Restrictive practice in Irish designated centres: HIQA guide

This guide covers Ireland. For the UK equivalent, see our guide: Restrictive Practice Reduction: What CQC Inspectors Actually Look For.

Restrictive practice in an Irish designated centre for older people means an intentional limit on a resident's movement, access or choices, such as bedrails, locked or keypad doors, or restricted access to items. The Regulations do not ban every restriction, but they require that challenging behaviour is managed, as far as possible, without one, and that restraint follows national policy. This guide sets out what the Irish sources say and what they leave open, for providers, persons in charge and the managers who support them. It is about resident care and does not cover staff health and safety duties.

The legal starting point: Regulation 7

The Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013 (S.I. No. 415 of 2013) deal with this under Regulation 7, "Managing behaviour that is challenging". Reading the Regulations as made on the Irish Statute Book, Regulation 7 has three parts:

• Regulation 7(1): the person in charge must ensure that staff have up-to-date knowledge and skills, appropriate to their role, to respond to and manage behaviour that is challenging.
• Regulation 7(2): where a resident's behaviour is challenging or poses a risk to the resident or others, the person in charge must respond, in so far as possible, in a manner that is not restrictive.
• Regulation 7(3): where restraint is used in a designated centre, it must be used only in accordance with national policy as published on the Department of Health website from time to time.

Note who carries which duty. The skills and the non-restrictive response sit with the person in charge. The Regulations' wording on restraint is the intentional restriction of a person's voluntary movement or behaviour. Regulation 7 itself says nothing about specific devices, time limits or sign-off steps, so the detail comes from national policy and HIQA guidance. The S.I. 1 of 2025 amending Regulations (in operation from 31 March 2025, per the Irish Statute Book) did not amend Regulation 7.

Safeguarding duties apply alongside this. Regulation 8 requires the registered provider to take all reasonable measures to protect residents from abuse, including staff training. Our guide to safeguarding vulnerable adults training in Ireland covers that side in more depth.

The national policy that Regulation 7(3) points to

The policy is the Department of Health document "Towards a Restraint Free Environment in Nursing Homes". The policy PDF itself carries no publication date; it refers to a 2010 public consultation and to regulations in force from 1 January 2011. The policy's stated aim is to eliminate the use of restraint or, where that is not possible, to restrict the use of all forms of restraint. Points a provider should know from it:

• It describes three types: physical, chemical and environmental restraint.
• Restraint is a last resort, for imminent risk of serious harm, and should be temporary, the least restrictive form available and for the shortest time necessary.
• A full assessment comes first, covering physical, medical, psychological, emotional, social and environmental factors, the alternatives already tried and the resident's views.
• Adults are presumed to have capacity to make choices about their own care, and a diagnosis alone does not remove that presumption.
• The policy says every nursing home must have a restraint policy and must keep a record of every episode of restraint, including the type, duration and outcome.
• Restraint should not be initiated to overcome a lack of adequate staff support and supervision.
• The policy treats chemical restraint as always unacceptable, while noting that medication given to treat a medical condition is not restraint.

The policy does not name bedrails, though it says equipment meant to promote independence, comfort or safety can still amount to physical restraint.

What HIQA expects beyond the minimum

HIQA's "Guidance on promoting a care environment that is free from restrictive practice" (older people's services, version 1.1, May 2025) is written for registered providers and staff of designated centres for older people. HIQA says the May 2025 update changed references to the Regulations and to the Assisted Decision-Making Act, and made style edits; the original appeared in June 2023. It is guidance, not a Regulation, but inspectors use the National Standards for Residential Care Settings for Older People in Ireland (2016), and the guidance maps its advice to those Standards.

Definitions HIQA uses

• Physical restraint: a manual method, or a device, material or equipment attached or adjacent to the body that the person cannot easily remove and that restricts movement or normal access to their body.
• Environmental restraint: intentionally restricting a resident's normal access to their environment, for example to stop them leaving, or removing their usual means of mobility, communication or civil and religious liberties.
• Other "rights restraints": limiting choices such as access to food, cigarettes or the internet.
• Chemical restraint: not defined in the guidance, which says it is outside the scope of that thematic programme. The guidance does not discuss psychotropic medicines.

HIQA also notes that a restriction can arise through inaction, where needed care is not provided within a reasonable time.

Principles to build into practice

• Use a restrictive practice only when absolutely necessary, and keep it proportionate to the identified risk.
• Seek informed consent beforehand, explained in an accessible format. Capacity is assessed for a specific decision at a specific time and reviewed regularly. Where someone lacks capacity, the guidance points to a legal representative or decision supporter, or an independent advocate.
• Decisions about something like bedrails should be made by a multidisciplinary team. One of HIQA's worked scenarios treats bedrails raised at a family's request, with no assessed reduction in risk, as not appropriate.
• Review regularly, use reviews to trial less restrictive options, and remove the practice as soon as it is no longer required.
• In an emergency, restraint may be used without prior consent, with a debrief as soon as possible. The guidance says that debrief should look at whether it was the least restrictive option for the shortest time.

