Chemical Restraint Is Still Rampant. The New Aged Care Act Won’t Change That.

In Australian aged care homes, people living with dementia are still chemically restrained in an attempt to make them easier to manage. The new Aged Care Act, coming into effect on 1 November 2025, does nothing to change that. 

People living with dementia often experience increased anxiety and agitation, usually in the late afternoon and evenings. Crying, yelling, asking for a parent, or repeatedly wanting to “go home” are common behaviours. These behavioural changes are widely known as sundowning. 

While sundowning was once thought to be caused solely by brain changes, experts now believe there are contributing factors. These can include tiredness, pain, feeling overwhelmed, changes in the environment, lack of stimulation, lack of sunlight, too much noise, and unmet needs. 

Chemical restraint refers to the use of psychotropic medications such as sleeping pills, benzodiazepines and antidepressants used to alter behaviour rather than treat a medical condition. While we no longer physically restrain people in aged care homes, we still use drugs to make them more docile. 

Clinical studies have consistently shown that psychotropic drugs are not very effective for treating sundowning. They also come with a high risk of adverse effects, including psychological distress, functional decline, increased risk of stroke, falls and death. 

A 2024 study found that people living with dementia in aged care homes are nearly twice as likely to be prescribed psychotropic medications compared to those without dementia.

Same Rules, Same Problems

Over half of aged care residents live with dementia. It isn’t a normal part of ageing; it’s a cognitive impairment caused by a range of medical conditions, with Alzheimer’s Disease the most common. Dementia care and general aged care are two very different things, and require a fundamentally different approach. 

While rules around chemical restraint are part of the new Aged Care Act, the same basic requirements have been in place since the amendments to the Quality of Care Principles in 2019.

Just like the old regulations, the new Act states that restrictive practices should be used only as a last resort, that informed consent must be obtained before psychotropic medications are prescribed, and that well-documented alternative strategies should be attempted first. 

These can include gentle activities that focus on providing sensory stimulation, enhancing mood, and promoting social interaction. Personalised care strategies tailored to individual preferences have been found to be particularly effective. 

But when staff are responsible for around twenty residents per ward, finding one-on-one time to implement individualised strategies can be challenging. Lack of staff training is also an issue, as neither the new Act, nor its predecessor, requires people working in aged care homes to have any dementia-specific training.

Minimal Protections With Informed Consent

The new Act keeps the concept of “informed consent”, meaning doctors cannot prescribe psychotropic medications without explaining the risks and obtaining consent from the person who is living with dementia or their substitute decision maker, which is usually a family member. 

But rarely do families question medical recommendations, or ask what the aged care facility is doing to avoid chemical restraint. They don’t know they need to.

I’ve had conversations with several doctors about aged care homes that aren’t facilitating regular dementia-friendly activities, that expect residents to “remember” instructions, and fail to provide outdoor access, meaning people living with dementia could go years without sunshine. 

While most agreed this was concerning, there was little they could do other than speak to nursing staff and hope for the best. And of course, regularly monitor medications.

Aged care nursing staff are required to speak with medical professionals and families about residents’ behaviours, and in my own experience — and that of others I’ve spoken to — the discussion is sometimes steered toward describing sundowning as a “consistently low mood”. 

Chemical restraint excludes medications prescribed for the treatment of diagnosed conditions, and a depression diagnosis can sidestep the issue altogether. 

External Support Can Fall Short

Dementia Support Australia (DSA) is a Government funded program that provides nationwide behaviour support for people living with dementia, and their carers.

When a person living with dementia displays behaviours that an aged care facility finds challenging, they can contact DSA to request a trained staff member to visit. They observe the situation, speak to staff and the person living with dementia, and provide a written report of recommendations. 

From my discussions with the DSA, the report is considered the property of the aged care facility that requested their services. Families can request a copy, but it’s at the facility’s discretion as to whether it’s released. This removes key decision-makers (families) from the broader picture. 

That said, it’s still a useful model. But its impact depends largely on how facilities respond. 

While DSA may recommend and demonstrate the best way to facilitate an activity designed to reduce behavioural triggers, aged care facilities tend to use a rotating list of casual and agency staff. Small changes in the way the activity is approached can make a large difference to its effectiveness. 

Outcomes also depend on upper management's views on chemical restraint. Are they fully aware of the ineffectiveness of medication to treat sundowning? And the risks? Or do they see the rules around chemical restraint as a bureaucratic hurdle, requiring them to gather proof (including a DSA visit) that they’ve tried other options? 

Paper Trails Are Not Protection 

The new Aged Care Act talks about restraint as a “last resort” and requires well-documented alternative strategies, but these protections haven’t worked well in the past and rely on systems that aren’t fully equipped to handle the needs of people living with dementia. 

When personalised activities and sensory stimulation are difficult to implement, that leaves medication as the easiest option, even when it’s ineffective and harmful. 

The government needs to support the creation of a system that is capable of delivering genuine dementia-specific care. Funding significantly smaller ward sizes and mandating comprehensive dementia training for aged care staff are crucial first steps if we want to reduce chemical restraint.

It’s time to shift away from tokenistic paper trails and provide some real support.