Preventing Inappropriate Restrictive Practices in Residential Long-Term Care for Older People in Viet Nam: Safeguards, Alternatives and Quality Oversight

Preventing Inappropriate Restrictive Practices in Residential Long-Term Care for Older People in Viet Nam: Safeguards, Alternatives and Quality Oversight

An older resident repeatedly approaches the entrance of a residential care facility. Staff worry that the person may leave without assistance and become disoriented, so they consider keeping the door locked. In another facility, a resident who frequently tries to get out of bed is routinely kept behind raised bed rails. Elsewhere, a resident experiencing distress receives medication primarily to make the person easier to manage during the night.

Each situation may be explained as an attempt to maintain safety. Yet each raises important questions about the resident's freedom, individual needs and the responsibilities of those providing care.

An intervention intended to prevent harm can itself become harmful when it unnecessarily restricts an older person's movement, choices or dignity.

This is a challenging issue for residential long-term care organizations. Some residents require substantial assistance, experience changes in mobility or cognition, or face circumstances in which their safety and that of others require careful attention. Staff must respond to these needs while respecting residents as individuals with rights, preferences and personal histories.

The challenge is not to disregard foreseeable risks or assume that every protective measure is inappropriate. It is to distinguish necessary, proportionate assistance from practices that unnecessarily limit someone's freedom, particularly when restrictions become routine or are introduced to compensate for organizational difficulties.

As residential long-term care services develop in Viet Nam, this distinction deserves greater attention.

Facilities need to recognize how potentially restrictive practices arise, understand the reasons behind them, consider less restrictive alternatives and ensure that decisions affecting residents' freedom receive appropriate professional, legal and organizational scrutiny.

The central question is how residential long-term care organizations can prevent inappropriate restrictive practices while maintaining safety, respecting individual rights and establishing clear accountability for decisions that affect everyday life.

Understanding Restrictive Practices in Residential Long-Term Care

The term restrictive practices is used in international aged care systems to describe practices or interventions that restrict a person's rights or freedom of movement.

It is broader than physical restraint alone.

Australia provides a particularly relevant example. Under its current residential aged care framework, restrictive practices are classified into five categories: chemical restraint, environmental restraint, mechanical restraint, physical restraint and seclusion.

Under the Australian Aged Care Rules 2025, chemical restraint involves the use of medication or a chemical substance primarily to influence a person's behavior, subject to specific exclusions for certain prescribed treatments and end-of-life care.

Environmental restraint involves restricting access to parts of a person's environment, including items and activities, primarily to influence behavior. Mechanical restraint concerns devices used to prevent, restrict or subdue movement for that purpose, while physical restraint involves the use of physical force, subject to the exceptions specified in the legislation.

Seclusion involves solitary confinement in a space where voluntary exit is prevented, not facilitated or represented as impermissible, primarily to influence behavior.

These categories help professionals recognize that restrictions can arise through medication, equipment, environmental arrangements or direct staff actions.

However, they belong to a particular international legal framework. Their definitions, exceptions, authorization procedures and reporting requirements should not automatically be treated as identical statutory requirements in Viet Nam.

The purpose and practical effect of an intervention are especially important.

A bed rail may help a person reposition or feel supported in one situation but prevent another resident from leaving the bed. A secured entrance may serve a legitimate building safety function while also restricting someone's ability to leave independently. Medication may be appropriately prescribed to treat a diagnosed condition or, in different circumstances, used primarily to suppress behavior for organizational convenience.

The same equipment or intervention can therefore raise different concerns depending on the resident's circumstances, the reason it is used and its actual effect.

A facility should not assume that an intervention is appropriate simply because it is commonly used, requested by a family member or described as a safety measure.

Equally, recognizing a potentially restrictive effect does not automatically establish that the intervention meets the legal definition of a restrictive practice, is unlawful or is inappropriate in every circumstance.

Identifying a possible restriction, determining its legal and professional status, and deciding what action is appropriate are separate responsibilities.

A meaningful assessment requires consideration of individual needs, the intervention's purpose and consequences, available alternatives, professional responsibilities and the applicable legal framework.

Why Restrictive Practices Matter for Quality and Safety

Residential long-term care facilities support people with diverse and changing needs.

Some residents require assistance moving between rooms, getting out of bed or participating in daily activities. Others may experience distress, communicate their needs differently or have difficulty understanding unfamiliar surroundings.

These circumstances can create genuine concerns for residents, families and staff.

However, attempts to address those concerns through restrictions may introduce additional problems.

Restrictions on movement can reduce independence, interfere with everyday activities and limit opportunities for social participation. Certain physical restrictions may expose residents to injury, entrapment or distress, depending on the intervention and circumstances. Medication used inappropriately for behavioral control may cause adverse effects while leaving the original reason for distress unresolved.

Restrictions can also damage trust. A resident who feels unable to move freely, communicate preferences or decline unwanted assistance may become more distressed or less willing to engage with caregivers.

These consequences matter because residential long-term care is not simply a place where health and safety risks are managed. It is also a person's home and everyday living environment.