The guidance does not set fixed review intervals; it asks for regular review. It does say that designated centres are required to review their restrictive practice policy every three years (Regulation 4(3) also sets a three-year maximum for written policies).

Governance: registers, data and a named lead

HIQA's guidance links this topic to leadership, governance and management. It suggests a senior manager or a committee (for example a restraint or human rights committee) whose aim is to reduce or eliminate restrictive practices, regular collection of data at resident and service level, and targets set from that baseline. It lists "a restrictive practice register" among the sources of evidence for the leadership, governance and management theme (which includes Standard 5.2). For what to record on each occasion, it lists time of day, staff involved, location, the resident's personal attributes, the reason and the alternatives tried first.

The Regulations themselves back this up. Regulation 23 requires a clearly defined management structure, management systems to ensure the service is safe and appropriate, and an annual review of the quality and safety of care prepared in consultation with residents and their families. Regulation 16 requires that staff have access to appropriate training and are appropriately supervised. As made, the Regulations' list of written policies includes the use of restraint and the management of behaviour that is challenging, and the schedule on records requires a record of each occasion restraint is used, with the resident, reason and interventions tried.

Notifying the Chief Inspector

Under Regulation 31, the person in charge provides a written report to the Chief Inspector at the end of each quarter covering the listed incidents, which as made included each occasion restraint was used. The 2025 amending Regulations replaced Schedule 4, and the quarterly item now covers any occasion when restrictive practices were used, including the type used and the number of residents affected. They also state that reports under Regulation 31 must follow guidance produced by the Chief Inspector. Check HIQA's current notification guidance for the form and portal; we have not set out those details here.

Staffing, training and resources

Standard 6.1 is cited by HIQA for the point that resources should be planned so that no restrictive practice is used because of a shortage of staff or equipment, and the Department of Health policy says the same about staffing. Standards 7.2 to 7.4 cover staff competence, supervision and training. Our suggestion: ask whether your training covers de-escalation, dementia communication, falls and risk assessment, and alternatives such as sensor equipment, low-low beds and environmental changes. Our guide to HIQA inspections and staff training explains how inspectors look at training, and our piece on medication management training for healthcare staff is relevant because medicines, and their review, sit close to the chemical restraint question even though HIQA's guidance leaves chemical restraint out of scope.

A practical checklist for providers in Dublin and elsewhere

The law is national, so the same duties apply in a Dublin centre as anywhere else. Our suggestions, which are not legal requirements:

• List every restriction in the centre, including keypad doors, bedrails, lap belts, tilting chairs and restricted access to rooms or items, and note why each exists.
• Check each against Regulation 7, the Department of Health policy and HIQA's guidance, and name the person responsible for its review.
• Confirm that the individual assessment, consent or decision-support steps and multidisciplinary sign-off are in the resident's file.
• Reconcile your internal register with what you report each quarter.
• Put restrictive practice on the agenda of the annual review and governance meetings.
• Run a short debrief after any emergency use and record what was learned.

Learnsignal's offices are off Baggot Street in Dublin, and we offer in-person training from there. For current details, see our CPD pages.

Frequently asked questions

Which Regulation covers restraint in Irish nursing homes?

Regulation 7 of S.I. No. 415 of 2013, "Managing behaviour that is challenging". It requires staff skills, a non-restrictive response so far as possible, and use of restraint only in line with national policy.

Are bedrails a restrictive practice?

HIQA's guidance uses bedrails as an example of a restrictive practice and says the decision to use them should be made by a multidisciplinary team, after making sure the resident is aware of the potential risks and the available alternatives. The Regulations do not mention bedrails by name.

Must restrictive practices be reported to HIQA?

Yes, on a quarterly basis. The Regulations, as amended in 2025, include in the quarterly notifications any occasion when restrictive practices were used, with the type and the number of residents affected.

Can restraint be used in an emergency without consent?

HIQA's guidance says it may be, followed by a debrief as soon as possible. It does not remove the duty to use the least restrictive option for the shortest time.

Does the Regulation set a time limit on restraint?

The text of Regulation 7 does not. The Department of Health policy says restraint should be for the shortest time necessary and HIQA asks for regular review, but neither source sets a fixed number of hours or days.

Restrictive practice is easiest to manage when it is visible, reviewed and led by someone senior. Start with the list, and keep asking whether a less restrictive option exists.