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Restraint, bed rails and alarms

Residents & families Aged care staff Facility leadership 6 min read

By Dr Josh Hatch, FRACGP

When someone you love keeps falling, asking for the bed rails to go up, or for them to be kept in their chair, is an understandable request. The trial evidence and Australian aged care law both point the other way.

Numbers in the text link to the 7 sources listed at the foot of this page.

What counts as a restrictive practice

A restrictive practice is any practice or intervention that has the effect of restricting the rights or freedom of movement of a resident 44. Australian aged care law recognises five kinds: chemical, environmental, mechanical and physical restraint, and seclusion 44.

Mechanical restraint means using a device to prevent, restrict or subdue a person’s movement. Bed rails used to prevent falls are given as an example, along with harnesses, straps and restrictive clothing. Environmental restraint means restricting a person’s free access to all parts of their environment, such as a locked room or area, or restricted access to the outside 46.

In the January to March 2025 quarter, 19.8% of Australian aged care residents were recorded as subject to physical restraint under the national indicator. For 15.3% of residents, the only restraint was living in a secure area 4.

Why restraint does not prevent falls

The trials are consistent. A Cochrane review of 11 studies in residential care found that programs to reduce restraint probably did so without changing the number of falls or fall-related injuries, and describes clear evidence that physical restraints lack effectiveness and safety 18. In a German trial across 36 nursing homes, restraint use fell from 31.5% to 22.6% of residents, and falls and fall-related fractures did not rise 19.

An older observational study suggests why. Among confused residents who could still walk, those who were restrained had more recurrent falls, not fewer 20. A person who is held still loses strength and balance, and many will try to climb over a rail or out of a chair.

What the rules require before a restrictive practice is used

These requirements sit under the Aged Care Act 2024 and the Aged Care Rules 2025. This is a summary, not legal advice 4446.

  • A last resort. A restrictive practice is used only as a last resort to prevent harm, after best-practice alternatives have been considered or tried and recorded in the person’s behaviour support plan 46.

  • Informed consent. Consent is required, including consent to how the practice is to be used 46.

  • Least restrictive, shortest time. It is used in the least restrictive form and for the shortest time necessary 4446.

  • Assessment. There is a documented assessment by an approved health practitioner 44.

  • Monitoring and review. The person is monitored regularly for distress, side effects and changes in wellbeing, and the use of the practice is reviewed 4446.

What can be asked for instead

Each of these lowers risk while the person keeps moving. All are drawn from the national guidelines 1.

  • Exercise. Supervised strength and balance exercise that continues.

  • A medicines review. Particularly of sedating medicines, and after any fall.

  • A plan for the toilet. Regular, proactive help with toileting, especially overnight.

  • Glasses and shoes. Clean glasses within reach and well-fitting shoes in place of socks.

  • Closer observation at risky times. More frequent checks for a person with dementia or delirium, at the times of day when they tend to get up.

Sources cited on this page

  1. 1 Australian Commission on Safety and Quality in Health Care. Preventing Falls and Harm from Falls in Older People: Best Practice Guidelines for Australian Residential Aged Care Services. Sydney: ACSQHC; 2025. View source
  2. 4 Australian Institute of Health and Welfare, GEN Aged Care Data. Residential aged care quality indicators — January to March 2025. (2,593 services; 220,707 residents assessed for falls: 31.1% had one or more falls, 1.7% a fall with major injury; 19.8% subject to physical restraint, 15.3% through a secure area only.) Reported quarterly; later quarters are available from the same page. View source
  3. 18 Möhler R, Richter T, Köpke S, Meyer G. Interventions for preventing and reducing the use of physical restraints for older people in all long-term care settings. Cochrane Database Syst Rev. 2023;7:CD007546. View source
  4. 19 Köpke S, Mühlhauser I, Gerlach A, et al. Effect of a guideline-based multicomponent intervention on use of physical restraints in nursing homes: a randomized controlled trial. JAMA. 2012;307:2177–84. View source
  5. 20 Capezuti E, Evans L, Strumpf N, Maislin G. Physical restraint use and falls in nursing home residents. J Am Geriatr Soc. 1996;44:627–33. (Observational; secondary analysis of trial data.) View source
  6. 44 Aged Care Quality and Safety Commission. Inappropriate use of restrictive practices (Serious Incident Response Scheme guidance). View source
  7. 46 End of Life Law for Clinicians, Australian Centre for Health Law Research, Queensland University of Technology. Restrictive Practices in Aged Care (factsheet). November 2025. View source

See every source cited across the falls and frailty section →

Written by Dr Josh Hatch, FRACGP. General information only, reflecting his reading of the published evidence as at October 2026. It is not individual medical advice, does not create a doctor–patient relationship, and must not be used to start, stop or change any treatment. Evidence and Australian regulatory and PBS arrangements change — always confirm current advice with the treating GP, pharmacist or specialist.

This is general education, not a clinical protocol. The doctors who practise with Umbrella Aged Care are independent general practitioners, and each makes their own clinical decisions with the resident and family. Your GP’s advice for an individual may differ from what is written here. If it does, please ask them to talk it through with you.

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