The World Health Organization's approach to healthy aging emphasizes functional ability and the interaction between individuals and the environments in which they live.

The United Nations Principles for Older Persons recognize the importance of independence, care, participation, dignity and respect for the rights of people living in residential care.

These principles do not remove an organization's responsibility to address foreseeable harm. They require facilities to examine whether the measures used to provide protection are appropriate and proportionate.

Safety should not be assessed only by the absence of adverse events. It should also take account of how care affects a person's freedom, dignity, well-being and ability to participate in everyday life.

Restrictive practices are therefore an issue of organizational quality and governance, not merely a matter of individual staff technique.

The Legal and Regulatory Context in Viet Nam

Viet Nam has legal provisions protecting the rights, dignity and lawful interests of older people and persons with disabilities.

The Law on the Elderly No. 39/2009/QH12, as amended, provides an important foundation.

Article 3 addresses older people's rights, including the fulfillment of basic needs, healthcare, decisions concerning living arrangements and opportunities to participate in social and cultural activities.

Article 9 prohibits acts including mistreatment, humiliation, abuse, discrimination and interference with older people's lawful rights.

The Law on Persons with Disabilities No. 51/2010/QH12, as amended, provides additional protections where older residents have disabilities.

Article 14 prohibits discrimination and acts infringing upon the bodies, dignity, honor, property, rights and lawful interests of persons with disabilities.

These provisions establish important legal principles for organizations supporting older people.

However, they should not be interpreted as automatically creating the same detailed system for classifying, authorizing and monitoring restrictive practices that operates under Australian residential aged care legislation.

The legality of a particular intervention in Viet Nam must be assessed according to its nature, the circumstances, the facility's legal status and the applicable laws and professional requirements.

The Civil Code No. 91/2015/QH13 is also relevant when questions arise about civil act capacity, guardianship and representation.

Article 22 addresses loss of civil act capacity, while Article 23 addresses adults experiencing difficulties in cognition and behavioral control. Both provisions establish specific legal processes involving court decisions and relevant professional assessment.

An older person's diagnosis, disability or need for assistance should not automatically be treated as equivalent to a legal determination that the person lacks civil act capacity.

Similarly, a family relationship alone does not necessarily establish authority to consent to every proposed intervention.

Where legal representation or guardianship is relevant, organizations need to verify the applicable arrangements and the scope of the representative's authority.

Another important development is Decree No. 395/2026/ND-CP, issued on October 23, 2026, concerning the operation and management of social assistance facilities.

The decree is scheduled to take effect on December 7, 2026.

It provides an updated framework for specified categories of social assistance facilities, including certain facilities serving older people. Article 6 identifies tasks that may apply according to a facility's functions, type, service population and applicable legal requirements, including care, assistance, protection and prevention of abuse and violence.

These provisions are relevant to safeguarding and organizational accountability.

Nevertheless, Decree No. 395/2026/ND-CP should not automatically be interpreted as creating a specific restrictive-practice authorization system or as applying identically to every residential long-term care arrangement in Viet Nam.

Facility classification remains important.

A social protection facility, a privately operated residential care provider and an organization that also delivers licensed healthcare activities may be subject to different requirements.

Where an intervention involves medical assessment, prescribing or another regulated healthcare activity, the Law on Medical Examination and Treatment No. 15/2023/QH15 and its applicable implementing regulations must also be considered.

Such activities remain within the lawful scope and responsibilities of appropriately authorized healthcare professionals and organizations.

International human rights commitments provide additional context. Viet Nam ratified the United Nations Convention on the Rights of Persons with Disabilities through National Assembly Resolution No. 84/2014/QH13.

The Convention establishes a rights-based framework concerning autonomy, liberty, protection from abuse and respect for physical and mental integrity. These principles are particularly relevant where older residents have disabilities, although older age alone should not automatically be equated with disability.

For residential long-term care organizations, the practical implication is that a restrictive-practice policy cannot simply be copied from another country's regulations and treated as Vietnamese law.

Facilities must determine the requirements applicable to their services and develop safeguards consistent with those requirements.

What International Aged Care Practice Can Teach Us

Australia offers a useful example of how residential aged care organizations can manage potentially restrictive practices through legal safeguards and organizational oversight.

The Aged Care Act 2024 and Aged Care Rules 2025 form the national legislative framework, together with applicable state and territory laws relevant to certain decisions and consent arrangements.

Australian Government guidance current in October 2026 emphasizes eliminating the inappropriate use of restrictive practices.

Under that framework, restrictive practices may be used only in legally permitted circumstances, as a last resort to prevent harm to the older person or others, after appropriate consideration of alternatives and the consequences for the individual.

The requirements address proportionality, the least restrictive form, the shortest necessary duration, informed consent through the legally applicable process, monitoring, documentation and regular review.

They also include behavior support planning and specific arrangements for reporting inappropriate restrictive practices.

Australia's National Aged Care Quality Indicator Program measures certain restrictive practices, excluding chemical restraint from that particular indicator. This illustrates why definitions and measurement boundaries matter when reported data are interpreted.

