Restraint and Seclusion in NZ Aged Care: Compliance Guide for Managers

Managing restraint and seclusion in New Zealand aged care requires a precise understanding of legal obligations, clinical best practice, and documentation standards. This guide covers the key requirements under the Health and Disability Services (Safety) Act 2001, the Code of Health and Disability Services Consumers’ Rights 1996, and the Nga Paerewa Health and Disability Services Standard NZS 8134:2021. It is written for frontline managers who must ensure every episode is justified, consented, documented, and reviewed.

What Is Restrictive Practice?

Restrictive practice means any intervention that limits a person’s rights, freedom of movement, or access to their environment. In aged care, this includes:

• Physical restraint (e.g., bed rails, lap belts, chairs that prevent standing)
• Chemical restraint (medication used to control behaviour, not for a therapeutic condition)
• Environmental restraint (locked doors, enclosed courtyards without free exit)
• Seclusion (isolating a person alone in a room they cannot freely leave)

Under Nga Paerewa 2.1, services must have a policy that ensures restrictive practices are used only as a last resort, for the shortest time possible, and with documented consent.

Consent Requirements

Consent for restraint must be informed and voluntary. Under Right 7 of the Code of Health and Disability Services Consumers’ Rights, the resident (or their legal representative if the resident lacks capacity) must understand:

• Why the restraint is proposed
• What alternatives have been tried
• The risks and benefits
• Their right to withdraw consent at any time

If the resident lacks capacity, the Protection of Personal and Property Rights Act 1988 (PPPR Act) applies. An Enduring Power of Attorney (EPOA) or welfare guardian can consent, but the decision must be in the resident’s best interests. Document the capacity assessment and the substitute decision-maker’s authority.

Documentation Before, During, and After Restraint

Before Restraint

• Comprehensive assessment of the behaviour (triggers, frequency, severity)
• Documentation of all de-escalation attempts (see below)
• Signed consent form (specific to the type of restraint)
• Care plan detailing the restraint protocol, monitoring frequency, and review date

During Restraint

• Observation records: at least every 15 minutes for physical restraint; continuous observation for seclusion
• Vital signs, skin integrity, hydration, toileting, and comfort checks
• Any changes in behaviour or distress
• Staff signatures and times

After Restraint

• Debrief with the resident, family/whānau, and staff within 24 hours
• Incident report (see reportable events below)
• Review of the care plan and restraint necessity
• Update the restraint register

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De-escalation: The First Line

Before any restraint, staff must attempt de-escalation. Techniques include:

• Verbal calming and validation
• Offering choice and control
• Reducing environmental stimuli
• Using distraction or redirection
• Calling for additional support

Document every de-escalation attempt in the progress notes. If restraint becomes necessary, the record must show why de-escalation failed.

Reportable Events

Under Nga Paerewa 2.4, the following must be reported to the Ministry of Health via the HealthCERT reporting system within 24 hours:

• Any use of seclusion
• Physical restraint resulting in injury
• Chemical restraint that causes an adverse reaction requiring medical treatment
• Any restraint used without documented consent
• Any episode lasting longer than 4 hours (or 2 hours for seclusion)

Additionally, notify the Health and Disability Commissioner if the event involves a breach of the Code of Rights. Internal incident reporting must follow your organisation’s policy and be reviewed by the clinical governance committee.

Staff Training and Competency

All staff who may be involved in restraint must complete annual training covering:

• De-escalation techniques
• Safe restraint application
• Monitoring and documentation
• Legal and ethical considerations
• Cultural safety, particularly for Māori residents (Nga Paerewa 2.1 requires culturally appropriate care)

Training records must be kept and available for audit.

Audit and Continuous Improvement

Conduct monthly audits of restraint documentation, including:

• Consent forms signed and dated
• Observation records complete
• Debriefs conducted
• Incident reports submitted

Use findings to update policies and retrain staff. The Ministry of Health and Te Whatu Ora may review restraint data during certification audits.