Since the commencement of the new restraint provisions in July last year, there has been an increased focus on the issue of restraints. A particularly vexing issue for the industry is what to do about keypads on the entrances and exits to/from aged care facilities, or areas within them (eg. secure dementia units). With most of the industry using coded keypads to enter and exit, we are receiving a number of questions on this issue.
1. The keypad is there for everyone’s safety so it’s not a restraint right?
Incorrect. Coded keypads have the potential to function as perimeter or environmental restraint (a special sub-set of physical restraint).
If a resident can’t leave whenever they want to because of the keypad, they are being restrained. It doesn’t matter whether you are restraining them for their safety, or because their family want you to, or for the safety of others. It doesn’t even matter if the resident was admitted to your facility because they were wandering from their home unsafely.
2. Is a keypad exit always a restraint?
No. A keypad isn’t a restraint if residents are able to use it themselves, or if there are staff or others on hand to assist them. A keypad is only a restraint if a resident requires assistance to exit the home (or an area of the home), whether due to a physical or cognitive impairment, and that assistance is not available to them as and when they need it. Therefore the same keypad may be a restraint to some residents, but not all residents – and on some occasions for some residents, but not on all occasions.
3. Do I need consent from everyone in the facility?
No. You only need consent for those residents who are in fact being restrained – noting that keypads are only a restraints if they actually prevent residents from leaving, provided they want to.
Consent is not required for those residents who will not be restrained by a keypad - for example, a resident who has no interest in leaving. Likewise, a resident who can enter the code and exit freely is not being restrained. Likewise, a resident who is permanently bed bound is not being restrained by the keypad for the simple reason that it is not the keypad that is restricting their movement but their physical condition. In this sense, the keypad is no different to an unlocked door and is therefore not a form restraint.
4. What do I need to do if I have residents who can’t leave because of the keypad?
The answer to this will depend on the reason why they can’t leave.
If the only reason a resident can’t leave is because they have a physical impairment - such as not being able to reach the keypad, or a visual impairment which means they can’t read the code - then they are being restrained, potentially unlawfully. In such instances, you should to identify ways to facilitate the resident’s free movement, such as ensuring a staff member lets them out when they ask, or changing the design (eg displaying in the code in legible large font).
If the resident is prevented from leaving because the family have requested it, or because you are concerned for the resident’s safety, then you will need to consider whether the resident can be lawfully restrained, and if so obtain the necessary authorisations.
This will require you to consider:
- Whether the restraint is necessary. Why do you consider the resident needs to be restrained?
- What alternatives have been trialled? Can you demonstrate this?
- Has a medical practitioner or nurse with day-to-day knowledge of the resident assessed that the restraint is necessary?
- Do you have consent from an appropriately authorised representative to restrain the resident?
- Have all of the above considerations/steps been properly documented and a consent form obtained?
- You will also need to continue to monitor the resident for signs of distress or harm and assess the use of the restraint on a regular basis (ie. whether it remains necessary for the resident to be prevented from leaving), and you should document these measures.
- Do I need a clause in my resident agreement to say we have keypads and seek residents’ consent to this?
No. Having a clause in the agreement isn’t necessary, nor is it sufficient. Resident agreements won’t obviate the need for a proper restraint authorisation.
- However while not legally necessary, disclosing the existence of keypads to residents and their families whether by way of the agreement, Resident Handbook/information materials or just a conversation prior to admission (which should be documented), could help you manage expectations and hence, facilitate a smoother process down the track.
What do I need to do next?
The Aged Care Quality and Safety Commission is continuing to focus on the use of restraints, including “perimeter restraints”. If you have keypads in your home, you should consider whether all residents subject to it are able to leave when they wish - and if not, whether they are being restrained. If they are being restrained, you should have a properly documented and compliant consent form in place. Due to the particular issues that arise with environmental/perimeter restraints and the need to balance regulatory compliance with your duty of care, we recommend you use a separate more specific consent form to that used for chemical and physical restraint.
If you require any further information regarding keypads and restraints in aged care homes, please contact Anita Courtney on (03) 8602 7211, Melanie Tan (03) 9609 1577 or our expert Aged Care team.
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