Use of Restraints in Long-Term Care

Use of Restraints

The Residential Care Regulation define a restraint as any chemical, electronic, mechanical, physical or other means of controlling or restricting a care facility resident’s freedom of movement. This includes accommodating the person in a secure unit (for example, a locked wing of the facility).

The law does not specifically define chemical restraint, but other sources have described chemical restraint as the use of a medication to restrict a person’s movement, reduce a behaviour, or sedate a person beyond any therapeutic purpose. For more information about the use of chemical restraints, see the 2020 BC Law Institute blog by Sara Pon.

The Residential Care Regulation sets out the general requirements for how and when restraints can be used in long-term care:

• Restraints can only be used if they are needed to protect the adult or others from imminent harm, and not for discipline or the convenience of staff.<ref>Residential Care Regulation, BC Reg 96/2009, s 74, online: <canlii.ca/t/89ln>.</ref>
• Restraints must be as minimal as possible.
• Other options must have been tried before restraints can be used.
• The adult being restrained must be monitored to protect their “safety and physical and emotional dignity”<ref>Residential Care Regulation, BC Reg 96/2009, s 73, online: <canlii.ca/t/89ln>.</ref>

These requirements must be met in every instance that restraints are used. In addition, the Residential Care Regulation sets out specific requirements for both emergency and non-emergency use of restraints.

If restraints are used in a non-emergency situation, the regulation requires prior consent from the resident or, if they are incapable of making decisions about restraint use, from their substitute decision-maker.<ref>Residential Care Regulation, BC Reg 96/2009, s 74, online: <canlii.ca/t/89ln>. </ref> The resident’s physician or nurse practitioner must also agree. The resident or their substitute decision-maker and the health practitioner must both consent in writing. Note that the Public Guardian and Trustee cannot provide substitute consent for the use of restraints.<ref>Residential Care Regulation, BC Reg 96/2009, ss 74-75, online: <canlii.ca/t/89ln>. </ref>

If restraints are used in an emergency, the regulation states:

• Prior agreement is not required if the adult or others are at imminent risk of harm.<ref>Residential Care Regulation, BC Reg 96/2009, s 74, online: <canlii.ca/t/89ln>.</ref>
• The use of restraints must be documented in the care plan; and
• After the restraint has been used, the facility must share information and advice regarding the restraint use, in a manner that fits the person’s skills and abilities, with:
  • the resident,
  • anyone who witnessed the restraint use, and
  • any employees involved in the restraint use.<ref>Residential Care Regulation, BC Reg 96/2009, s 73, online: <canlii.ca/t/89ln>.</ref>

During restraint use, regular reassessments are required:

• The need for the restraint must be reassessed within the first 24 hours of using it.
• If the restraint is used in an emergency and continues for more than 24 hours, the adult or their substitute decision-maker and the adult’s doctor or nurse practitioner must agree to it.
• If the restraint is used with prior consent, reassessment must occur based on what is listed in the care plan or when the adult or substitute decision-maker has specified, whichever is earlier.<ref>Residential Care Regulation, BC Reg 96/2009, s 75, online: <canlii.ca/t/89ln>.</ref>

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References

This information applies to British Columbia, Canada. Last reviewed for legal accuracy by Seniors First BC, February 2024.

(1) Agreement, or (2) the giving of permission for a thing to happen or not happen.

In law, (1) a judge's conclusions after hearing argument and considering the evidence presented at a trial or an application, (2) a judgment, or (3) the judge's reasons. A judge's written or oral decision will include the judge's conclusions about the relief or remedies claimed as well as their findings of fact and conclusions of law. A written decision is called the judge’s "reasons for judgment." See "common law," "conclusions of law" and "findings of fact."