The machinations of restraint use in residential aged care. A critical discourse analysis

The Australian Government has implemented a myriad of restraint tools, bulletins, policies, reform documents and legislation restricting the use of physical and chemical restraint use in Residential Aged Care Facilities (RACFs). Despite this, the use of restraint in RACFs remains commonplace. One of the foci of the recent Royal Commission into Aged Care Quality and Safety was the inappropriate use of restraint which exposed considerable abuse, neglect, and atrocities of care throughout the sector. Methodology. Discourses around physical and chemical restraint use were investigated, using a critical discourse analysis methodology including the discourses around restraint practices in legislation and policy, reports, media representation, as well as the dialogue of RACF owners, staff, and those contracted to provide services within RACFs were examined. Findings/Discussion. Restraint is influenced, sustained, and normalised in cultural ideology as a form of social order. Discursive changes have redefined restraint and have normalised and enabled restraint. Messages promising flexibility and customer choice are used by the government to rationalise neoliberal constructs; however, the government is incentivised by the cost savings of open market corporations. Restraint is often used in environments that do not have adequate staff and/or skilled staff and this is further complicated by an absence of company culpability. Understaffing and the use of unskilled staff have a devastating effect on care quality and has therefore left staff feeling that they have no choice but to restrain. Conclusion. Restraint use in RACF is influenced by a multiple factors. Complex macro-systemic influences of culture, social order, neoliberal ideology, discourse, normalisation, and hegemonic quests to control RACF residents sustain restraint use.