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 being inappropriately medicated 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 clinically referred to as behavioural and psychological symptoms of Dementia (BPSD).

While BPSD was once thought to be caused solely by brain changes, experts now believe it’s driven by a combination of biological, psychological, social and environmental 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, antipsychotics, benzodiazepines and antidepressants used off-label 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 BPSD. 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.

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. 

In reality, informed consent isn’t very informed at all. “Explaining the risks” means the doctor lists out the possible side effects.

Doctors aren’t required to disclose other key facts: that psychotropic drugs have been shown to have minimal efficacy for changing unwanted behaviours; that they carry extremely high risks (listing side effects is not the same as explicitly explaining this); that legislation states they should only be used to avoid harm; and that a behaviour plan should have been genuinely attempted first.

When families provide their “informed consent”, they are trusting their doctor that the benefits of these drugs will outweigh those risks, when studies show that’s often not the case. 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.

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 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 very useful service, but its impact depends largely on how facilities respond. A DSA report that isn’t properly discussed or distributed among staff is unlikely to have meaningful impact.

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

Outcomes also depend on upper management views on chemical restraint. Are they fully aware of the ineffectiveness of medication to treat BPSD? 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? 

Policies 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.