All residential aged care providers must have Behaviour Support Plans (BSP) in place from 1 September 2021. Here’s what you need to know.

Overview of the new requirement

This new requirement is one of several introduced under the Aged Care and Other Legislative Amendment (Royal Commission Response No.1) Act 2021 (Cth) which commenced 1 July 2021.

From 1 September 2021, this Act updates the Quality of Care Principles 2014 by:

• requiring providers to create and regularly review BSP for care recipients that need behaviour support and where a restrictive practice is being considered or used
• requiring providers to consult with recipients in the creation of BSP
• setting out the matters that need to be included in BSP.

Responsibilities relating to Behaviour Support Plans

From 1 September 2021, the new laws require providers to include a BSP in the care and services plan of any care recipients:

• that need behaviour support
• where the use of a restrictive practice has been assessed as necessary
• where a restrictive practice is being used
• where there is an ongoing need for a restrictive practice to be used.

When preparing BSP, providers must ensure that they are considering any previous assessment relating to the care recipient. Providers also need to make sure that they are regularly reviewing these BSP and making necessary revisions as soon as possible after any change in the recipient’s circumstances.

It is also important that providers are consulting care recipients during the preparation, revision or reviews of BSP. If care recipients lack the capacity to be consulted, providers need to make sure that they consult the proper representatives instead.

Additionally, if the use of a restrictive practice is assessed as necessary, providers must also consult the approved health practitioner who made the assessment and, if the recipient lacks the capacity to be consulted, the “restrictive practices substitute decision-maker”. Providers will need to make the plan available in an appropriately accessible format for the purposes of such consultation.

See our previous article for a definition of “restrictive practices substitute decision-maker”.

Matters to be set out in Behaviour Support Plans

The following provides a short summary of what needs to be included in BSP in certain instances. Please consult the Quality of Care Principles 2014 for full details of what needs to be set out in BSP.

Alternative strategies for addressing behaviours of concern

• information about the recipient and their behaviour including any behaviours of concern for which the recipient may need support

• any assessment of the recipient that is relevant to understanding their behaviour
• information about the occurrence of behaviours of concern for which the recipient has needed support including the date, time and duration of the occurrence and any triggers or warning signs for the occurrence
• alternative strategies for addressing the behaviours of concern that are best practice alternatives to the use of restrictive practices
• alternative strategies that have been considered for use, or have been used, including the effectiveness of such strategies in addressing the behaviours of concern and records of the monitoring and evaluation of the strategies
• a description of the provider’s consultation about the use of alternative strategies with the recipient or their representative

If use of restrictive practice assessed as necessary

• the recipient’s behaviours of concern that are relevant to the need for the use of the restrictive practice
• the restrictive practice and how it is to be used, including its duration, frequency and intended outcome
• the best practice alternative strategies that must be used before using the restrictive practice
• how the use of the restrictive practice is to be monitored and reviewed
• a description of the provider’s consultation about the use of alternative strategies with the recipient or the restrictive practices substitute decision-maker
• a record of the recipient’s, or the restrictive practices substitute decision-maker’s, informed consent to the use of the restrictive practice

If restrictive practice used

• the restrictive practice and how it was used including when it began and the duration, frequency and outcome of its use
• if the restrictive practice is being used on an as-needed basis, the particular behaviours of concern that led to the use of the restrictive practice and the actions taken up to the use of the restrictive practice including alternative strategies that were used beforehand
• details of the persons involved in the use of the restrictive practice
• a description of any engagement with external support services in relation to the use of the restrictive practice
• details of the monitoring of the use of the restrictive practice
• the outcome of the review of the use of restrictive practices as required by the plan

If need for ongoing use of restrictive practice indicated

• the restrictive practice and how it is to be used, including its duration, frequency and intended outcome
• how the ongoing use of the restrictive practice is to be monitored and reviewed
• a description of the provider’s consultation about the ongoing use of the restrictive practice with the recipient or the restrictive practices substitute decision-maker
• a record of the recipient’s, or the restrictive practices substitute decision-maker’s, informed consent to the ongoing use of the restrictive practice

Where a restrictive practice is used, especially in an emergency, providers must ensure that they also include any other relevant matters in the BSP that need to be documented, including those mentioned in our previous article.

Enforcement of new requirements

From 1 September 2021, the Aged Care Quality and Safety Commission will be checking to ensure that providers comply with the new requirement to have BSP in place where necessary. The Commission will also continue to check that providers have established appropriate policies and procedures to promote the proper use of restrictive practices and that these practices are now being used in accordance with the relevant BSP.

Accordingly, providers must ensure that they update their policies, procedures and training materials to include the new requirements relating to BSP before next month. It is also crucial to brief staff and familiarise them with these changes to ensure that the dignity and wellbeing of care recipients are upheld.