These are requirements operating within Australia's aged care system.

They do not mean that residential long-term care facilities in Viet Nam must automatically adopt Australia's substitute decision-making arrangements, statutory consent procedures, behavior support plans or incident reporting systems.

The broader professional lessons remain valuable.

Organizations should recognize when care arrangements restrict a person's freedom, examine the reasons for the intervention, consider less restrictive alternatives and ensure that decisions receive appropriate scrutiny.

Continuing review is particularly important because residents' circumstances may change. An intervention considered in response to one situation should not become a permanent feature of care merely because it was previously introduced.

International guidance also emphasizes understanding the reasons behind distress or changes in behavior.

For example, NICE guideline NG97 on dementia recommends assessing possible clinical and environmental causes of distress and considering appropriate psychosocial and environmental interventions.

These recommendations can inform efforts to prevent unnecessary restrictions, although comprehensive dementia assessment and treatment fall outside this article's scope.

The central lesson is that restrictive interventions should not become the default response to difficult care situations.

Recognizing Restrictions That Become Part of Everyday Routines

Potentially restrictive practices do not always begin with an explicit decision to limit someone's freedom.

Sometimes they develop gradually through ordinary care routines.

A staff member may move a walking aid out of reach because a resident previously attempted to walk without assistance. A wheelchair tray may be positioned in a way that prevents someone from standing. Bed rails may remain raised because they have become the usual arrangement for residents requiring additional support.

A facility may also restrict access to shared spaces during certain periods because staff are occupied elsewhere.

These practices may be intended to prevent incidents or simplify care delivery. Their effects on individual residents nevertheless deserve attention.

The key question is whether the arrangement prevents a person from moving, making choices or participating in activities that they would otherwise be able and entitled to undertake.

The answer requires context.

Moving a walking aid temporarily during an agreed activity is different from deliberately keeping it out of reach to prevent someone from moving.

A wheelchair positioning device used for an appropriate therapeutic purpose is different from equipment used primarily to stop a person from leaving the chair.

A secured entrance forming part of legitimate building access arrangements should be distinguished from a measure that effectively confines a particular resident without appropriate justification.

The same distinction applies to monitoring systems and other technologies. Their classification and appropriateness depend on their actual purpose, operation and effects, not merely on whether they are described as safety equipment.

These examples should prompt assessment, not automatic classification.

Staff should be encouraged to report situations in which they are uncertain whether a routine arrangement has become unnecessarily restrictive.

Facilities that examine these practices only after receiving a serious complaint may overlook problems that have gradually become accepted as normal care.

Understanding What Lies Behind a Proposed Restriction

Restrictive practices may be considered when a resident is thought to be at risk, distressed, difficult to support or likely to disrupt established routines.

Before accepting those explanations, the organization should look more carefully at the circumstances.

What is the person trying to do? What need might remain unmet? Has their usual routine changed? Is the surrounding environment contributing to the problem? Does the situation arise at particular times or during particular activities?

These questions may identify difficulties that cannot be resolved appropriately by limiting movement.

A resident who repeatedly approaches the entrance may be looking for a familiar activity or place. Someone who frequently attempts to leave the bed may need assistance with an ordinary activity. A resident who resists personal care may be uncomfortable with the timing, method or person providing that assistance.

Such observations should not be used to make a medical diagnosis.

Where a change in behavior may be related to pain, illness, delirium, medication effects or another clinical concern, assessment by an appropriately qualified healthcare professional may be necessary.

Nonclinical care staff should recognize changes, communicate their observations and seek suitable support within their responsibilities.

Facilities should also examine organizational and environmental factors.

Unfamiliar routines, inadequate communication, limited access to meaningful activities or delays in obtaining assistance may contribute to distress.

A restriction may appear to resolve the immediate problem while leaving its underlying cause unchanged.

Understanding the circumstances is therefore an important part of preventing unnecessary restrictive practices.

Finding Less Restrictive Ways to Provide Support

The purpose of considering alternatives is to address legitimate concerns without unnecessarily limiting the resident's freedom.

The most appropriate approach depends on the individual and the circumstances.

Some residents may benefit from clearer explanations, familiar routines or additional time to complete everyday activities. Others may need changes to their environment, more reliable assistance or support from staff who understand their communication needs and preferences.

A resident distressed by a crowded shared area may prefer a quieter environment or a different activity.

Someone who needs assistance moving around the facility may benefit from timely staff support rather than having mobility equipment placed out of reach.

Where the environment contributes to the difficulty, changes in furniture arrangement, access or daily routines may be helpful.

These are examples of possible approaches, not universal solutions.

An arrangement that works for one resident may be unsuitable for another. Alternatives should reflect individual needs, preferences, available resources and any necessary professional assessment.

Organizations should also avoid replacing one restriction with another that has a similar practical effect.

For example, removing a locked barrier but introducing another arrangement that still prevents the person from accessing the same space does not necessarily resolve the underlying concern.

Technology deserves similar consideration.

