Restrictive practice and least restrictive care

Restrictive practice goes beyond physical restraint. In care homes it includes chemical restraint, mechanical devices, physical holding, blocked exits, locked cupboards, removal of call bells or mobility aids, restricted visiting, surveillance, blanket routines, controlling language, and environmental changes that limit movement and choice. Some restrictions are obvious; others become accepted because they are built into daily working patterns.

Restrictions must be used only when necessary to prevent harm and must be proportionate to the seriousness and likelihood of that harm. They must not be applied simply because staffing is short, the unit is busy, a person is noisy, or a routine is easier to manage.

Least restrictive care means seeking safer alternatives before resorting to control. Rather than asking how to stop behaviour, staff should ask what is driving it and what support is missing. Pain, boredom, fear, constipation, unfamiliar staff, poor communication, sensory overload, and past trauma can all underlie behaviour that is then managed restrictively.

Repeated or routine restriction should trigger review. If staff are regularly redirecting, blocking, sedating, or preventing access to everyday items, the care plan may have drifted into over-restriction.

Examples of over-restrictive practice

• Locking away clothes, toiletries, or walking aids without clear rationale and regular review.
• Using sedating medicines mainly to make care easier rather than for a properly reviewed clinical reason.
• Applying one rule to all residents because it is easier than providing individualised care.
• Preventing movement or contact without exploring less restrictive alternatives.

Blanket rules are a warning sign. A restriction that applies to everyone because it makes the shift easier is unlikely to be person-led or least restrictive.