrictive practice? The prescriber or the provider?

In the context of aged care, restrictive practices is usually vaguely understood as something that happened in residential facilities e.g. lap belts, bedrails, locking the door of a dementia-specific unit. It was known to be happening, and that it wasn’t right. Facilities should be adequately staffed to supervise people at risk, and not leaving people in tilt and space chairs ‘to keep them safe’ as they would fall otherwise. That’s a staffing issue. But how does that translate to community aged care? Family and providers, most of the time, have the best interests of the client in mind - trying to keep them safe. Trying to manage their own stress levels or compliance risk, alongside that.

However, Occupational Therapists are the ones prescribing the equipment.

A lap belt prescribed for postural support, with full consumer consent, documented thoroughly, and reviewed regularly: not a restrictive practice.

The same lap belt prescribed because the consumer keeps trying to stand and fall: mechanical restraint. And if it's mechanical restraint without proper consent and a behaviour support plan, it's a compliance failure.

It wasn’t until the introduction of mandatory reporting in community aged care, the Serious Incident Reporting System in December 2022, that actually make restrictive practices in the home, part of the legislative framework.  

Something Significant Has Changed

On 1 November 2025, the Aged Care Act 2024 came into force.

It replaced the Aged Care Act 1997, which had governed aged care for a long time. The new Act is rights-based, which we know, centres the older person, not the funding structure and it came with the Aged Care Rules 2025, a detailed set of subordinate rules that operationalise exactly what providers, workers, and clinicians must do.

For community OTs, the changes that matter most are these:

1. The Care and Services Plan is now the legal vehicle. A restrictive practice cannot be applied in a home or community setting unless it is documented in the consumer's Care and Services Plan. If your recommendation led to a restrictive device being used, and it isn't in that plan, with the behaviours of concern, the manner of use, the duration, and the frequency, the provider is non-compliant. Occupational Therapy assessments should triggered that documentation, but many providers are catching up.

   
   

2. The consent rules are more explicit, but for residential care. Where does that leave in-home care? Informed consent must come from the consumer, or if they lack capacity, from a Restrictive Practices Substitute Decision-Maker (RPSDM) with verified authority (residential care only). VCAT notes that an RPSDM appointed under the 2024 Victorian Act cannot consent to the use of restrictive practices in settings outside of residential aged care, such as home care. While the specific Victorian RPSDM Act doesn't apply to home care, all Commonwealth-funded providers (including home care) must adhere to the Serious Incident Response Scheme (SIRS), which requires reporting the inappropriate use of restrictive practices.

   
   

3. There is now personal liability for 'responsible persons'. The new Act creates statutory duties with personal civil penalties. This means that providers must ensure compliance with the legislation and Occupational Therapists are pivotal in helping older adults, their carers, and provider understand how to support behaviour and engage in restrictive practices as a last resort.

   
   
   
   

The GPS Wearable Paradox

Here is a scenario that illustrates the genuine clinical nuance to each scenario. Every person and every situation is different. Which is why we need a framework to help guide the decisions, not just a checklist.

Margaret has moderate dementia. She has always loved walking. It is one of the few things that still brings her joy and keeps her calm. Her daughter is terrified she will get lost. The OT is trying to preserve Margaret's independence while managing a real risk of harm.

Her daughter Sarah wants to lock the front door when she is home alone. That is an environmental restraint. Without proper consent and a behaviour support plan, it is non-compliant and it takes away something that matters enormously to Margaret.

Her daughter requests a GPS wearable instead. Margaret can keep walking. If she wanders too far, an alert goes to her daughter. This appears to be the the least restrictive option available.

But, a GPS wearable, used without Margaret's knowledge or consent, is a potential human rights concern of its own. Consent under the new Act applies not just to the use of the device, but to the collection and storage of the location data it generates.

So, the least restrictive alternative to an environmental restraint can itself become a rights issue if it isn't introduced and consented to properly.

This is not hypothetical. Dementia Support Australia's own guidance on GPS devices flags covert use as requiring specific legal consideration. These are the conversations community OTs need to be having and most are not happening yet.

What Competent Practice Actually Looks Like Now

The good news is that none of this requires OTs to become legal experts. It requires something we are actually trained for: structured clinical reasoning applied to a specific regulatory context.

The question is no longer just: Is this the best intervention for this client?

The question is: Is this the best intervention for this client, and have I documented the alternatives I considered, the primary purpose of this device, the consent process, the review date, and the contribution this makes to the Care and Services Plan and behaviour support plan?

That second question is harder. But it is also the question that protects your client's rights, supports your provider's compliance, and protects your professional registration.

Why This Matters

The Aged Care Act 2024 is in force. The Aged Care Rules 2025 are in force. The Aged Care Quality and Safety Commission is auditing against them. And community OTs are, at times being pressured, into making recommendations that may or may not be consistent with a framework that most haven't had the chance to properly read and understand.

The pace of legislative and reform change has been extraordinary, and the resources translated specifically for AHPs, rather than for providers or lawyers are thin on the ground.

Details of our upcoming session will be announced soon.

Register your interest here!