Is a bed against a wall or use of bed rails considered restraint?

Yes. The use of bed rails or a bed pushed against a wall, are restricting the free movement of the person using that bed and are therefore considered a restraint. This does not mean that the restraint cannot be used if a consumer requests this situation; rather, it means that the requirements in the Principles must be met. If the consumer has the capacity, they are able to consent to the restraint.

Of note, a low bed is not generally considered a restraint as this is a recommended strategy to minimise the use of other forms of restraint, unless the use of a low bed restricts the movement of the consumer to get in and out of bed themselves. In this event and in the absence of documentation to determine the use of the low bed, this would be considered a form of restraint. In this circumstance, as in all circumstances (except in an emergency) where physical restraint is used, the Commission would be looking for the provider to demonstrate that:

1. 1. the provider has the informed consent of the consumer (or their representative); and
2. 2. the consumer is regularly monitored, and information is recorded in the consumer’s care and services plan; and
3. 3. updates are made to the use of these restraints over time as the needs of the consumer changes.

The Commission has released the Restraint Scenarios booklet, which details case studies and explores whether the provider’s response can be defined as restraint. The Restraint Scenarios booklet can be found on the Commission’s website

Restraint Scenarios

Merle, 79 year old female

Merle is in a secure (locked) facility. She has very poor vision and hearing, and does not want to go out alone and unassisted. She is very concerned about her bed mobility as she has recently fallen out of bed while trying to get up. She is frightened to roll over in bed in case she is too close to the edge. She would like to have the bed rails up at night to prevent her falling out and give her confidence to move in bed. She also finds rails help her move in the bed by giving her something to grab on to. If she wants the rails down she is able to use the call buzzer. The care worker is concerned that the use of bed rails represents physical restraint. The provider regularly monitors Merle for signs of distress or harm. It also reviewed the necessity of the restraint in the context of Merle’s wishes, and determined that there was no practical alternative.

OUTCOME:
The secure facility and the use of bed rails are BOTH physical restraint, as they are restricting Merle’s free movement. However if assessment, documentation and consent according to the Principles and the relevant S & T legislation have been obtained then the provider is compliant with their responsibilities.

Wally, 88 year old male

Wally has dementia and has started to get up by himself and try to get to the bathroom at night. He has recently commenced on risperidone at night to try to prevent him waking and becoming agitated. Since administering this medication, the care staff have observed him staggering in the wrong direction, looking very unsteady and confused. They wonder if putting the bed rails up will prevent Wally from getting up and putting himself at risk. On the first night that the bed rails are used, Wally is found with his leg caught, very distressed, trying to get over the rail. Now very concerned, the facility staff reassess the situation and realise that the risperidone has made Wally more unsafe at night, as he is more drowsy, confused and unsteady. The rails also have increased the risk of harm from falling while trying to climb over them.

OUTCOME:
The staff realise that this management IS restraint, both chemical and physical, and it is not working well for Wally. They cease both measures immediately. They look for causes of Wally’s night time agitation and find that he is having difficulty emptying his bladder. This is raised with Wally’s GP and the staff also provide regular assisted toilet opportunities through the night with a bottle. They move Wally’s bed so that staff can see him easily if he wants to get up.

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