The keypad is usually beside the door, at about shoulder height, with a small printed sign asking visitors to close the door firmly behind them. Most families barely register it on the first visit. It is only later, usually after a particular conversation, that it starts to mean something. Your father wants to go out for a walk and is told that someone will take him later. Your aunt asks for her coat and is gently redirected towards the day room. Nobody has been unkind. Nobody has said no. But the code is not written down anywhere she can see it, and she cannot leave.
If you ask what the legal basis for that is, you will get a range of answers, all of them given in good faith. The nurse will talk about risk assessments and best interests. The person in charge will point to a care plan signed by the family. A solicitor will tell you something quite different: that in Irish law, an adult who has not been detained under the Mental Health Act 2001 and is not the subject of a court order is entitled to walk out the front door, and nobody in the building has the power to stop them.
Both of those answers are honest. The gap between them is where tens of thousands of people in Ireland currently live.
TL;DR
- The Assisted Decision-Making (Capacity) Act 2015 does not contain the word “liberty” anywhere in its text. It has twelve Parts. Part 10 is called “Detention Matters” but deals only with detention under the Mental Health Act 2001 in approved centres. Nursing homes are not covered.
- The only rule governing a locked door in an Irish nursing home is Regulation 7(3) of SI 415/2013, which says restraint may be used only “in accordance with national policy as published on the website of the Department of Health from time to time”. That national policy is a document from 2011.
- HIQA’s own published research found 550 of 608 nursing homes (90.5 per cent) notified at least one restrictive practice in the twelve months to October 2020. Door locks accounted for 29,296 recorded uses and bedrails for 16,843.
- The 2011 policy states that chemical restraint is “always unacceptable”. In the same dataset there were 4,048 notifications of chemical restraint, and in 85.2 per cent of them no drug was named.
- The Protection of Liberty Safeguards Bill has appeared in three consecutive Government Legislation Programmes (Autumn 2025, Summer 2026, Autumn 2026) with identical wording, filed under “All Other Legislation” rather than priority drafting, status: “Work is ongoing.”
What “deprivation of liberty” actually means
The phrase sounds dramatic, and that is part of why it does not get used. It conjures handcuffs and locked wards, not a well-run home in a market town with a garden and a hairdresser who comes on Thursdays.
In law, it is a much quieter idea. A person is deprived of their liberty when they are under continuous supervision and control, and they are not free to leave. Neither limb requires anyone to be rough or careless. A home where staff know where every resident is at all times, where the front door opens only to a code, and where a resident who walked towards the gate would be brought back, meets that description. It meets it whether the resident is distressed by it or perfectly content, and whether the family agreed to the admission or not.
That last point surprises people most. A son or daughter cannot consent on a parent’s behalf to that parent being kept somewhere. Next of kin has no standing in Irish law to authorise it. Signing an admission form, agreeing a care plan, even holding an enduring power of attorney does not give anyone the power to say that an adult may be prevented from leaving a building. We have written before about what happens when capacity is lost without an enduring power of attorney in place, and this is the sharpest edge of it: the arrangement everyone believes is settled and agreed often has no legal foundation at all.
The word the Capacity Act never uses
Ireland spent the better part of a decade reforming its capacity law. The Assisted Decision-Making (Capacity) Act 2015 was signed in December 2015 and finally commenced on 26 April 2023. It abolished wardship, created the Decision Support Service, and built a tiered system of assistants, co-decision-makers and decision-making representatives. It is, by any reasonable measure, a serious piece of law reform.
It is also silent on this question. Read the Act from end to end and the phrase “deprivation of liberty” does not appear once. Neither does the word “liberty”. There are twelve Parts. Part 10 carries the promising title “Detention Matters”, and anyone hoping for an answer there will find sections on a panel of independent consultant psychiatrists to be established by the Mental Health Commission, and on the review of detention orders in approved and non-approved centres. It is machinery for the mental health system. It has nothing to say about a woman with advanced dementia in a nursing home in Roscommon who would like to go home. The intention was always that liberty safeguards would be added by later legislation. They have not been.
Meanwhile, a decision-making representative appointed under the 2015 Act, the most powerful tier the new system offers, has no power to detain and no power to authorise restraint. They can make decisions about treatment and about property and affairs within the terms of their court order. They cannot make the decision that is being made, informally and daily, in hundreds of buildings around the country.
What actually governs a locked door
This is where the story becomes genuinely strange, and the chain is short enough to follow in full.
Nursing homes in Ireland are regulated under the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013, SI 415 of 2013. Regulation 7 is headed “Managing behaviour that is challenging”. Sub-article 7(3) is the operative provision on restraint, and it reads in full:
“The registered provider shall ensure that, where restraint is used in a designated centre, it is only used in accordance with national policy as published on the website of the Department of Health from time to time.”