A monitoring device or alert system may support staff awareness, but its purpose, effect and implications for privacy should be examined.

A device is not automatically restrictive merely because it monitors movement. Equally, it is not automatically nonrestrictive simply because it is electronic or does not involve physical contact.

The question is how the system is used and whether it unnecessarily interferes with the resident's rights, choices or movement.

Any proposed changes to physical access arrangements must also remain consistent with applicable building, accessibility and fire safety requirements.

The objective is to provide appropriate support while preserving independence and participation as far as reasonably possible.

Why Organizational Pressures Need Attention

Restrictive practices may sometimes arise because an organization lacks sufficient capacity to provide individualized support.

A resident may be discouraged from moving independently because staff cannot respond promptly when assistance is requested. Access to shared spaces may be limited because appropriate supervision has not been arranged. Care routines may be organized primarily around staff availability rather than residents' individual needs.

These circumstances raise questions about service design and workforce capacity.

A facility should not treat avoidable staffing or operational limitations as sufficient justification for unnecessarily restricting residents.

Where individualized assistance is needed, management should examine whether the organization can provide it reliably.

This may involve reviewing staff responsibilities, supervision, training, allocation of work or the facility's overall service capabilities.

The solution will not always be more staff. Some problems may be addressed through communication, environmental changes or better organization of daily activities.

However, organizational limitations should be visible rather than concealed behind general statements that a restriction is necessary for safety.

Frontline workers also need a safe way to question established practices.

A caregiver may recognize that an arrangement causes distress or unnecessarily limits movement but hesitate to challenge instructions that have been followed for years.

Responsible management should encourage staff to raise concerns and obtain appropriate advice.

Staff should not be expected to make complex legal or clinical decisions independently. Management must ensure that responsibilities are clear and that issues requiring professional assessment are referred appropriately.

Where the organization lacks the resources or competencies needed to provide suitable individualized care, that limitation should be addressed through appropriate service planning and management rather than normalized restrictions.

Protecting Choice, Consent and Decision-Making

Older people living in residential care should remain involved in decisions affecting their everyday lives to the extent possible and in accordance with their legal rights.

Needing help with mobility or personal care does not automatically mean that someone cannot make decisions.

A person may require substantial physical assistance while remaining fully capable of understanding information, expressing preferences and accepting or declining proposed support.

Similarly, a dementia diagnosis or another health condition should not automatically be equated with a legal determination of incapacity.

Where a proposed intervention could restrict someone's freedom, the organization should pay particular attention to how the resident is informed and involved.

The purpose and likely consequences of the proposal should be explained in a way the person can understand. Their preferences, concerns and objections should be taken seriously.

Where questions arise about legal capacity, guardianship or representation, the applicable provisions of Vietnamese law must be considered.

The Civil Code provides for specific legal arrangements concerning capacity and representation. The authority of anyone acting on behalf of a resident should be verified rather than assumed.

Family involvement can be valuable, but a family member's request does not automatically establish that a restrictive intervention is lawful, necessary or appropriate.

A relative may ask staff to prevent a resident from leaving bed because of concern about injury. The facility should consider that concern respectfully while examining the intervention's purpose, consequences and legal and professional implications.

Family agreement, staff convenience or a general intention to maintain safety cannot, by themselves, justify an otherwise inappropriate restriction.

Consent should also not be regarded as a means of making any proposed intervention acceptable.

The nature of the intervention, applicable legal requirements and relevant professional responsibilities remain important.

In particular, the detailed consent and substitute decision-making procedures used in Australia should not automatically be imported into Vietnamese residential care.

Where uncertainty exists, facilities should seek appropriate professional or legal clarification rather than treating an informal agreement as sufficient authorization.

The broader principle is that residents' participation should be genuine. The need for support should not be used to exclude them from decisions affecting their everyday lives.

Medication-Related Restrictions Require Particular Care

Medication-related restrictive practices deserve attention because medications used in residential care may have legitimate therapeutic purposes while also being capable of inappropriate use for behavioral control.

International guidance distinguishes medication prescribed for appropriate treatment from medication used primarily to influence behavior under circumstances that meet the relevant definition of chemical restraint.

The distinction depends on purpose, clinical indication, individual circumstances and the applicable regulatory framework.

It would be incorrect to classify every antipsychotic, sedative or other psychotropic medication prescribed to an older resident as chemical restraint.

Australian law contains specific exclusions from its definition, including medication prescribed for the treatment of certain diagnosed mental or physical conditions and end-of-life care, as provided in its rules.

At the same time, the existence of a prescription does not remove the need to examine whether medication is being used appropriately.

Particular concern may arise when medication appears to be used primarily to make a resident easier to manage rather than to address an appropriate clinical indication.

For residential care organizations, the relevant quality question is whether medication-related decisions are made by appropriately authorized healthcare professionals and supported by suitable clinical review.

Care staff should not independently initiate, increase, discontinue or change prescribed medication to control a resident's behavior.

