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FRALTERNA - Evaluation of the practical application of restrictions on freedom and alternative measures in risk situations in nursing homes

Initial situation, problems and motivation: Restrictions on freedom in care, i.e., physical and chemical restraints, and nursing facilities for people with disabilities or mental illnesses to prevent endangerment of self and others (third parties) are acts of state use of coercive power and constitute serious infringements of fundamental and human rights. Since 2005, the Nursing and Residential Homes Residence Act (“Heimaufenthaltsgesetz” in German) regulates and restricts such infringements in institutional housing and nursing care facilities. This legal act aims for the lowest possible level of restraint use. For this purpose, an extrajudicial legal protection and control institution, the residents’ representative group (“Bewohnervertretung”), was founded. Existing data shows a high prevalence of the use of such restraints among residents in care facilities. At the same time, considerable differences between federal states, regions and facilities can be found. Legal provisions are confronted with differing regional and institutional structures and cultures, which account for the practical application of physical and chemical restraints and have an impact on the sustainable promotion of adequate and less invasive alternatives. There is a lack of scientific studies on the interrelationship of legal, institutional and organisational, professional, socio-economic and cultural factors, their effects on the use of physical and chemical restraints as well as their impacts on the living condition and security of the residents in Austria in particular.

Goals and innovative content: In consideration of these research gaps the planned study focuses particularly on the extrajudicial factors, which are of crucial importance for the achievable effects of the “Heimaufenthaltsgesetz”, and emphasises the work of the residents’ representative group (“Bewohnervertretung”). The objectives are:

to gain scientifically substantiated knowledge of how physical and chemical restraints are applied in the specific circumstances of the “Heimaufenthaltsgesetz” in different types of care institutions; how their use is monitored and how the use of restraints can be reduced by using adequate and less invasive alternatives.
to contribute to the highest possible protection of persons afflicted by unlawful restraints while at the same time protecting them from severe and substantial endangerments. Assistance will be provided to the concerned institutions to implement high ethical and professional standards; control bodies as laid down in the “Heimaufenthaltsgesetz”, particularly the residents’ representative group (“Bewohnervertretung”) but also courts, will be enabled to further develop their audit work on evidence-based grounds.

Intended results and findings

A research report comprising comprehensive evidence-based findings concerning the application practice of physical and chemical restraints as well as alternatives in nursing homes.
Recommendations for action and implementation for concerned institutions, professionals, audit bodies, judges, host organisations as well as other relevant stakeholders.
A set of measures enabling a sustainable transfer of the findings into practice (workshops of cooperative knowledge creation, training activities etc.).

The project is funded by the Austrian Federal Ministry of Finance (BMF) as part of the KIRAS security research program.

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