Restraint in NZ aged care — obligations and safe practice

Physical, chemical, and environmental restraint

Physical restraint is any manual or mechanical means that restricts a person's movement — including holding a person, bedrails raised on both sides, lap belts, and mittens.

Chemical restraint is the use of medication primarily to control behaviour or movement rather than for a therapeutic purpose.

Enablers are devices used with consent to assist independence — for example, a raised bedrail on one side to help the resident reposition themselves. Enablers are not restraint if they are used with the resident's informed consent and for their benefit.

Restraint is always the last resort

The NZ Standards require facilities to actively minimise the use of restraint. Every resident has the right to freedom from restraint under the Health and Disability Commissioner's Code of Rights. Restraint may only be used when:

• There is an imminent risk of harm to the resident or others
• All less restrictive options have been considered and are insufficient
• Informed consent has been obtained (from the resident or their representative)
• The least restrictive type and duration is used
• The decision is made or ratified by a registered health professional

Must have consent before using restraint

Informed consent must be obtained from:

• The resident themselves if they have capacity to consent, or
• Their welfare guardian or person authorised under an Enduring Power of Attorney (EPA) for personal care, if the resident lacks capacity

In an emergency, restraint may be used without consent where there is immediate risk of serious harm — but consent must be sought as soon as practicable, and the incident must be documented and reviewed.

Comprehensive documentation is mandatory

• Assessment identifying the risk and why restraint is required
• Evidence that less restrictive alternatives were considered and are insufficient
• Type of restraint to be used and duration
• Informed consent obtained — from whom, when, and in what form
• Name of the registered health professional who authorised the restraint
• Monitoring record — how often checked, resident's condition during restraint
• Review date and outcome of review

Frequent checks required

Any resident in restraint must be monitored at regular intervals as specified by the authorising clinician and your facility policy — typically at least every 15–30 minutes. Monitoring must check: the resident's physical comfort, skin integrity, circulation, breathing, hydration, and psychological state. All monitoring must be documented.

Regular review is mandatory

Every restraint must be reviewed regularly to determine whether it is still necessary and whether less restrictive options have become appropriate. The care plan and restraint documentation must be updated at each review. The goal is always to reduce and eventually eliminate the need for restraint.