How to Reduce Restrictive Practice in Care Homes

Reducing restrictive practice starts with understanding why a person is distressed. Restrictions often begin when distress is treated as a behaviour to be managed rather than a message to be understood. When teams find and address the cause, the need for restriction falls, and the reduction lasts.

What counts as restrictive practice?

Restrictive practice is anything that limits a person's freedom of movement or choice. In care homes this can include:

• locked doors or keypads
• bed rails and lap belts
• sensor mats and constant observation
• covert medication
• medication used to manage distress or behaviour
• restricting access to areas, belongings or activities

Some restrictions may be necessary. All of them must be lawful, proportionate and reviewed.

What does the law say?

The Mental Capacity Act 2005 requires that, before doing something to or for a person who lacks capacity, you consider whether the same purpose can be achieved in a way that is less restrictive of their rights and freedom. Where a person is deprived of their liberty, the Deprivation of Liberty Safeguards apply. CQC checks restrictive practice under the regulations on consent and on safeguarding people from abuse and improper treatment.

Seven steps to reduce restrictive practice

1. Create a register of every restriction. Record what it is, why it is used, who agreed it and when it will be reviewed.
2. Ask what the distress is communicating. Pain, unmet needs, the environment and how care is delivered are common causes.
3. Know the person. Care plans built around life story, routines and preferences prevent much of the distress that leads to restriction.
4. Review the environment. Noise, lighting, signage and layout all affect distress.
5. Always consider the least restrictive option. Staff should be able to explain why it was chosen.
6. Review medication used to manage distress regularly with the prescriber.
7. Make restriction a governance issue. Leaders should track restrictions over time and ask why each one is still needed.

Why short-term fixes don't last

Short-term measures may lower incidents for a time, but without understanding the cause the distress returns. Sustained reduction comes from changing care planning and everyday practice, supported by leadership and regular review.

How PMH can help

PMH's dementia care consultancy uses the Unique Life, Unique World Unique Environment™ and Behaviours that Challenge™ frameworks to help organisations understand the causes of distress and reduce restrictive practice. Staff can learn the approach through our challenging behaviour training.

Frequently asked questions

Is restrictive practice illegal in care homes? No, but any restriction must be lawful, necessary and proportionate, and for people who lack capacity it must follow the Mental Capacity Act.

Do inspectors look at restrictive practice? Yes. CQC looks at whether restrictions are recorded, justified and reviewed, and whether less restrictive options were considered. Our CQC inspection checklist includes these checks.