Where staff notice concerning effects, changes in alertness or circumstances suggesting potentially inappropriate medication use, the issue should be communicated through an appropriate clinical and management process.

NICE guidance on dementia provides a relevant example of the importance of assessing distress, considering psychosocial and environmental approaches, and applying appropriate indications and review when antipsychotic medication is considered.

Detailed prescribing, medication monitoring and treatment adjustment remain outside this article's scope.

The purpose here is to ensure that potentially restrictive medication practices receive appropriate scrutiny rather than becoming hidden within ordinary care routines.

Emergency Situations Still Require Appropriate Safeguards

Residential care facilities may encounter unexpected situations involving immediate danger or significant risk of harm.

Such situations require an appropriate response, but they should not be treated as providing unlimited justification for restrictive interventions.

Personnel must act within their training, assigned responsibilities and applicable legal requirements.

Where urgent clinical assessment, emergency assistance or another specialized response is needed, the facility should obtain that support rather than depend on staff who lack the necessary competence or authority.

An intervention considered during an emergency should not automatically become a continuing routine.

Actions affecting a resident's freedom require appropriate scrutiny under the relevant legal and professional framework.

Where the organization cannot establish whether a proposed intervention is lawful and appropriate, qualified professional or legal advice should be obtained.

Events involving suspected mistreatment, harmful physical force, unlawful confinement or other serious concerns may also require action through applicable safeguarding, incident management or reporting procedures.

These requirements depend on the circumstances and the facility's legal status.

This article does not establish an emergency authorization procedure or provide instructions for applying restraint or seclusion.

The underlying principle is that immediate safety concerns and residents' rights must both be considered, even when circumstances are difficult.

An emergency response should also be reviewed afterward, particularly where the event reveals gaps in staff preparation, service capability or access to appropriate professional support.

A Restrictive Practice Prevention and Oversight Framework

Residential long-term care organizations can address these concerns through a structured approach focused on prevention, recognition and accountability.

The proposed Restrictive Practice Prevention and Oversight Framework connects six activities: recognizing potential restrictions, understanding the circumstances, considering less restrictive alternatives, verifying applicable safeguards and responsibilities, monitoring effects, and reviewing organizational practice.

Recognition begins with identifying arrangements that may restrict movement, choices, access or participation. This includes practices that have gradually become part of ordinary routines.

Understanding the circumstances involves examining why the arrangement was introduced, what concern it is intended to address and how it affects the resident.

Considering alternatives means exploring whether appropriate support, environmental changes, improved communication or adjustments to daily routines could address the concern with fewer restrictions.

Verifying safeguards and responsibilities involves determining which legal and professional requirements apply, who has authority to make relevant decisions and whether specialist assessment or clarification is necessary.

Monitoring concerns the effects of any intervention that is lawfully and appropriately used, including distress, adverse consequences, continuing necessity and changes in the resident's circumstances, according to applicable requirements.

Review involves considering whether the intervention remains justified, whether appropriate professional processes allow it to be reduced or discontinued, and whether recurring situations suggest a wider organizational problem.

These activities should be connected rather than treated as isolated administrative tasks.

For example, identifying a potentially restrictive arrangement is useful only when the concern reaches someone who can arrange an appropriate review. Similarly, documenting alternatives has limited value if they are not genuinely considered.

The framework is intended to support quality improvement and organizational oversight.

It does not authorize restrictive practices, replace legally required assessments or establish a separate procedure for clinical or legal decisions.

Making Decisions Visible and Accountable

Restrictive practices become particularly concerning when decisions are informal, undocumented or difficult to challenge.

A caregiver may follow instructions passed between shifts without knowing why an intervention was introduced. A practice may continue long after the original circumstances have changed. A family member may believe that a clinician recommended a restriction, while staff regard it as a routine facility procedure.

These situations create uncertainty about responsibility.

Organizations should establish a clear process for identifying and reviewing concerns about potentially restrictive practices.

The process should clarify who can report a concern, who is responsible for reviewing it, when professional or legal assessment is required and how unresolved matters are escalated.

Responsibilities should reflect the facility's legal status, services and applicable professional requirements.

Managers should not authorize clinical interventions outside their competence simply because they lead the organization.

Likewise, frontline personnel should not be expected to determine the legality of complex interventions without appropriate support.

Where an intervention is lawfully permitted, the organization should ensure that relevant decisions, safeguards and reviews are documented as required.

Documentation should make the circumstances, purpose, responsible persons and outcome of the review clear without collecting unnecessary personal information.

When the legal or professional basis is uncertain, that uncertainty should be recorded and referred for clarification.

An internal record does not, by itself, establish that a restrictive intervention is lawful.

Accountability depends on appropriate decisions, actions and follow-up, not simply on the existence of paperwork.

Involving Residents and Families Appropriately

Residents and families can provide valuable information about personal preferences, familiar routines and circumstances that cause discomfort or distress.

A family member may know that an older person has always enjoyed walking after meals or prefers a quiet environment.

A resident may be able to explain why an established routine feels uncomfortable or unnecessarily restrictive.