That is the whole of it. The regulation does not define restraint. It does not set thresholds, require independent authorisation, create a right of appeal, or specify who may decide. It delegates the entire question to a policy document on a government website.
The policy in question is Towards a Restraint Free Environment in Nursing Homes, published by the Department of Health in 2011. It is a thoughtful document for its era. It says that all nursing homes should be committed to a restraint-free environment, that residents should be permitted to engage in activities involving personal risk to themselves, that capacity must be presumed, and that a diagnosis of cognitive impairment is not in itself grounds to assume someone cannot decide. HIQA has confirmed it remains the current national policy.
It was written two years before the regulation that points to it, four years before the Capacity Act was passed, and twelve years before that Act commenced. A document that predates the entire modern Irish framework for decision-making capacity is still, in October 2026, the only thing standing between a resident and a locked door.
How often this happens
We are not short of data, which makes the legislative silence harder to explain. HIQA’s own researchers published a study in BMC Geriatrics in 2022 analysing every restrictive practice notification from Irish nursing homes over a twelve-month period ending in October 2020. It remains the most complete picture we have. Across 608 operational nursing homes with a combined occupancy of 28,664 residents, there were 70,663 recorded uses of restrictive practice. Of those homes, 550, or 90.5 per cent, notified at least one. Fifty-eight, 9.5 per cent, notified none at all.
The breakdown is instructive. Environmental restraint was the largest category, and within it door locks accounted for 29,296 recorded uses, 77.1 per cent of the category, with window locks adding a further 4,906. Among physical restraints, bedrails accounted for 16,843 uses, just under two thirds of that category.
Then there is chemical restraint, 4,048 notifications. The 2011 national policy, the one that Regulation 7(3) makes legally binding, states plainly that the use of chemical restraint is always unacceptable. It was notified over four thousand times in a year. In 3,449 of those notifications, 85.2 per cent, the drug administered was not specified. Where it was named, antipsychotics were the most common.
A regulator collecting four thousand annual notifications of a practice its governing policy describes as always unacceptable, in a form that usually does not record what was given, is not a system with a gap in it. It is a system that has been running without a floor for fifteen years.
It is worth saying clearly what these numbers are not. They are not evidence that Irish nursing homes are cruel places. Most of these decisions are made by people trying to keep someone safe, often at three in the morning, with no statutory guidance, no independent authoriser to ring and no process to follow. The absence of law does not make staff into villains. It makes them improvise, and it leaves residents without the one thing a legal framework would guarantee: somebody independent whose job is to ask whether this is necessary, and whether anything less restrictive would do.
The court route, and what it costs
There is a lawful route. It runs through the High Court, and it is expensive, slow and almost entirely invisible to families.
The leading case is AC v Cork University Hospital. AC was a woman of 93, admitted after breaking both hips, assessed by the hospital team as lacking capacity to decide about her discharge. In June 2016 her son and daughter came to take her home and the hospital prevented them from leaving with her. The Court of Appeal, in a judgment of Mr Justice Gerard Hogan, held that the hospital did not have the power to detain her and had acted unlawfully. Staff could lawfully attempt to persuade a patient not to leave, he said, but that must involve persuasion and not restraint. There is, in his phrase, no “self-created power of detention”. The Supreme Court delivered its own judgment in the proceedings in October 2019, reported at [2019] IESC 73.
The practical consequence is that where a person cannot consent and is not free to leave, somebody has to go to court. That is a real process with real costs, and the figures are now in the public domain. Reporting published by The Journal Investigates in June 2026 found that the HSE spent €940,750 in 2025 on legal matters arising from 106 separate cases involving deprivation of liberty issues. As of mid-May 2026, there were 60 live cases of people who had been clinically discharged from acute hospitals but whose actual discharge was held up by consent, capacity, wardship or liberty questions. In 2025, 257 patients were recorded as delayed transfers of care for reasons of legal complexity.
Those are hospital beds occupied by people who are well enough to leave, and court time, and nearly a million euro of public money, all spent doing by litigation what most comparable jurisdictions do by administrative process.
The Bill that keeps being listed
The promised legislation has a name. It is the Protection of Liberty Safeguards Bill, and its stated purpose in the Government Legislation Programme is “to provide procedural safeguards to ensure that people who cannot consent to their care arrangements in relevant facilities are not unlawfully deprived of their liberty”.
That wording appears, word for word, in the Autumn 2025 programme, the Summer 2026 programme and the Autumn 2026 programme. In all three it sits in the section headed “All Other Legislation”, not among the bills marked for priority publication or priority drafting. In all three, the status column reads: “Work is ongoing.” No heads of bill, no general scheme, no pre-legislative scrutiny. The Health (Adult Safeguarding) Bill, which would underpin a national adult safeguarding policy, sits two entries above it with the same status.