This information can help the organization understand individual needs and develop better support arrangements.

However, family involvement should not become a mechanism for transferring professional or legal responsibility away from the facility.

A family may request a restriction because of understandable concerns about safety. The organization must still consider whether the request is lawful, appropriate and consistent with its responsibilities.

Similarly, staff should not seek family agreement simply to justify a practice that is convenient for the organization.

Where a resident objects to a proposed intervention, the objection should receive appropriate consideration through the relevant decision-making and review process.

Residents and families should also have suitable ways to raise concerns about practices they believe are unnecessarily restrictive.

These arrangements should respect the person's privacy and lawful decision-making rights.

Where relevant personal information is collected or shared, the Law on Personal Data Protection No. 91/2025/QH15 and Decree No. 356/2025/ND-CP, both effective January 1, 2026, must be considered.

The aim is to support genuine participation while keeping professional and organizational accountability clear.

Three Practical Tools for Implementation

Residential long-term care organizations can begin improving oversight through structured observation, review and follow-up.

Three complementary tools may support this work: a Restrictive Practice Identification and Review Tool, a Least-Restrictive Alternatives Review, and a Restrictive Practice Oversight Register.

These are proposed organizational quality improvement resources. They are not statutory authorization forms, clinical restraint protocols, official reporting instruments, accreditation requirements or certification schemes.

Restrictive Practice Identification and Review Tool

The Restrictive Practice Identification and Review Tool helps staff and management recognize arrangements that may unnecessarily limit a resident's freedom.

The review should examine the intervention, its purpose and its practical effect on the person.

For example, the organization may consider whether a bed rail serves a legitimate support function or prevents the resident from leaving the bed.

It may examine whether restrictions on access to shared spaces have become a routine means of controlling movement.

The review may also identify situations where mobility equipment is deliberately kept out of reach to prevent someone from moving independently.

The tool should encourage observation and reporting rather than require frontline staff to make definitive legal or clinical classifications.

Where a concern is identified, it should be referred to an appropriate responsible person or professional.

Records should distinguish what was observed, what concern was raised, what has been established through review and which questions remain unresolved.

The objective is to make potentially restrictive practices visible before they become normalized or lead to harm.

Least-Restrictive Alternatives Review

The Least-Restrictive Alternatives Review helps organizations determine whether the concern underlying a proposed restriction can be addressed through a more appropriate arrangement.

The review should begin with the resident's circumstances, needs and preferences.

It may examine communication, daily activities, environmental conditions, available assistance and organizational routines.

Where professional assessment is required, appropriately qualified personnel should participate.

The purpose is to identify feasible alternatives that support safety while preserving freedom and participation as far as possible.

A facility may discover that more reliable assistance or a simple environmental change addresses the original concern more appropriately than limiting movement.

In another situation, management may recognize that the organization lacks the resources or competencies needed to provide suitable support and must seek external assistance or reconsider its service capabilities.

The review should not be used to authorize an intervention that is prohibited or falls outside the facility's legal authority.

It should also avoid documenting alternatives that have not been meaningfully considered.

Where changes are introduced, their effects should be reviewed with the resident and relevant personnel.

An alternative is useful when it addresses the concern without creating an equally inappropriate restriction.

Restrictive Practice Oversight Register

The Restrictive Practice Oversight Register provides a structured way for management to review identified concerns and track their resolution.

Depending on the facility's functions, it may record the nature of the concern, relevant circumstances, responsible reviewer, professional advice obtained, corrective action and review status.

The register should distinguish suspected inappropriate practices, issues awaiting assessment, confirmed incidents and interventions that have undergone appropriate review under the applicable framework.

These categories should not be combined in a way that creates misleading conclusions.

Where restrictive interventions are legally permitted, the register may support oversight of relevant documentation and review processes. It must not replace statutory records, clinical documentation or legally required incident reporting.

Serious harm, possible abuse or other reportable matters must be addressed through the appropriate legal and organizational procedures.

The register may also help identify recurring patterns.

Concerns arising repeatedly during particular staffing periods may indicate limitations in service organization or workforce capacity.

Repeated restrictions involving access to shared spaces may suggest a need to review operating routines or environmental arrangements.

The purpose is not simply to count restrictions. It is to help management recognize patterns, assign responsibility and verify that identified problems have been appropriately addressed.

Measuring Quality Without Creating Misleading Targets

Restrictive-practice prevention should not be evaluated through a single number.

A facility reporting no restrictive practices may have successfully reduced inappropriate interventions. It may also lack effective systems for identifying or recording them.

Conversely, an increase in reported concerns may reflect better awareness and reporting rather than worsening care.

Measurement therefore needs careful interpretation.

Organizations may monitor the number and types of concerns identified, the proportion receiving appropriate review, the completion of corrective actions and the recurrence of previously identified problems.

They may also examine whether staff understand how to report concerns and whether residents and families have suitable opportunities to raise them.

The effects on residents should remain central.

A reduction in a particular restrictive practice is meaningful when it is accompanied by appropriate support, maintained dignity and suitable attention to safety.

Organizations should avoid targets that discourage reporting or lead staff to describe a restriction differently simply to improve performance data.

Lower medication use or fewer recorded restrictions should not automatically be interpreted as better care without considering clinical needs and individual circumstances.

Measures should reflect the facility's services, resident population and applicable requirements.

Internal indicators proposed by an organization should not be presented as equivalent to statutory quality indicators established in another country.

The objective is to understand whether the facility recognizes potentially inappropriate restrictions, responds reliably to concerns and improves the quality of decisions affecting residents.

Responding to Suspected Inappropriate Restrictive Practices

When a potentially inappropriate restrictive practice is identified, the organization should ensure that the concern receives prompt and suitable attention.

The initial response should consider whether the resident is experiencing immediate harm or requires urgent assistance.

Where urgent clinical assessment or emergency services are needed, the appropriate procedures should be followed.

The facility should then establish who has authority to review the circumstances and whether safeguarding, professional or legal reporting obligations apply.

Suspected abuse, mistreatment or unlawful restriction should not be handled solely as an ordinary quality improvement matter.

Depending on the circumstances, the concern may require action through relevant safeguarding, administrative, professional or legal processes.

Facilities should preserve necessary records and manage personal information appropriately.

Residents, relatives and staff should have ways to raise concerns without inappropriate pressure or retaliation.

The organization should avoid prejudging allegations before adequate assessment while also avoiding delays that expose a resident to continuing harm.

Following the immediate response, management should consider whether the situation resulted from an isolated decision, insufficient staff preparation, unclear responsibilities or a wider organizational problem.

Corrective actions should be reviewed to confirm that the original concern has been addressed.

Simply reminding someone of a policy may be insufficient if the underlying conditions remain unchanged.

The organization should establish whether appropriate arrangements have been restored and what further action is needed to prevent recurrence.

Building a Culture That Questions Unnecessary Restrictions

Restrictive practices can become difficult to challenge when they are embedded in long-established routines.

Staff may assume an arrangement is necessary because it has always been used. Families may believe that restrictions are unavoidable in residential care. Managers may interpret the absence of visible incidents as evidence that a restrictive practice is effective.

These assumptions deserve careful examination.

A responsible care culture allows staff to question whether an intervention remains necessary, whether it has an appropriate legal and professional basis and whether less restrictive support could address the concern.

It also recognizes that uncertainty should lead to appropriate assessment rather than informal experimentation.

Training and supervision can support this approach.

Caregivers should understand what potentially restrictive practices may look like, why they raise concerns and how to report situations requiring review.

Managers need to understand their responsibilities for responding to concerns, obtaining appropriate professional advice and ensuring that unresolved matters receive attention.

Where medical decisions are involved, appropriately authorized healthcare professionals must retain responsibility for those decisions.

Residents' and families' experiences should also contribute to organizational learning.

A facility should not judge its performance solely by whether restrictions are reported less frequently. It should consider whether residents feel respected, can participate in everyday activities and receive assistance that supports their individual needs.

The aim is to make respect for freedom and dignity part of normal care rather than a concern considered only after an incident.

Applying the Approach in Viet Nam

Residential long-term care services in Viet Nam operate through different public, nonpublic and other legally established arrangements.

Some facilities are part of the social assistance system. Others may operate under different organizational models or provide personal care alongside services delivered by external healthcare professionals.

Applicable legal requirements depend on the facility's status, functions and actual services.

For organizations within its scope, Decree No. 395/2026/ND-CP is a relevant development concerning the operation and management of social assistance facilities, including certain responsibilities related to care, protection and support.

However, it should not automatically be interpreted as establishing the same restrictive-practice classifications, authorization processes or reporting requirements used in Australia.

Likewise, an internal policy informed by international guidance does not replace applicable Vietnamese law.

Facilities can nevertheless begin with practical improvement activities.

Management can review established routines to identify arrangements that may unnecessarily restrict movement or participation.

Staff can be encouraged to report concerns and seek appropriate advice rather than continuing practices simply because they are familiar.

Organizations can examine whether staffing, environmental conditions or daily routines contribute to the use of restrictions.

They can also establish clearer procedures for reviewing concerns and verifying that corrective actions have been effective.

These activities should be coordinated with existing safeguarding, quality improvement, professional supervision and incident management arrangements.

A separate certification scheme or complex administrative system is not necessary to begin recognizing and addressing potentially inappropriate restrictions.

What matters is that the facility has a lawful, credible and workable approach to protecting residents' rights while fulfilling its responsibilities for safety and care.

Conclusion: Safety and Dignity Must Be Protected Together

Residential long-term care organizations have an important responsibility to protect older people from foreseeable harm.

However, that responsibility should not be interpreted as permission to impose unnecessary restrictions on movement, independence or everyday choices.

An intervention introduced with good intentions can become inappropriate when its purpose, effects or continuing necessity are not adequately examined.

The challenge for facilities is to distinguish legitimate assistance from unnecessary control, recognize when restrictive practices arise and ensure that decisions affecting residents' freedom receive appropriate scrutiny.