It would be easy to conclude that capacity law simply moves slowly in Ireland. The same document shows otherwise. The Assisted Decision-Making (Capacity) (Amendment) Bill 2026 was published on 26 February 2026 and enacted on 31 March 2026, five weeks later, because a deadline affecting the courts was about to be missed. The Mental Health Act 2026, a full-scale replacement of the 2001 Act, was enacted on 7 May 2026. The Oireachtas can move at speed on capacity and detention when it decides something matters.
Nor is this waiting on analysis. The Law Reform Commission’s report A Regulatory Framework for Adult Safeguarding, published on 17 April 2024, sets out a detailed structure including draft legislation, and Safeguarding Ireland has been calling for its implementation since.
What families can actually do now
None of the above helps you on a Tuesday afternoon when you are worried about your mother. Here is what is practically available.
Ask the direct question, and ask for the answer in writing. “Is my father free to leave this building if he asks to?” A good home will answer honestly, and the honest answer is usually a qualified no. Ask what the restriction is, why it is in place, what less restrictive options were considered, and when it will be reviewed. Ask for it to be recorded in the care plan in those terms. You are entitled to that, and the asking itself changes the conversation.
Know that restrictive practices are notifiable. Providers must notify HIQA of the use of restraint. If you are told that bedrails, a locked door, a lap belt or sedating medication is being used, that use should be appearing in a quarterly return, and you can ask whether it has been notified.
Read the inspection reports. Every HIQA inspection report for every designated centre is published on hiqa.ie, searchable by name, with Regulation 7 findings set out explicitly. Read the last two or three for the home you are considering, or the home your relative is already in. They are plainly written and they are free.
Put the arrangements in place while they can still be made. No document authorises detention. But an enduring power of attorney, and an advance healthcare directive recording what the person would want about where they live and what treatment they would refuse, give everyone involved something to work from other than guesswork. Both can only be made while the person has capacity. The Decision Support Service can be reached on 01 211 9750.
Use the independent advocacy that exists. The National Advocacy Service works with adults with disabilities, including people with dementia, and can act independently of both family and provider. SAGE Advocacy works specifically with older people and those in care settings. Neither charges.
Raise a safeguarding concern if you need to. Every HSE community healthcare area has a Safeguarding and Protection Team. A restriction being applied without discussion, review or any clear reason is a legitimate thing to raise. Our guide to recognising and responding to elder abuse in Ireland sets out how that process works.
Ask these questions before admission, not after. Door policy, restraint policy and review arrangements belong on the list alongside the questions about fees and single rooms that families usually remember to ask. Our guides to choosing residential care and to the Fair Deal scheme cover the rest.
The thing worth holding on to
There is a version of this subject that frightens people away from residential care, and that is not the point. Many people are safer, better fed, less isolated and considerably happier in a good nursing home than they were alone at home, and the locked door is very often the least bad option available to the people standing in front of it.
The point is narrower and harder to argue with. In Ireland, in October 2026, a decision to restrict an adult’s freedom of movement in a nursing home is made without any statutory test, without independent authorisation, without an automatic review, and without a route of appeal that does not involve the High Court. The national policy governing it is fifteen years old and forbids a practice that is notified four thousand times a year. The legislation that would fix it has been described as ongoing work for three parliamentary sessions running, while two other pieces of capacity and detention law were drafted, published and enacted around it.
At Críonna Health we keep returning to the same shape of story: a protection everyone assumes exists, that turns out never to have been put in law, and that nobody is responsible for telling you about. This is the largest example we have come across. It touches tens of thousands of people on any given day, almost all of them in their eighties and nineties, and almost none of them or their families have been told that the arrangement they are living under has no legal basis.
Ask the question anyway. Ask it politely, ask it early, and ask for the answer in writing. Until there is a law, the questions families ask are the only review mechanism there is.
This article is for general information and is not legal or medical advice. If you are concerned about the lawfulness of a particular care arrangement, seek advice from a solicitor or contact an independent advocacy service.
Sources: Assisted Decision-Making (Capacity) Act 2015 (revised text, Law Reform Commission); Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013, SI 415/2013, Regulation 7; Department of Health, Towards a Restraint Free Environment in Nursing Homes, 2011; HIQA, Restrictive Practices Literature Review, 2020; Dunbar P, McMahon M, Durkan C, Walsh KA, Keyes LM, “Incidence and type of restrictive practice use in nursing homes in Ireland”, BMC Geriatrics 22:396, 15 October 2022; AC v Cork University Hospital, Court of Appeal, and [2019] IESC 73; Government Legislation Programme, Autumn 2025, Summer 2026 and Autumn 2026; Law Reform Commission, A Regulatory Framework for Adult Safeguarding, 17 April 2024; The Journal Investigates, June 2026; Decision Support Service.
📷 Photo by Franco Debartolo on Unsplash