The proposed Restrictive Practice Prevention and Oversight Framework offers an operational approach based on recognition, understanding individual circumstances, considering alternatives, verifying safeguards and responsibilities, monitoring and review.

Its associated tools—the Restrictive Practice Identification and Review Tool, Least-Restrictive Alternatives Review, and Restrictive Practice Oversight Register—can help organizations make concerns visible and organize improvement.

These resources do not authorize restrictive practices or replace legal and professional requirements.

For Viet Nam, the opportunity is to strengthen rights-based residential long-term care while recognizing the practical responsibilities of staff, managers, families and healthcare professionals.

The objective is neither to disregard safety risks nor to accept restrictions as an inevitable part of caring for older people.

High-quality residential long-term care should protect older people from harm without unnecessarily taking away the freedom, independence and dignity that care is intended to support.

Professional and Regulatory References

Viet Nam

Law on the Elderly No. 39/2009/QH12, as amended, particularly Articles 3 and 9 concerning older people's rights and prohibited acts.

Law on Persons with Disabilities No. 51/2010/QH12, as amended, particularly Article 14 concerning prohibited acts affecting persons with disabilities.

Civil Code No. 91/2015/QH13, particularly Articles 22 and 23 concerning civil act capacity and relevant judicial determinations, together with applicable provisions on guardianship and representation.

National Assembly Resolution No. 84/2014/QH13, dated November 28, 2014, on ratification of the United Nations Convention on the Rights of Persons with Disabilities.

Law on Medical Examination and Treatment No. 15/2023/QH15, together with applicable implementing regulations.

Government Decree No. 395/2026/ND-CP, dated October 23, 2026, on the operation and management of social assistance facilities, scheduled to take effect December 7, 2026.

Law on Personal Data Protection No. 91/2025/QH15, effective January 1, 2026.

Government Decree No. 356/2025/ND-CP, detailing provisions and implementation measures of the Law on Personal Data Protection, effective January 1, 2026.

Other applicable requirements concerning residential care operations, professional practice, safeguarding, reporting, legal representation and protection of residents' rights must be determined according to each facility's legal status, services and individual circumstances.

International

Australian Government. Aged Care Act 2024 and Aged Care Rules 2025, including current provisions concerning restrictive practices in residential aged care.

Australian Government Department of Health, Disability and Ageing. Restrictive Practices in Aged Care — A Last Resort (2026).

Australian Government Department of Health, Disability and Ageing. Types of Restrictive Practices (2026).

Aged Care Quality and Safety Commission, Australia. Minimising Restrictive Practices and associated guidance for residential aged care providers.

National Institute for Health and Care Excellence (NICE). Dementia: Assessment, Management and Support for People Living With Dementia and Their Carers, Guideline NG97 (2018), particularly recommendations concerning distress, psychosocial and environmental interventions, and appropriate prescribing.

World Health Organization. World Report on Ageing and Health (2015).

World Health Organization. Mental Health: Promoting and Protecting Human Rights (2023).

United Nations. United Nations Principles for Older Persons (1991), particularly the principles concerning care and dignity.

United Nations. Convention on the Rights of Persons with Disabilities (2006), including provisions concerning autonomy, liberty, protection from abuse and respect for physical and mental integrity.

About This Article

This article is published by Healthy Longevity Vietnam (HLVN) as an independent educational and quality improvement resource addressing the prevention, recognition and organizational oversight of potentially inappropriate restrictive practices in residential long-term care for older people in Viet Nam.

The discussion focuses on safeguards, less restrictive alternatives, professional boundaries, resident participation, accountability and quality improvement. It does not provide instructions for applying physical restraint, seclusion or chemical restraint, establish clinical indications for such interventions or authorize their use.

The proposed Restrictive Practice Prevention and Oversight Framework, Restrictive Practice Identification and Review Tool, Least-Restrictive Alternatives Review, and Restrictive Practice Oversight Register are organizational quality improvement resources. They are not statutory authorization procedures, legally prescribed consent forms, clinical treatment protocols, mandatory reporting instruments, accreditation requirements or certification schemes.

International classifications and safeguards are provided for comparative and educational purposes. In particular, Australian legal definitions, consent arrangements, substitute decision-making provisions, behavior support planning and incident reporting requirements should not be interpreted as automatically applicable to residential long-term care facilities in Viet Nam.

This article does not constitute legal, clinical or regulatory advice, determine the legality or appropriateness of an intervention in an individual case, or replace assessment by appropriately qualified professionals.

Organizations should determine the requirements applicable to their legal status, services, personnel and specific circumstances. Where potentially restrictive practices, serious safeguarding concerns or regulated clinical activities are involved, appropriate professional, legal or regulatory assessment is necessary.

The purpose of this article is to promote careful recognition, prevention, accountability and quality improvement while respecting the rights, dignity and safety of older people.

Legal and professional context reviewed: October 26, 2026. Decree No. 395/2026/ND-CP is scheduled to take effect on December 7, 2026.